Ethnic And Cultural Diversity In Healthcare

6.12.05

Ethnic minority groups in the UK:
• 7.9% in 2001 (4.6 million in 58.8 million).
• Younger than white population - more than 25%.
• Have fewer older people - less than 20%.
• Concentrated in cities, except Chinese.
• Indian 28%, Pakistani 19%, Black Caribbean 15%, African 13%, Black other 12%, Bangladeshi 7%, Chinese 6 % (2001).

Ethnic minorities and health inequalities:
• Diverse ethnic minority groups include refugees, travellers and Irish people.
• Health issues vary with ethnic group - coronary heart disease, diabetes (Asian), hypertension/stroke (African, Caribbean).
• Poverty leads to poor health in Pakistanis and Bangladeshis (Fourth National Survey of Ethnic Minorities 1997).

Cardiovascular disease and BME (British minority ethnic) groups:
• Bangladeshi and Pakistani men 60-70% higher than general population.
• Pakistani, Bangladeshi and Black Caribbean women 33-45% higher rate.

Factors in South Asian coronary heart disease:
• Smoking - some BME men smoke more than white men, but Sikh men and most Asian women do not smoke.
• Alcohol - low, except Sikh men.
• Blood pressure - same as white.
• Serum cholesterol - same/lower.
• Insulin resistance in South Asians - body needs more insulin to cope with blood sugar, resulting in diabetes and low fibrinolysis.

Diabetes in BME groups 1999:
• Diabetes non-insulin dependent.
-Pakistani and Bangladeshi 5 or more times greater than white rate.
-African/Caribbean 2-4 times greater than white rate.
• Diabetic nephropathy, end-stage renal disease several-fold more.
• Deaths:
-South Asian 3.5 times more than white.

NHS PLAN 2000
Aim: improve health and reduce health inequalities by:
• Primary care trusts knowing health needs of local people.
• Access to information and health services.
• Entitlement to quality care with respect for privacy, dignity, religious and cultural beliefs.
• Little mention of ethnic health.

NHS race equality schemes (RESs):
• RESs required by Race Relations Amendment Act 2000.
• In the NHS, RESs not just to comply with the law.
• To improve services to black and ethnic minority groups.
• Decreased health inequality.

Delivering race equality in mental healthcare January 2005:
• More appropriate and responsive services.
• Community engagement.
• Better information.
• Minister's vision:
-Equality of access.
-Equality of experience.
-Equality of outcome.

General practitioners' views of ethnic minorities:
Issues…
• Mental health: highest priority.
• Frequent visits for minor but multiple problems.
• Substance abuse by young men.
• Problems of deprivation.

Solutions…
• Effective health education for BME patients on chronic disorders and lifestyle (diet, exercise).
• Bilingual workers for users who do not speak fluent English.

Princes Park Liverpool Survey 2000:
• 4581 patients: white 62%, BME 34%.
• Minority ethnic patients needed language interpreters.
• Women wanted female health professionals.
• Cigarette smoking high in Somali and Yemeni.
• Need for health team to know ethnic and cultural issues.

Ethnic healthcare: the way forward:
• Involve local groups in plans, delivery, audit and evaluation.
• Identify health needs and respond within resources.
• Train staff to be aware of ethnic diversity.
• Use ethnic group data in the NHS.
• Quality standards in healthcare.
• Feedback from ethnic users.

Health inequalities and ethnic minorities:
• Trained interpreters needed for some groups to improve access to services.
• NHS needs to be culturally sensitive.
• Today, NHS response patchy - depending on people ("champions") with local knowledge and networks.

Improving Ethnic Health 2004:
• Tackling health inequalities essential for improving ethnic health.
• Ethnic group, first language needs.

Healthcare commission audit 2004 measures for ethnic minority patients:
• Fair access and patient's choice.
• Effective delivery of appropriate healthcare.
• Patient/user experience.
• Health outcomes of NHS care.