Bridging the Gap: A health inequalities learning resource

Barriers to Equality

 Social barriers are the main cause of our problems…These barriers include people’s attitudes to disability, and physical and organisational barriers. Disability Wales (2009)



When considering issues of stereotyping, prejudice and discrimination in relation to NHS services we often talk in terms of overcoming the Barriers that people and groups might face. But what do we mean?

What are Barriers? 

Barriers are those things that prevent or make access to a service more difficult for certain groups and individuals.

Much as we described discrimination as existing at different levels, barriers can be personal, cultural, institutional and structural.

Barriers image

Different kinds of Barriers

Structural, where circumstances create or result in barriers - for example in access to a 'good education' adequate housing, sufficient income to meet basic needs. And as we have observed, structural barriers are associated with poor life outcomes that can be observed in the significant disparities in health between areas of affluence and those associated with poverty.

Institutional, where policies, processes, practices sustain an organisational or service culture that excludes certain people or groups; an obvious example being what has been called the 'glass ceiling', i.e. that while not visible, a ceiling exists beyond which women - find it very difficult to progress.

Cultural barriers can prevent, for example, consideration of spiritual, relational  or dietary needs that do not conform with traditional expectations. For example "it took 3 days to organize Halal food".

Personal barriers, for example where healthcare staff hold individual prejudices that influence their practice. These actions may be conscious, but as we have discussed, they can often be unconscious or unwitting. Attitudinal barriers are not as easy to identify as physical barriers, but they can feel every bit as real to those who are exposed to them.

Barriers can be…

Physical in nature; observed in the built environment, for example in accessing buildings, narrow doorways, the absence of lifts or accessible toilets…

About communication; where for example the language, communication or information needs of certain group and individuals are assumed, not taken into account, valued or given weight.

Case study three - Alex


Pause for thought...

Drawing on your own experiences, can you think of any examples you have come across of barriers that have made it more difficult for some people to use an NHS service?

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