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Human Rights & Discrimination

Phoebe Arslanagic-Wakefield: Medical bias – not a woman’s world

By Centre Write, Health & Social Care, Human Rights & Discrimination, Phoebe Arslanagic-Wakefield

Despite forming half of the British population, women continue to suffer from persistent and significant gender inequalities in modern medical research and practice. The impact of this pernicious erasure of the female body, which can be seen in research, diagnostic waits, and even in a doctor’s perception of a patient’s physical pain level, leads to worse health outcomes for women. 

The state of endometriosis care in the UK is illustrative of the long-term effects of medical bias against women. This female-only condition results in debilitating pain by causing uterine tissue to grow on other organs, such as the liver or bladder. Two million women in the UK have endometriosis. In 2019, the largest study of its kind found that severe diagnostic delays leave UK women to suffer with endometriosis for an average of seven and a half years. By this late stage, the condition can be severe enough to result in infertility and life-long pelvic problems. Of 13,500 women with endometriosis surveyed by the BBC in 2019, half said the pain had led to suicidal thoughts. 

Repeated studies have shown that medical professionals take female pain less seriously. One study found that women with acute abdominal pain who present themselves to an emergency department are not only less likely to be given effective painkillers than men, they must also wait longer to actually receive them. Women’s pain is also less likely to be perceived as having a physical, organic cause. Instead, they are more likely to be referred for psychiatric help. Such attitudes are a major contributing factor to the average endometriosis diagnosis wait-time of seven and a half years. The effect can also be seen in the context of heart disease; women suffering heart attacks are 50% more likely than men to be initially misdiagnosed and, in England and Wales, are 7.4% less likely to be prescribed important preventative medications when leaving hospital following a heart attack. 

Even drugs are often not as safe or efficacious for women as they are for men. Sex has a startling effect on drug response; early male-only studies of aspirin showed that the drug had a clear protective effect against heart disease. A female-only study did not find the same; in women aspirin reduces stroke risk but not heart attack risk, whilst in men the opposite is true. The reasons for and extent of sex divergence in aspirin’s effects are not totally understood, yet it is one of the world’s most common medications. Though women are known to metabolise medications differently, clinical trials frequently fail to take this into consideration; a 2014 report condemned this state of affairs as ‘leaving women’s health to chance’.

The lack of understanding on how commonplace drugs like aspirin affect the female body is at least in part due to the fact that, until the early 1990s, the exclusion of women from medical trials was the norm; it was thought that treatments that worked well for men would work for women too. Furthermore, it was simpler when designing a new study to build upon older research that had also been male-only. Even studies on heart disease, which is the leading killer of women in the UK and US, were predominantly male-only until the mid-1990s. Today only a third of cardiovascular clinical trial subjects are women and only 31% of such trials report their results by sex.

As clinical trials continue to be weighted towards men, it is possible that many drugs continue to be less efficacious for women. A frequent explanation for the exclusion of women today is ‘the complexities of the menstrual cycle’.  The menstrual cycle does undoubtedly result in hormonal changes in the body which could have an impact on the effect of drugs. However, it is also a regular and predictable event that will occur throughout much of a woman’s life, making excluding women from trials illogical, considering that drugs are taken during the cycle.

The European Medicines Agency released a report in 2005 which argued that guidelines on including women in trials were unnecessary as gender representation was now adequate, but in 2019 new analysis of 1.5 million biomedical studies found that only one in three reported sex-related differences. Thus, whilst improving, an understanding gap around how drugs affect women persists. 

The issue of imbalance in medical trials is in some senses easier to fix than the wider issue at hand here; clearer guidance can be released, sex-specific reporting can be made compulsory. However, what endometriosis diagnosis delays, in conjunction with medical attitudes to female pain, highlight is a much thornier and deep-rooted issue. Patients must self-report their pain to medical professionals, and that communication is affected by implicit biases. Unconscious bias training courses have become fairly commonplace in the public and private sector; perhaps it is time to consider a similar model for medical professionals. 

Phoebe Arslanagić-Wakefield is a Research Assistant at Bright Blue.

November 21, 2019

Phoebe Arslanagic-Wakefield: A place for faith schools? 

By Centre Write, Human Rights & Discrimination, Immigration & Integration, Phoebe Arslanagic-Wakefield

The British Social Attitudes Survey has found that 52% of Brits are atheist or do not belong to any religion. In this era of plummeting religious belief, it is worth examining whether there is a place for state-funded faith schools in British society.

The majority of UK state faith schools, 68%, are Church of England. The leadership of the Church of England insists that faith schools are inclusive. However, research conducted by the Humanists last year in their report, Non-religious need not apply, strikes at the heart of this defence. The report found that 40% of all state faith secondary schools in England discriminate against non-religious families, by giving priority to families of any religion, regardless of whether or not that religion corresponds to that of the school.

Catholic schools are the worst offenders for this kind of discrimination with 60% of Catholic schools discriminating against non-religious families in this manner. Twenty-five percent of Church of England schools do so also, as do 20% of Islamic schools. These figures mean that non-religious families have their access restricted to 240,000 more state secondary places in England than they would if this discrimination did not exist. This unacceptable state of affairs has the legal character of a human rights violation and severely handicaps the ability of religious leaders to claim that faith schools serve the entire community.

Another defence mounted by proponents of faith schools is that they offer a very high standard of education, and should be preserved on this basis. It is true that the quality of schooling provided at state faith schools is good; 81% of all Church of England primary and middle schools are rated good or outstanding, in comparison with 77% of all non-faith schools. Is this exceptional standard due to the faith-based nature of the schooling or attributable to the fact that these schools are selective, and selective schools perform better than comprehensives? Proponents of faith schools argue the former, highlighting the impact of the religious ethos that such schools instil in their students. However, disadvantaged children are underrepresented at faith schools. According to the Education Policy Institute, at an average faith secondary school, the odds of a child being eligible for free school meals is at around two-thirds of that for all children living in the local area. Indeed, when characteristics such as deprivation and prior attainment are controlled for, the attainment gap between faith and non-faith state schools significantly decreases. In short, faith schools have no special character, they are simply selective and ultimately as good as any other good school.

Finally, state faith school defenders argue that the existence of these schools is vital in upholding Article 2(1) of the ECHR, which protects the right of parents to educate their children in conformity with their own religious and philosophical convictions. Though Article 2(1) grants parents this right, it does not correspondingly give the State a positive obligation to create or subsidise any particular education system or school. For example, religious schools exist in France, but they are private institutions that operate without state funding.

In 2019, ONS figures showed that the number of irreligious people in Britain has increased by 46% since 2012. Of those aged 18-24, a mere 1% identify as Church of England. In 2018, Church of England service attendance reached a record low of 722,000, compared to 1.2 million 30 years ago.

These figures point to the conclusion that there is no longer a place for state faith schools. However, the UK is not a secular state. Indeed, we are far from it with a monarch who doubles as religious leader, and twelve archbishops and bishops sitting in the House of Lords in the quaintly named ‘Lords Spiritual’ conclave.

Yet alongside our flourishing atheism, there are no popular calls for the Archbishop of Canterbury, Justin Welby, to be ejected from the House of Lords or for the Queen to reject Anglicanism. Religious institutions still form an important part of the fabric of British life. Church of England volunteers contribute over 23 million hours of community work per month and the number of parcels given out by church-run food banks has increased by 20% since last year. In this context, the existence of a place for state faith schools in modern Britain appears more certain.  After all, 60% of all state faith schools are not discriminating against non-religious families, but are serving their communities well and inclusively, at a generally high education standard. If this increasingly irreligious nation can tolerate a non-secular State and its accompanying accoutrements, then why not well functioning, inclusive state faith schools? The principle behind state faith schools is easily attacked, but ultimately, the de-funding of good schools is unnecessary.

Indeed, in this pragmatic country, there will perhaps always be a place for state-funded faith schools that serve the whole community and deliver good education. There will not, however, be a place for schools of the ilk that reject children from non-religious families. If this practice is stamped out, the future of state-funded faith schooling in the UK is bright, and to remove or de-fund them, counterproductive.

Phoebe Arslanagić-Wakefield is a Research Assistant at Bright Blue.

October 21, 2019

Jennifer Twite: Isn’t there more to conservative DNA than punishing people who commit crimes?

By Centre Write, Human Rights & Discrimination, Law & Justice

In her first words at the podium at the Conservative Party conference, Home Secretary Priti Patel established the theme of her speech in no uncertain terms. “Today, here in Manchester, the Conservative Party takes its rightful place as the Party of Law and Order in Britain once again.” she opened, continuing: “We stand with the brave men and women of our police and security services. And we stand against the criminals.”

This rhetoric will no doubt be welcomed by many who rightly worry about the effect of crime on our communities. It is not always so easy, however, to divide society between innocent, law-abiding citizens and the criminals. There are many people who, for a host of reasons, commit criminal acts in their youth but go on to make positive contributions to society. This is reflected in the longstanding principle that rehabilitation should be a key aim of our justice system – a principle which unfortunately is often forgotten when it comes to the disclosure of criminal records.

Take the example of Isaac (not his real name). Isaac was 16 years old when he got involved in a scuffle with some other boys after a rugby match, leaving one of the other children involved with a black eye. The police were called and Isaac was questioned, facing the serious charge of Actual Bodily Harm. Deciding that proceeding with prosecution was not in the public interest, the police persuaded Isaac to accept a youth caution – a measure designed as way to deal with minor crimes committed by children which avoids dragging them into the criminal justice system.

That’s where this story should have ended – with Isaac receiving the legal equivalent of a slap on the wrist for what was no doubt a regrettable incident, but not one, most would reasonably agree, that should blemish his reputation for life. But that was not the end of this story. Six years later, Isaac decided to serve his community by enrolling as a community police officer. His application was refused on the basis of the caution that showed up on his criminal record check. Isaac wanted to become one of those “brave men and women” that the Home Secretary lauded – but the system could only see him as one of “the criminals”.

Isaac was a victim of an anomaly of the current system for disclosing criminal records. Youth cautions are considered “spent” immediately and do not usually need to be disclosed when applying for jobs and volunteering opportunities. But certain roles – such as community police officers – require applicants to undergo a criminal records check, on which spent convictions and cautions can be disclosed.  Most youth cautions are only disclosable on criminal record checks for the first two years after they are issued, and from then on are “filtered” and don’t get seen by potential employers. However, for some types of offences, this “filtering” rule does not apply. For people in Isaac’s position, their cautions will show up on record checks until they are 100 years old.

Some might say that it is right that future employers are aware of these offences – but this ignores the intention of youth cautions and the circumstances that must be present for them to be issued. Cautions are only ever handed out in cases where police and prosecutors have decided that proceeding with criminal charges is not in the public interest. They are supposed to be diversionary measures that aid the rehabilitation of children who have committed minor offences that do not warrant prosecution. But the current system fails to live up to this ambition, instead locking these young people out of a host of professions and voluntary work that would allow them to make a positive difference to society.

This is a view shared by the justices of the Supreme Court. In January, they ruled to uphold a judgment of the High Court and Court of Appeal that this situation runs contrary to the aims of the youth justice system and human rights legislation, and that the current regime for disclosure of youth reprimands (the predecessor to cautions) and cautions is unlawful. Delivering the judgment, Lord Sumption wrote that the disclosure of reprimands and cautions was “directly inconsistent” with their intended purpose of diverting children from crime. This ruling forces the government to introduce new legislation to rectify this. That was in January. It is now October, and new draft legislation is yet to emerge.

As one of the parties to the judgment, it is up to the Home Secretary – along with the Justice Secretary – to put this new legislation forward. It is thus disappointing that in a conference speech dominated by criminal justice issues, in which she made a host of pledges, no mention was made of reform to the criminal records system.

The Home Secretary justified her tough talk through an appeal to conservative values – asserting that “backing the forces of law and order is central to our DNA as Conservatives.” But isn’t there more to Conservative DNA than punishing people who commit crimes? Isn’t conservatism also supposed to value and work towards a society that enables each individual to contribute and reach their potential? Many Conservatives seem to think so, including figures considered to be on the right of the party such as Theresa Villiers MP. In a Westminster Hall debate in March she said that despite believing in “a firm justice system that punishes crimes appropriately” she did not find it fair “for people to have to live for the rest of their lives with the consequences of terrible mistakes they may have made in childhood.”

If the Home Secretary truly wishes to make the Conservatives “the Party of Law and Order”, she must work with Ministry of Justice to enact the judgment of the Supreme Court and bring forward new legislation that complies with the law. In the meantime, people like Isaac will continue to face the injustice of having mistakes from their childhood preventing them from giving back to their communities.

Jennifer Twite is Head of Strategic Litigation at Just for Kids Law. She led on the case against the Home Office concerning the disclosure of youth reprimands and cautions on DBS certificates. The views expressed in this article are those of the author, not necessarily those of Bright Blue.

October 15, 2019

Bethany Morris: Football: the bridge between asylum seekers and integration

By Centre Write, Human Rights & Discrimination, Immigration & Integration

The life of an asylum seeker can often feel like a vacuum.. The memories of traumas such as physical, emotional and sexual abuse, torture and the deaths of loved ones can be consuming.  Building life in a new country all alone only exacerbates their plight. As unlikely as it may seem, football has the power to change all of this. To engage in an activity which promotes social integration, a sense of competition, belonging and the familiarity of routine, can make all the difference to the lives of these vulnerable people.

After successfully helping to integrate asylum seekers and refugees into local football teams, Football Unites, Racism Divides (FURD) conducted a three-year research project with the aim of examining the extent to which football helped these people integrate successfully into their new lives. Ultimately, they discovered that football helps foster a sense of belonging by promoting routine, catharsis, sociality, empowerment and plurality whilst providing a safe space and improving mental health. The game itself can help realign players with their sense of identity, particularly if they regularly partook in the game in their home country. 

Routine and regularity “builds relationships with other participants” and interestingly, the sociality of football provides players with an alternative means of communication that “avoids the reduction of identity to that of ethnicity or political status”. This is of particular importance to asylum seekers and refugees who often report feeling out of place or unwelcome when settling into new countries. The inclusive nature of football allows them to engage and communicate with others from all walks of life; a feeling of belonging is fostered through working together to achieve a shared target, eliminating the sense of marginalisation that these groups often feel. The study describes mental-wellbeing and a sense of belonging as “mutually interdependent”; therefore, the benefits of social integration via sporting activities such as football can drastically alleviate the symptoms of mental health issues such as anxiety and depression. Lamentably, such issues are commonplace amongst asylum seekers, with around 61% experiencing mental distress. 

Whilst asylum claims are being processed, applicants are not permitted to work. The majority must depend on support from Section 95, which provides less generous support than  that received by UK citizens who are also unable to work. Links between poverty and ill-health have been well documented over the years. Processed foods are often cheaper than fresh, meaning eating unhealthily becomes an “economic, not a moral choice”. This is an issue for refugees and asylum seekers who receive little financial aid and often live in poor-quality accommodation too, which has been proven to be linked to the onset of health issues particularly in children, such as meningitis, asthma and tuberculosis. 

Not only does football facilitate social integration, but for those living in poverty and substandard accommodation, it can provide a means of escape that promotes exercise and a healthy lifestyle, ultimately increasing the effectiveness of the immune system in battling illness and disease.  Many football initiatives intended for refugees and asylum seekers such as those run by FURD also provide a free hot meal, showers, toiletries and funding to cover travel costs. This helps to break down the economic barrier between poverty and general well-being, which can be a lifeline for those isolated from society and living in poverty due to their immigration status. 

Initiatives such as those run by FURD have been incredibly successful for refugees and asylum seekers by promoting social integration, reducing the prevalence of mental and physical health issues and breaking down barriers between poverty, sociality and health and wellbeing. Sports such as football are universal: by providing vulnerable people with opportunities and a sense of identity, we are giving them the best possible chances to succeed in life, make friends and stay healthy – all whilst having fun and not fearing further judgement or marginalization due to their immigration status. 

Bethany Morris is a content writer for the Immigration Advice Service, an organisation of immigration solicitors that help undocumented migrants to regulate their status. Views expressed in this article are those of the author, not necessarily those of Bright Blue.

October 4, 2019

Virginia Crosbie: Through the glass ceiling

By Centre Write, Economy & Finance, Human Rights & Discrimination

Women are becoming the most powerful force in US politics. Three of the most influential US activists – Cecile Richards, Alicia Garza and Ai-jen Poo – have launched ‘Supermajority’, with the goal of rallying two million women over the next year to become political leaders in their communities.

Women are having a voice and using it; the Women’s March the day after the inauguration of Donald Trump was the largest single-day protest in US history. The 2018 mid-term elections saw a record number of women, including women from ethnic minority groups, elected to Congress and the US now has the highest number of women ever running for the 2020 Democratic presidential nomination.

The political phenomenon, Alexandra Ocasio-Cortez, has had a meteoric rise to Congress and is now the second most talked about politician in the US after Trump with her ‘winning hearts and minds’ approach to campaigning.

Women now realise that if they don’t get involved then things won’t change. With a record level of women in office, these are the women who create opportunities for other women to follow. There is still a long way to go; women make up over half the US population, but they are still underrepresented in every aspect of leadership from local politics to the boardroom.

So what does this mean for the UK? We too have seen an increase in participation of women in politics. ‘Processions 2018’ saw tens of thousands of women across the UK march to celebrate 100 years of suffrage. In 2018, the first statue of a women, Dame Millicent Fawcett, the women’s right-to-vote campaigner, was erected in Parliament Square. Later this year, as a result of a crowdfunding initiative, a statue of Lady Nancy Astor, the first female MP to sit in UK Parliament, is to be erected in Plymouth to celebrate 100 years since her election. The campaign to have a woman scientist on the new £50 note has been loud and clear and we will know the result this summer. These are just a few high-profile examples; everywhere, women are raising their voices, getting involved and getting results.

So how do we harness the talents and enthusiasm of women willing to enter the political debate? Groups like 50:50 Parliament are successfully encouraging women from all parties to come forward with its #AskHerToStand campaign. Brandon Lewis MP, the Conservative Party chairman, has announced his ambition of having 50% women candidate lists. The Conservative Party is holding its first Women’s Conference in Birmingham, featuring policy discussions and skills workshops.

Why does this matter? Is this just political correctness? No. It matters because politics often reflects the experiences of those making the policies; unless we have representation on our green benches in Parliament, we are not going to have the policies that reflect the electorate. And without policies that reflect the electorate we are going to find it even harder to win elections.

Women have different perspectives because they have had different life experiences; not better or worse, but different. Women make up 50% of the talent in the UK: let’s make sure we all benefit from it.

Virginia Crosbie is the director of Women2Win. This article first appeared in our Centre Write magazine Identity crisis?. Views expressed in this article are those of the author, not necessarily those of Bright Blue.

October 3, 2019

Lord Holmes: Accessing talent

By Centre Write, Human Rights & Discrimination

I lost my sight at the age of fourteen. Ironically, one of the most challenging aspects was the fact that people immediately stopped seeing me. The attitudes of those around me became everything.

Practical challenges can be solved with practical solutions. But access to practical solutions – and the willingness of people to consider, or provide, these solutions – can be the difference between inclusion and opportunity, and an insurmountable barrier.

Attitudes and culture remain one of the major challenges faced by disabled people in modern Britain. Humans are social animals and we are predisposed towards ‘people like ourselves’. It feels safer and it is natural, but expanding our definition of who is included is an essential part of creating a civilised society. Qualitative research conducted in advance of the 2012 Paralympics found that almost no one would be likely to buy tickets for the Paralympics. Respondents were quoted as saying “why would I spend money, when I spend my life trying to avoid people like that.” Thinking about disability can make people without disabilities, or without direct experience of disability, feel awkward and frightened. Disability, when viewed as weakness or a personal tragedy, is something that sets an individual apart from the ‘ordinary’ and outside social norms.

One of the most successful ways we challenged these attitudes and stereotypes was with the Channel 4 ‘Meet the Superhumans’ campaign. Part of the campaign was a ninety second advert, soundtrack by Public Enemy, introducing Paralympic athletes. Simultaneously showing people with disabilities whilst inverting presumptions of weakness, the advert also showed short, shocking glimpses of a car crash, an IED, a neo-natal scan; in so doing connecting us all to the experience and challenging assumptions of difference. Disability is not ‘other’. It happens to you. It happens to me.

People in the end did buy tickets, did come and watch the Paralympics, did enjoy an incredible world-class summer of sport. After the games many people reported feeling for the first time that their disability was not perceived as a negative thing. Attitudes can change, and we can all be part of effecting that change.

Further challenges exist – around equality of opportunity in education and employment. In 1995, a Conservative Government passed the Disability Discrimination Act, which subsequently became part of the Equality Act 2010. This Act enshrines the principles of equal access to education and employment. But despite this, currently, we are not where we must be.

The Head of Ofsted has recently described the lack of support for children with diagnosed special educational needs as a “national scandal”. Twenty seven percent of children on the autism spectrum have been excluded from school. A BBC investigation in 2017 found that, over the previous five years, numbers of children with special educational needs being home-schooled had grown by 57%.

We must not allow the clock to be turned back to a time when the visually impaired were offered careers as piano tuners or basket weavers. This “national scandal”, as the Head of Ofsted describes it, harms us all. Failing to ensure equal access to high-quality education misses out on a pool of talent that will be a devastating waste, not just to the individuals but to all of us.

The consequences of failing with education inevitably impact on employment. Just over 51% of people with disabilities are in employment, significantly below the employment rate for people without disabilities which now sits at just over 81%. Forty percent of young people with visual impairments do not reach employment and are instead condemned to a life on benefits. Again, the core principles are individual opportunity and enabling talent; talent in its broadest most brilliant form, not just that of a tiny elite. Creating opportunities for disabled talent is not looking to give anyone an unfair advantage. An equitable, inclusive, fully accessible jobs market puts everyone on the same start line. It allows everyone to run whatever race they choose with fairness, dignity and respect.

One of the areas that does give me hope is the potential for technology to furnish us with incredible, enabling solutions. The mainstreaming of assistive technology demonstrates just what a difference the new tools we have will make to all our lives. Disability research is often the ground-breaking, boundary-pushing work that leads to technology we all become familiar with, such as text-to-speech software and predictive text. Artificial intelligence, nanotechnology, 3D printing, genetic sequencing, to name but a few, are turbo-charging this process. Correctly deployed, the ‘Fourth Industrial Revolution’ will enable, include and transform our world. As ever, though, we must root it all in ethical principles, with a ruthless focus on the society we want to create and the lives we want to live. No one must be left behind, no talent wasted, no individuals excluded.

I have been working recently on two specific issues of access and inclusion: access to the public realm; and, representation in public appointments. In the public realm, a street-design approach known as ‘shared space’ has been transforming our high streets. Pedestrian crossings and pavements are removed to create a space that is ‘shared’ by vehicles and pedestrians. However, without a clear demarcation between safe space and road space visually impaired pedestrians lose the ability to navigate independently. Many others suffer too; children armed with the green cross code cannot stop, look and listen when there is no obvious place to stop. I commissioned my own research into the problem and have been working for years to raise awareness of the issues and help direct government policy to ensure our high streets are safe and accessible for all.

Public appointments have an equally significant impact on all our lives. Public bodies, and the appointees that constitute them, are responsible for the distribution of £200 billion of public funds across, but not limited to, healthcare, education, the criminal justice system, energy, security and defence. Currently – shockingly – just 3% of public appointees declare a disability. I was invited to conduct an independent review for the Government into why this figure is so low and make recommendations to ensure that public appointees better represent the society they serve. My recommendations call for a more innovative and flexible approach at all stages of the recruitment process. There are also important recommendations around improving data collection and transparency, including setting a target of 11.3% of all public appointments being for disabled people. I look forward to the government response to the review.

If you believe in individual rights, freedom and opportunities, and desire a world in which all people can contribute their talents and benefits, then there is work to be done. Currently, talent is everywhere, but opportunity is not. There is much that we can all do to change this. The rewards, should we succeed, will be great indeed.

Lord Holmes of Richmond was Director of Paralympic Integration for the London Olympics. He writes about his parliamentary and policy work here. This article first appeared in our Centre Write magazine Identity crisis?. Views expressed in this article are those of the author, not necessarily those of Bright Blue.

September 18, 2019
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