Action on patient safety can reduce health inequalities

Health inequalities are widening in many high income countries and have been thrown into focus by the covid-19 pandemic.1-4 Not only have black, Hispanic, Asian, and other marginalised ethnic groups in many high income countries had disproportionate death rates from covid-19, but non-covid health outcomes have also worsened.5 -7 These unfair and avoidable differences in health between population groups are driven by a range of social determinants such as education, poor housing, and unemployment that contribute to social exclusion and disadvantage.1 When people already negatively affected by unfavourable social determinants of health seek care, healthcare itself may exacerbate health inequalities rather than mitigate them.8 One way in which this occurs is when patients experience disproportionate levels of harm from the healthcare they receive. For example, a 2022 review in the UK found that ethnic minority women's experiences of poor communication and discrimination during interactions with healthcare staff may explain some of the stark inequalities observed in maternal health outcomes.9 Healthcare may therefore be less safe for some patients than others. Patient safety is the science and practice of minimising harm and error experienced by patients while receiving healthcare.10 Harm typically centres on a "patient safety incident" in which a failure in healthcare causes physical or psychological injury to a patient.11 12 Most clinicians would recognise patient safety incidents such as administering a drug to the wrong patient as potentially extremely harmful and preventable (box 1), but it is less clear whether the concept of harm should encompass population level health inequities such as more severe diabetic complications in one group compared with another. We focus here on patient safety incidents to emphasise that the responsibility for their avoidance lies directly with the healthcare system and its workforce.