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Marginalisation has been defined as the position of individuals, groups or populations outside of ‘mainstream society’ (Schiffer & Schatz; ENSIH 2008). These groups experience severe health inequities that can result in poorer health status, higher premature morbidity, and increased risk of patient safety incidents in comparison to the general population (Aldridge et al.; Lancet 2017). Poor healthcare outcomes are driven by:

  • Systemic exclusion from policy making forums
  • Poor or non-inclusive organisational service designs leading to gaps in service provision for marginalised patients
  • Barriers to communication regarding healthcare needs and treatment due to impairment or personal context (language barriers or sensory, learning or age-related disability; perceived or actual stigma)

Cheraghi-Sohi et al. (Int J Equity Health; 2020) undertook a narrative scoping review to identify the particular patient safety issues affecting these groups. A bubble plot summarises the findings, which highlight the range of patient safety issues and the clustering of risks that impact certain groups. The paper also highlights groups for which there is insufficient research, including those with mental health problems, communication and cognitive impairments.

To ensure health equity, services must recognise vulnerabilities and marginalisation and take action to mitigate the risks for those individuals and groups. Services should ensure that needs are identified and that mitigations are in place. These actions have the potential to make significant improvements in service quality and patient outcomes.