What are Marginalised Groups in Health and Social Care?

Marginalised groups in health and social care refer to individuals or communities who face obstacles in accessing services or achieving the same level of care as the general population. These barriers can arise from social, economic, cultural, or systemic factors, leaving such groups disadvantaged and vulnerable in health and social care settings.

Recognising and addressing the challenges faced by marginalised groups is essential to promoting fairness and equality in care delivery.

What is Marginalisation?

Marginalisation occurs when certain groups are excluded or discriminated against due to their identity, circumstances, or social position. This exclusion results in limited access to resources, support, or opportunities that others take for granted. In health and social care, marginalisation directly impacts people’s ability to receive timely or appropriate care.

Factors contributing to marginalisation include:

• Poverty and income inequality
• Racial or ethnic discrimination
• Gender inequality
• Disability status
• Language barriers
• Legal status, such as being an asylum seeker or undocumented migrant
• Stigma or prejudice related to sexual orientation or gender identity

These factors often intersect, creating layers of disadvantage for individuals and groups.

Examples of Marginalised Groups

A variety of individuals and communities may be considered marginalised in health and social care. Below are some common examples:

People Living in Poverty

Poverty limits access to health and social care services. Those on low incomes might struggle to afford transport, childcare, or time off work to attend appointments. They may also live in areas with fewer healthcare providers or longer waiting times.

Ethnic Minorities

Racism and cultural misunderstandings can lead to unequal treatment for ethnic minority groups. For example, Black women are statistically more likely to die during childbirth than their white counterparts in the UK. Language barriers can make it harder for some individuals to understand medical advice or communicate their needs.

Disabled People

People with physical or learning disabilities often face structural barriers, such as inaccessible buildings or inadequate staff training. They may also encounter prejudice or assumptions about their quality of life, which can lead to poor care.

Older People

Older people may experience ageism, where their concerns are dismissed or overlooked. Limited mobility and social isolation can further restrict their access to care. Cuts to social care budgets have also disproportionately affected this group.

LGBTQ+ Individuals

People who identify as LGBTQ+ often face discrimination within healthcare settings. For example, transgender individuals might struggle to access gender-affirming care or face stigma when disclosing their healthcare needs.

Refugees and Migrants

Refugees and migrants often face unique challenges, including legal and language barriers. Fear of deportation may prevent some from seeking care, while others may not understand their rights to NHS services.

People Experiencing Homelessness

Those without stable housing are often excluded from routine care. Without an address, it can be difficult to register with a GP or receive correspondence about appointments. Homeless individuals also face a higher burden of illnesses related to their living conditions.

People with Mental Health Conditions

While mental health care in the UK has improved in recent years, stigma and a lack of understanding still lead to marginalisation for those with mental health conditions. Waiting lists for services remain long, and individuals may be reluctant to seek help due to fear of judgement.

Causes of Marginalisation in Health and Social Care

Several systemic and individual factors cause marginalisation in health and social care services. These include:

• Institutional Discrimination: Policies or practices that unintentionally disadvantage certain groups. For example, administrative systems may not account for non-binary gender identities, making it difficult for individuals to access appropriate care.
• Underfunding of Services: When public health or social services are underfunded, those with fewer resources bear the brunt. Marginalised groups often lose out when demand exceeds supply.
• Stigma and Stereotyping: Prejudicial attitudes among healthcare professionals can lead to bias, affecting treatment decisions.
• Geographical Inequalities: Living in rural or deprived areas can limit access to high-quality care facilities.

The Impact of Marginalisation

Being marginalised within health and social care systems can have severe consequences for individuals and society. These can include:

• Worse Health Outcomes: Exclusion from timely care often leads to avoidable illnesses or complications. For example, individuals who feel unable to seek medical advice might delay a cancer diagnosis, leading to poorer survival rates.
• Mental Health Deterioration: Marginalisation contributes to stress, anxiety, and other mental health issues. Feeling unsupported, stigmatised, or excluded takes a toll on an individual’s emotional wellbeing.
• Increased Health Inequalities: Gaps in health outcomes between different groups grow when marginalisation goes unaddressed. This reinforces cycles of poverty and ill-health.

Efforts to Include Marginalised Groups

Addressing marginalisation requires systemic change and targeted interventions to improve access and care quality for vulnerable groups. Below are some key strategies:

Improving Communication

Language barriers can be tackled by providing interpreters or translated materials. Using plain language helps to ensure that individuals understand their care options and treatment plans.

Training for Staff

Healthcare and social care professionals need training on unconscious bias, cultural sensitivity, and inclusive practices. This equips staff to treat everyone fairly and without judgement.

Community Outreach

Engaging with marginalised groups in their communities makes services more accessible. Outreach clinics or home visits are effective for those facing transport or mobility challenges.

Advocating for Policy Change

Policies that protect and support marginalised groups should be prioritised. For example, campaigns for accessible facilities, such as ramps or hearing loops, help improve conditions for disabled individuals.

Reducing Financial Barriers

Measures including free prescriptions, free transport to appointments, or subsidised childcare can help people on low incomes access necessary care.

Working with Charities

Partnerships with organisations that specialise in supporting marginalised communities, such as homelessness or LGBTQ+ charities, can bridge gaps in service provision.

Legal Protections

In the UK, laws exist to protect individuals from discrimination and to promote equality. The Equality Act 2010 requires public services, including health and social care, to treat everyone fairly and without discrimination. It identifies nine “protected characteristics” under which discrimination is prohibited. These are:

1. Age
2. Disability
3. Gender reassignment
4. Marriage and civil partnership
5. Pregnancy and maternity
6. Race
7. Religion or belief
8. Sex
9. Sexual orientation

The NHS Constitution also reinforces the principle of equal access to healthcare for all citizens, regardless of their background or circumstances.

Challenges in Tackling Marginalisation

Although efforts have been made to address marginalisation, challenges remain. Budget constraints within the NHS and local councils limit the resources available to respond to worsening inequalities. Contested political landscapes often slow progress in implementing long-term improvements.

Additionally, deeply ingrained biases and societal attitudes take time to change. Marginalised groups themselves may lack trust in health and social care systems due to previous mistreatment, further complicating efforts to engage with them.

Final Thoughts

Supporting marginalised groups in health and social care is about more than just meeting legal requirements. It is about building a system that values and respects every individual, regardless of their background. Inclusion should be at the heart of all services, ensuring that no one is left behind.

The collective involvement of government bodies, healthcare providers, charities, and local communities is required to combat marginalisation. From better policies to grassroots action, every effort brings the UK a step closer to fair and equal access to health and social care.