J R Soc Med 2002;95:293-295
doi:10.1258/jrsm.95.6.293
© 2002 Royal Society of Medicine
Health issues in ethnic minorities: awareness and action
M Memon MPh MBA 1,2
F Abbas PhD 1
M Khaonolakar MB BS MD 3
J Dixon1
I Singh MRCP DipRehab 3
1 Guild Community Healthcare NHS Trust, Preston, UK
2 Multicultural Studies Centre, Bolton Institute, Bolton, UK
3 Queen's Park Hospital, Blackburn, UK
Correspondence to: Professor I Singh, Consultant physician, Queen's Park
Hospital, Blackburn BB2 3HH, UK E-mail:
IS25BP{at}aol.com
 |
SUMMARY
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A key issue in health provision is the approach to health inequalities.
In
the UK, black and ethnic minority populations are disadvantaged
in this
respect. We obtained annual/public health reports from
13 health authorities
(HAs) and 22 primary care trusts/groups
(PCT/Gs) serving conurbations with
large black and ethnic minority
populations, and examined them for mention of
special health
issues for these groups and the action being taken. 22 of the
35
reports referred to such issues but only 17 referred to special
initiatives;
the most frequently mentioned were diabetes and coronary heart
disease.
We recommend that HAs and PCT/Gs serving large black and ethnic
minority
populations state specifically in their annual reports their
awareness
of health-equality issues and the action being taken to address
them.
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INTRODUCTION
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In 1991, according to the Census, about 6% of the population
of England and
Wales were of black and ethnic minority
origin
1.
Today the
proportion is likely to be higher—partly because
of the higher birth
rate in these groups, but partly also because
1.2 million people were missed
from the 1991 estimates. People
from ethnic minorities tend to perceive
themselves as less healthy
than those in the general UK
population
2; for
example, those
from the Indian subcontinent have a substantially higher rate
of
coronary heart disease. The present British government understands
that its
aim to increase life expectancy and number of years
of freedom from illness in
the population cannot be achieved
without addressing the issue of
inequalities—in other
words, improving the health of those who are worst
off. We have
conducted a survey to determine the approaches to this issue
being
adopted by health authorities and primary care trusts/groups
in
districts of England with large black and ethnic minority
populations.
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METHODS
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We used data from the 1991 Census to identify conurbations with
a high
proportion (10-45%) of people of black and ethnic minority
origin. 20 health
authorities (HAs) and 64 primary care trusts
or groups (PCT/Gs) from such
conurbations were asked to supply
copies of their annual/public health
reports. Each of the reports
received was examined to determine which aspects
of black and
ethnic minority healthcare were mentioned and what action was
being
taken to address them.
|
RESULTS
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Replies were received from 13 HAs and 22 PCT/Gs. Figures
1 and
2 illustrate the response
rates, mentions of issues and references
to action taken. 12 (92%) of the 13
HA reports identified health
issues for black and ethnic minority groups and 9
specified
initiatives to address them. Health concerns mentioned were
coronary
heart disease, hypertension, diabetes, mental health,
sickle-cell anaemia,
thalassaemia, tuberculosis, and inequalities
in access to services. The most
frequently mentioned concern
was diabetes
(
Figure 3), but only 4 reports
referred to special
initiatives or programmes to deal with this disorder. 7
(54%)
of these reports mentioned inequalities of access to health
services, of
which 5 described current or planned measures to
deal with this issue.
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Figure 1. Reports from health authorities. HasRes=health authorities
responding; HasNR=HAs not responding; NEA=not stating ethnic awareness;
EA=ethnic awareness; EA&A=ethnic awareness and action
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Figure 2. Reports from primary care groups/trusts. PCGRes=PCGs responding;
PCGNR=PCGs not responding. For other abbreviations see legend to
Figure 1
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Of the 22 PCT/Gs who responded, 10 (45%) referred in their reports to
special health issues in black and ethnic minority populations and 8 were
addressing these issues (Figure
4). The issues most commonly identified were high rates of
coronary heart disease (5 reports) and diabetes (4); just 4 reports described
action being taken to address these disorders. 5 mentioned inequalities of
access to health services and the same number referred to initiatives, either
underway or planned, to counter them.
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DISCUSSION
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There was a clear discrepancy between the number of reports
mentioning
healthcare issues for black and ethnic minority communities
and the number
identifying actions being taken. Even for coronary
heart disease and
diabetes—the most frequently discussed
issues—only one-third of
the reports referred to special
interventions. Because many of the authorities
(especially PCT/Gs)
did not respond to our requests for reports, the results
must
be interpreted cautiously. Seemingly the PCT/Gs were less sensitive
than
HAs to these matters—a finding that might reinforce
concerns about loss
of the public health function in the latest
National Health Service
reorganization
4—but
these are
early days for the PCT/Gs.
We recommend that HAs and PCT/Gs with a large black and ethnic minority
population in their territory should state specifically, in their annual
reports, their awareness of the major health issues for these populations.
They should identify the high-priority health needs and the actions being
taken to address inequalities, both of disease incidence and of access to
services. Explicit commitments of this sort will help promote confidence, in
these communities, that health inequalities are being taken seriously.
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REFERENCES
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-
Balarajan R. Ethnic Diversity in England and Wales: an
Analysis by Health Authorities Based on the 1991 Census. London:
NIESH, 1997
-
Department of Health. Saving Lives, our Healthier
Nation. London: Stationery Office, 1999
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Health Education Authority. Black and Ethnic Minority
Groups in England—Health and Lifestyles. Exeter: Wheatons,1994
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Holland WW. A dubious future for public health? J R Soc
Med 2002;95:182
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Memon M, Abbas F. Reducing health risks in ethnic minorities.
Nurs Times1999; 95:49
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Memon M, Abbas F, Singh I, Gupta R. Restricted access.
Health Serv J2001; 111:22
-4
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SUMMARY
INTRODUCTION
) and number taking action (
)