For many Nigerians and Africans living in the UK and across the diaspora, health inequality is not theoretical, it is deeply personal. From medical devices that perform differently on darker skin to clinical trials that fail to reflect diverse communities, the consequences can be life-altering.
In a powerful intervention, Professor Bola Owolabi CBE, a Nigerian-born public health leader and senior NHS figure, says the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) is uniquely positioned to change that reality. Writing in a guest blog, she argues that fairness must be built into medicines and medical devices from the very start — not added later as damage control.
MHRA Urged to Embed Fairness in Medicines and Medical Devices
The MHRA has a critical role in shaping how medicines and medical devices are designed, tested and approved in the UK — and, increasingly, beyond its borders. According to Professor Owolabi, the COVID-19 pandemic exposed how inequitable design and testing can translate directly into unequal health outcomes.
“The lessons from the pandemic must not be lost,” she warns, pointing to the real-world consequences of medical products that fail to account for the full diversity of the population.
Professor Owolabi currently serves as Director of the National Healthcare Inequalities Improvement Programme at NHS England, alongside roles as a Chief Inspector at the Care Quality Commission (CQC), Honorary Professor at the University of Birmingham, Vice President of the Royal Society of Public Health, and a practising GP.
Pandemic Lessons and Medical Device Inequality
During the pandemic, concerns emerged around devices such as pulse oximeters, which were found to be less accurate on people with darker skin tones. These were not marginal technical issues, Professor Owolabi notes, but failures with serious clinical implications.
She highlights the equity in medical devices review, led by Professor Dame Margaret Whitehead and commissioned by the Secretary of State for Health and Social Care, as a turning point. The MHRA played what she describes as a “mission-critical role” in addressing these shortcomings — an experience she says should now shape the regulator’s future priorities.
Three Areas Where the MHRA Can Drive Health Equity
Looking ahead, Professor Owolabi believes the MHRA can help create a stronger climate for health equity by influencing not just regulatory decisions, but the wider health and life sciences ecosystem. She identifies three key areas where the agency can have transformational impact: access, experience and outcomes.
Equitable Access: Clinical Trials, Co-Design and Rare Diseases
One of the clearest lessons from COVID-19, she says, was the erosion of trust among people who did not see themselves represented in vaccine clinical trials. That lack of representation undermined confidence in safety and effectiveness.
For Professor Owolabi, inclusivity in clinical trials is fundamental. She argues that the MHRA has the authority to insist that developers place inclusion at the heart of product design and approval, ensuring evidence of safety and effectiveness holds true across all communities.
She also calls for full implementation of recommendations from the equity in medical devices review, particularly around co-design with end users and “inclusivity by design.” Even within a universal health system, access to innovative technologies often favours the most socio-economically advantaged, she notes a gap regulatory leadership can help close.
Rare diseases represent another area of concern. Conditions such as sickle cell disease, thalassaemia and cystic fibrosis have historically received limited research investment. Professor Owolabi says the MHRA can help create conditions that encourage industry to invest in these areas, aligning with the goals of the England Rare Diseases Action Plan.
Experience: Centring Marginalised Communities
Beyond access lies the issue of experience, how people actually live with medicines and devices in their daily lives. Professor Owolabi stresses that regulatory approval should account for real-world use, not just technical performance.
She points to organisations like Devices for Dignity as examples of how user experience can be embedded throughout product development. This, she suggests, offers a model for how the MHRA could more deeply assess the lived experiences of marginalised communities.
Outcomes: Focusing on the Greatest Benefit
Professor Owolabi also urges the MHRA to examine how it influences research priorities and outcomes. Too often, she argues, innovation focuses on marginal gains in well-established fields, while areas with potential for much larger health benefits remain underdeveloped.
A more equitable regulatory approach would direct attention towards innovations with the greatest potential for improved outcomes. This includes assessing how well product developers understand health inequalities. She points to her work with the Association of the British Pharmaceutical Industry (ABPI) as evidence that embedding inequality awareness across training and assessment can drive system-wide change.
A Global Leadership Opportunity
The MHRA’s influence extends beyond the UK. Professor Owolabi notes that the regulator is widely respected internationally, citing recent engagement with a Singaporean government delegation seeking to learn from the UK’s regulatory infrastructure.
This global standing, she argues, gives the MHRA an opportunity to lead internationally as a champion of equity-focused regulation, a role that will be increasingly important over the next five years.
For Nigerians, Africans and other minority communities across the UK and the global diaspora, the stakes are clear: health systems that overlook diversity can cost lives. Professor Bola Owolabi’s message is a reminder that regulation is not just about compliance, it is about justice, trust and inclusion.
By embedding equity through access, experience and outcomes, and by applying the hard lessons of COVID-19, the MHRA can help shape a future where medicines and medical devices work fairly for everyone.
For diaspora communities who have long felt invisible in healthcare design, that shift would be more than policy progress — it would be long overdue recognition.