JRSM >
Volume 101, Number 9 >
Pp. 463-465
1 Glasgow
2 Division of Community Health Sciences: GP Section, University of Edinburgh Edinburgh EH8 9DX, UK
Correspondence to: Aziz Sheikh Aziz.Sheikh{at}ed.ac.uk
 | Introduction |
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Given the difficulties in reducing health inequalities for certain disorders, the very considerable gaps remaining in our knowledge in relation to minority communities for many other conditions, and the known under-representation of minority groups in research (both in the UK and US),3,4 it is important that every effort is made to make use of existing data sources to describe and understand the nature of ethnic- and faith-based variations in health outcomes, and assess progress in tackling these inequalities.
The UK enjoys some of the foremost datasets of routinely collected health statistics, and greater exploitation of these is potentially of considerable importance to shaping policy, prioritizing research and identifying foci for service delivery improvements. In order to investigate the fitness for purpose of these datasets, we sought to interrogate them for evidence of inclusion of ethnicity and faith variables and, where recorded, to see whether there was a consistent approach to recording that would allow comparisons between datasets.
| Methods |
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Launched in 1999, DoCDat was developed and has since been maintained by the London School of Hygiene and Tropical Medicine.5 A structured questionnaire is used by those compiling and maintaining DoCDat to determine general details about individual datasets relating to, for example, when the dataset was established and what fields it contains. The quality of datasets is also assessed by scrutinizing the validity and reliability of data held against pre-defined criteria.5
DoCDat was accessed between May and August 2006 and a table detailing information on all datasets available online was compiled. Each dataset within the Directory was interrogated online by means of detailed searches of questionnaires and webpage information against pre-defined criteria using a standardized approach to ascertain whether or not ethnicity- and faith-related data were collected and, if so, which specific questions were used. If answers were unavailable through online searches, the custodian of the individual datasets was contacted by email in an attempt to obtain this information.
Data were abstracted onto a customized data extraction sheet and descriptive statistics were employed to summarize results.
| Results |
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The questions used to determine ethnicity varied widely, as demonstrated in Table 1. Of the 62 datasets collecting ethnicity data:
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The email responses from data custodians revealed two major reasons for these data not being collected: perceived irrelevance of or difficulty in collecting such information; and a failure to appreciate the importance/potential uses of these data (
Box 1 Examples of email responses from data custodians
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Box 1).
| Discussion |
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It is important to note that our findings are likely to paint an overly optimistic picture. In many datasets, even where there is provision to record ethnicity data – for example Hospital Episode Statistics or primary care datasets, which would have been counted as a positive outcome in our study – recording of ethnicity data is known to be so poor that any meaningful analysis is precluded. This problem is compounded further by the fact that many datasets fail to use standard validated ethnic and religious codes.
While the immediate clinical relevance of collecting information on ethnicity and religion may reasonably be debated by some, the legal imperative on health-care providers to demonstrate equality of service provision would seem to make the importance of having access to such data for research and audit purposes beyond argument. Such data have, for example, been able to demonstrate marked differences in asthma outcomes between UK minority ethnic groups and whites.6 Whilst scepticism still exists, it should also be noted that such identity descriptors may also prove useful in planning and delivering clinical care to individuals. For example, in some parts of the UK South Asian babies are selectively offered BCG vaccinations.7
Our work corroborates the view that collection of data on ethnicity and religion are in general still not seen as a priority. This is in sharp contrast to the view taken by the Department of Health, which notes in its ‘Position Statement’ the importance of – and accords ‘top priority’ to – the need to collect data on ethnicity; it furthermore urges that this should be consistent with the census categories.8 At present, neither routinely occurs: given the Equality and Human Rights Commission's recent insistence that public bodies meet the needs of minority groups, be they ethnic or religious and no matter how small, this reflects a worrying lack of awareness amongst clinicians and academics.9
In 2001, the UK Census and Home Office Citizenship Survey clearly demonstrated that it is feasible to collect valid and reliable data on ethnicity and religion, and that these data can be used for extremely important analyses.10,11 Years on, it is time that the standard set in these national surveys is much more widely adopted within health-care services.
| Footnotes |
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DECLARATIONS
Competing interests None declaredFunding None
Ethical approval Not applicable
Guarantor KS
Contributorship AS conceived this study and oversaw protocol development, data extraction and analysis. KS undertook data extraction, analysis and drafted the paper
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