Health inequalities resources and references

Case studies

We have brought together a collection of case studies showcasing good practice in meeting the needs of under-served groups and delivering quality care to service users who may be particularly vulnerable to health inequalities.

The case studies show how SLTs can support a service user/their families’ engagement with speech and language therapy and other health services and include examples of culturally sensitive care, use of trauma-informed approaches, service-level changes and the role of SLTs in wider health promotion.

Speech and language therapists should always take an evidence-based approach to practice (HCPC, 2014) and should always triangulate the findings from research, with clinical expertise and service user preferences.

The case studies illustrate successful examples of speech and language therapy practice, but it should be noted that each service user is an individual and it should not be considered that the care exemplified in case study is suitable for all people who meet the descriptions given.

We’ve developed a template with members to encourage SLTs to share their stories. Download the template (Word) to submit your case study (Word).

Read the case studies

Related guidance

Members should refer to the following pieces of RCSLT guidance:

Clinical guidance pages (particular attention should be paid to the statistics, or incidence and prevalence sections of each topic)
Working with interpreters
Assessing needs of local population
Bilingualism
Outcome measurement
Measuring outcomes outside individualised care

Glossary

Ableism

Ableism is discrimination in favour of non-disabled people (Scope, 2021). See Scope for further discussion of both ableism and disablism.

Classism

“Classism is differential treatment based on social class or perceived social class. Classism is the systematic oppression of subordinated class groups to advantage and strengthen the dominant class groups.” (Classism, 2021)

Cultural humility

“A lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities.” (Yeager and Bauer-Wu, 2013)

Implicit bias

“Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender.” (FitzGerald and Hurst, 2017)

Institutional bias

Bias induced or embedded within a system or institution (ie not individual), operating at a systems level. Can include institutional or systemic racism, homophobia, transphobia, classism, ableism.

Transphobia

“The fear or dislike of someone based on the fact they are trans, including denying their gender identity or refusing to accept it. Transphobia may be targeted at people who are, or who are perceived to be, trans.” (Stonewall, 2021b)

Under-served groups

In the context of healthcare and health research, an under-served group describes a population or community with shared characteristics that have historically been disadvantaged in receiving adequate health care or quality/volume of research, to an equal standard of the ‘mainstream’ population. Characteristics of under-served groups may be (National Institute of Health Research, 2020):

“Lower inclusion in research than one would expect from population estimates.
High healthcare burden that is not matched by the volume of research designed for the group.
Important differences in how a group responds to or engages with healthcare interventions compared to other groups, with research neglecting to address these factors.”

References

This is the full list of references for our health inequalities guidance and the related glossary. For information on research and evidence relating to the broader topics of anti-racism, diversity and inclusion please see our dedicated anti-racism pages.

Bywaters, P. (2009) Tackling Inequalities in Health: A Global Challenge for Social Work. British Journal of Social Work, 39 (2), 353-367. DOI: 10.1093/bjsw/bcm096

Classism (2021) About Class. [Online] [accessed 7 July 2021]

FitzGerald, C. and Hurst, S. (2017) Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18 (19). DOI: 10.1186/s12910-017-0179-8

Ford, J. Aquino, M. R. J., Ojo-Aromokudu, O., Van Daalen, K., Gkiouleka, A. Kuhn, I., Turner-Moss, E., Thomas, K., Barnard, R. and Strudwick, R. (2021) Rapid Review of the Impact of Allied Health Professionals on Health Inequalities. University of Cambridge. Online. [Accessed 9 July 2021]

Hall, W. J. Chapman, M. V., Lee, K. M., Merina, Y. M., Thomas, T. W. et al (2015) Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health. 105 (12), e60-e76. DOI:10.2105/AJPH.2015.302903

Hui, A., Latif, A. Hinsliff-Smith, K and Chen, T. (2020) Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system. Health Policy. 124 (3), 298-301. DOI: 10.1016/j.healthpol.2020.01.003

Iacobucci, G. (2020) The BMJ Interview: Victor Adebowale on systemic racism in the NHS. BMJ, 371. DOI: 10.1136/bmj.m4111

Katikireddi, S. V., Lal, S.,Carrol, E. D., et al (2021) Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities. Journal of Epidemiology and Community Health. DOI:10.1136/jech-2020-216061

The King’s Fund (2020) What are health inequalities? [Online] [Accessed 15 April 2021]

The King’s Fund (2021) My role in tackling health inequalities: a framework for allied health professionals. [Online]. [Accessed 7 July 2021]

The King’s Fund (2021) The health of people from ethnic minority groups in England. [Online] [Accessed 7 April 2021]

Learning Disabilities Mortality Review (LeDeR) Programme (2020) Annual Report 2020. [Online] [Accessed 7 July 2021]

Marmot, M. (2010) The Marmot Review: Fair Society, Health Lives. [Online] [Accessed 15 April 2021]

Marmot, M., Allen, J., Boyce, T., Goldblatt, P and Morrison, K. (2020) Health equity in England: The Marmot Review 10 years on. [Online] [Accessed 18 May 2021]

Milner, A., Baker, E., Jeraj, S. and Butt, J. (2020) Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis. BMJ Open, 10:e034258. doi: 10.1136/bmjopen-2019-034258

Napier, A. D. et al (2014) Culture and health. Lancet, 384(9954), 1607-39. doi: 10.1016/S0140-6736(14)61603-2.

National Institute for Health Research (2020) Improving inclusion of under-served groups in clinical research: Guidance from the NIHR INCLUDE project. National Institute for Health Research. [Online] [Accessed 7 July 2021]

O’Dowd, M. G. (2020) Explainer: what is systemic racism and institutional racism? [Online] [Accessed 6 April 2021]

Olutende, M. O., Mse, E., Wanzala, M.N. and Wamukoya, E. K. (2021) The Influence of socio-economic deprivation on multi-morbidity: a systematic review. European Journal of Physical Education and Sport Science, 6(12), DOI: 10.46827/ejpe.v6i12.3656

Piacentini, T., O’Donnell, C., Phipps, A., Jackson, I. and Stack, N. (2018) Moving beyond the ‘language problem’: developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters. Language and Intercultural Communication, 29 (3), 256-271.

Pillay, M. and Kathard, H. (2015) Decolonizing health professionals’ education : audiology and speech therapy in South Africa. African Journal of Rhetoric, 7(1).

Roulstone, S. E. et al (2014) Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study. Programme Grants Appl Research, 3(5). DOI:10.3310/pgfar03050

Sabin, J. A., Riskind, R. G. Nosek, B. A. (2015) Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. American Journal of Public Health, 106(9), 1831-1841.

Scope (2021) Disablism and ableism. [Accessed 9 July 2021]

Smart, A. Harrison, E. (2017) The under-representation of minority ethnic groups in UK medical research. Ethnicity & Health, 22 (1), 65-82. DOI: 10.1080/13557858.2016.1182126

Stafford, A. and Wood, L. (2017) Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants. International Journal of Environmental Research and Public Health. 14 (12), 1535. DOI: 10.3390/ijerph14121535

Stonewall UK (2021a) Stonewall guide for the NHS. [Accessed 7 May 2021]

Stonewall UK (2021b) Glossary of items. [Accessed 9 July 2021]

Swihart, D. L., Yarrarapu, S. N. S. Martin, R. L. (2021) Cultural Religious Competence In Clinical Practice In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

Van Cleemput, P (2010) Social exclusion of Gypsies and Travellers: health impact. Journal of Research in Nursing. 15 (4), 315-327. DOI: 10.1177/1744987110363235

VanPuymbrouck, L., Friedman, C., Feldner, H. (2020) Explicit and implicit disability attitudes of healthcare providers. Rehabilitation Psychology. 65(2), 101–112. DOI: 10.1037/rep0000317

Zeeman, L., Sherriff, N., Brownse, K., McGlynn, N., Mirandola, M. et al (2019) A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. European Journal of Public Health. 29 (5), 974-980. DOI: 10.1093/eurpub/cky226

Acknowledgements

With thanks to the following RCSLT members who have provided feedback during development of this information.

Ilyeh Nahdi
Aydan Suphi
Sean Pert
Nabiah Sohail
Sahar Nashir
Sarah Spencer
Sally Morgan
Lindsey Thiel
Dharinee Hansjee
Julie Marshall
Dave McDonald
Katherine Pritchard
Toria Kilsby
Rachael Middle
Alex Wormall
Alpana Marwaha
Rachael Middle
Anna Raby
Sophie Woodford
Matthew Horton
Kerry Corley
Pat Mobley

Addressing health inequalities: the role of speech and language therapy

Health inequalities case studies

Health inequalities self-audit tool