The term ‘hard to reach’ is not recent; it is a commonly used term and regularly applied to Black and Minority Ethnic (BME) groups in public health, health research and healthcare services. However, the concept and application to these groups is part of the problem for furthering the marginalisation and inequalities they experience in health and healthcare access.

Academics and healthcare practitioners and providers have been debating this term for some time; however, they have made little progress in advancing the term and the exclusionary practices that accompany its application. The purpose of writing this book is to illustrate how this term plays a debilitating role in othering and problematising BME people within health research and services. This is because it is often synonymised with other terms, such as ‘vulnerable’, ‘challenging’, ‘marginalised’, ‘forgotten’, ‘less worthy’ and ‘disadvantaged’ (Edge, 2013; Rockliffe et al, 2018; Sydor, 2013; Bamidele et al, 2019).

What will be considered here, is whether these groups are hard to reach – or are health researchers and health service providers and practitioners just not trying hard enough to understand their health, and the practices required to engage with these groups? Furthermore, are health services and health research practices culturally competent, and do they address issues of equality that prevent access, involvement and engagement?

The aim of this book is to also illustrate that we need to shift away from the use of the term ‘hard to reach’ in health services and research, because it contributes to exclusionary practices and has implications for escalating inequalities in health and healthcare access for BME groups. This is evident because BME people are still being treated differently by health service providers and health researchers, and feel unequal to White British groups (Salway et al, 2016; Race Disparity Unit, 2019a).

Furthermore, ethnic minority groups generally have poorer health than the general population, but the evidence and methods utilised to understand these health inequalities and the factors that contribute to them, are often inaccurate and inappropriate. Unfortunately, it is also commonly assumed within this field that the existence of ethnic health inequalities is due partly to these hard-to-reach groups. This is because they are presumed to be difficult to engage in healthcare and research, and their health practices or behaviours do not align with those of the majority white population, for which services and research are designed.