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Page last updated: Fri, 24 Jul 2009 17:31:10 GMT

Ethnic Health Intelligence Overview

Overview

London is the most ethnically diverse city in the UK. Census 2001 population figures suggest that around 40% of Londoners belong to a black or minority ethnic group. The importance of health for Black and Minority ethnic populations in London has been identified as a key priority for the London Health Strategy and London Health Commission.

Why Ethnicity is important to the health of londoners

By nearly all measures of health, the health of the UK’s minority ethnic populations is poorer than that of the majority White British population.

  • In London, ethnic differences are particularly important. London is the most ethnically diverse region of the country, which gives organisations serving London’s population a responsibility to ensure that services address the needs of all its communities.
  • 40% of the population of London are from ethnic minority groups. Within London, the largest ethnic minority groups are Other White (8%), Indian (6%), Black African (5%) and Black Caribbean (5%).
  • In England and Wales in 2005, babies in the Asian and Black groups accounted for 11% of live births but 17% of infant deaths. Deaths in those aged less than a year are rare but are particularly high in the Pakistani and Caribbean groups. This difference is due to a combination of differences in the social and economic environment, lifestyle factors, access to services and genetic differences. This example of an ethnic inequity in health is typical of many.
Definitions

Ethnicity is a socially-constructed concept including elements of culture, place of birth and skin colour, and there is no adequate measure of it. For example, the experience of people in the same group may vary by generation, experience of migration or sub-group within the group.

Not recording ethnicity because it is difficult is not an option. It is important for organisations to be accountable in the way they deal with all communities, and that is only possible if we know about measures of health determinants, service use and health outcome by ethnic group.

Ethnicity was first measured in the 1991 census, and the measure was improved for the 2001 census. Categories are self-assigned. The 16 and 5 Ethnic Categories in the 2001 Census (England and Wales) are:

White British

White Irish

White Other*

Mixed White and Black Caribbean

Mixed White and Black African

Mixed White and Asian

Mixed Other*

Indian

Pakistani

Bangladeshi

Asian Other*

Black Caribbean

Black or Black British: African

Black African

Black Other*

Chinese

Other Ethnic Group*

Note* These were open response categories on the Census form.

The 2001 census categories are used by most public sector organisations. The more that organisations adopt the same measure, the easier it will be to track whether ethnic minorities are equitably served.

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Types of Inequality

Ethnicity is one factor on the spectrum of inequality. Some inequalities constitute inequity, that is, they are unfair and not accounted for by a difference in need.

Inequality can be found in:

  • the social and economic environment - factors such as jobs, housing, education and transport, sometimes called “wider determinants of health”
  • lifestyle and health behaviour - including diet, smoking and social networks
  • access to effective services - that result in health benefits

These factors combine to create inequalities in:

  • health outcomes - disease, disability or death

Genetic factors also make some contribution to ethnic health inequalities, for a few specific conditions such as diabetes and stroke.

In many measures of health and its determinants, the experience of some ethnic minority groups is unfavourable compared to that of the majority White British ethnic group. Even where inequalities in health status are not present, there is evidence of inequity in access to health care and preventive services. For example, there is little difference in cancer incidence between ethnic groups and yet there can be a poor experience of health services for some groups. Assessing equity of access to NHS stop smoking services for instance is made more difficult by lack of data on ethnicity of clients. For London to be able to tackle inequality between ethnic groups, there needs to be intelligence in all of these areas, and on the links between them.

Policies and Interventions

The Acheson Report on inequalities in health (1998) set the framework for health inequalities policy, and recommended that inequalities in health by ethnicity were best tackled through policies to address wider determinants of health, and that all policies should be assessed for their impact on minority ethnic groups.

Under the Race Relations (Amendment) Act 2002, public authorities including the NHS must assess how policies and programmes can affect ethnic minorities, and take remedial action where any potential for "adverse differential impact" on ethnic minority communities is identified. They have a general duty to promote race equality, and must be proactive in avoiding discrimination before it occurs. The most recent Department of Health response covering health and social care is the Department of Health Race Equality Scheme 2005-2008. Although all organisations should have their own schemes, the Healthcare Commission found that over 20% of trusts had not published a race equality scheme by 2007. In the delivery of services there is emphasis on mental health services (which have their own action plan) and screening and organ donation services. A review of PCT schemes by the Kings Fund (2007) found that policies were inadequate in number and content.

The Employment Equality (Religion or Belief) Regulations 2003 protect against discrimination on the grounds of religion and belief in employment, vocational training, promotion and working conditions.

The Equality Act 2006 establishes a single Commission for Equality and Human Rights that replaced the Commission for Racial Equality, the Equal Opportunities Commission and the Disability Rights Commission, to enforce equality legislation including that relating to race, religion or belief. It introduced a positive duty on public sector bodies to promote equality of opportunity and protect access discrimination on the grounds of religion or belief in terms of access to good facilities and services.

The government’s policy on inequalities in health, Tackling Health Inequalities: a Programme for Action (2003) and the accompanying guide to interventions Tackling Health Inequalities: What Works (2005) emphasise the need for local focus on minority ethnic groups in implementation of the strategy, and highlight the need to address ethnic inequity in infant mortality rates.

The policy for health and social care services in the community Our Health Our Care Our Say (2006) recognises the failings in existing community-based services in serving minority ethnic communities, and singles out a particular need to address the accessibility and delivery of child and adolescent mental health services (CAHMS).

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Health Inequalities: Resources, tools and data

General

London’s diversity

LHO holds datasets on the distribution of London’s population, and those of the boroughs, by ethnic minority and religion.

LHO is co-ordinating a campaign for recording ethnicity at birth and death registration, in order to address inequality by ethnicity more effectively. It has been working with organisations to fill numerous weaknesses in the data available for addressing ethnic inequity and inequality through the Ethnic Health Intelligence Programme.

Social and economic environment and lifestyle

  • LHO holds datasets on the distribution by ethnic minority and religion of determinants of health for the population of London and its boroughs.
  • The 2004 Health in London report focussed on how 10 headline indicators of health and health determinants affected London’s minority ethnic communities.
  • The Health of Ethnic Minority Elders in London(2000) reports on the lifestyle of London’s ethnic minority older people.
  • The last detailed survey of lifestyle and health behaviours was conducted for the 2004 Health Survey for England.

Services

There is particular inequity in the provision of mental health services for adolescents and adults by ethnicity, and a London Health Observatory report, Equal Access, Equal Care addresses this issue. LHO also hosts resources on inequalities and mental health.

The LHO has developed a toolkit to support NHS organisations in analysis of ethnic differences in health.

Routine information on several services where inequity by ethnicity has been found is weak, including:

  • uptake of screening and immunisation programmes
  • hospital treatment, where the recording of Hospital Episode Statistics (HES) by ethnicity is incomplete but improving. Ethnicity recording within HES would help NHS organisations comply with the duty under the Race Relations (Amendment) Act 2002 to be aware of and take remedial action on adverse differential. The LHO is working with other organisations to improve ethnicity coding.
  • service outcomes. A briefing in the LHO’s commissioning for equity series focuses on ethnic inequalities in access to specialist treatments for coronary heart disease in NHS hospitals in London, and is one of few pieces of work addressing this area.

Information on different level of need by ethnicity is needed to plan services. Some are collected for the LHO’s Ethnic Health Intelligence Programme.

Health outcomes

  • LHO holds datasets on the distribution by ethnic minority and religion of limiting long-term illness and general health for the population of London and its boroughs.
  • LHO is co-ordinating a campaign for recording ethnicity at birth and death registration, in order to address inequality by ethnicity more effectively.
  • Improvements are needed in the routinely available data on health outcomes by ethnicity.

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References
Resources

Ethnic Health Intelligence Programme - Resources - Set 1
Date Title Format
10 Mar 2006 Ethnic inequalities in men's health Icon representing a ppt filetype Download resource icon
13 Jan 2006 Presentation: Indications of public health in the English regions. ethnicity and health Icon representing a ppt filetype Download resource icon
25 Oct 2005 Indications of public health in English regions: press release Icon representing a doc filetype Download resource icon
25 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Executive summary Icon representing a pdf filetype Download resource icon
25 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Full report Icon representing a pdf filetype Download resource icon
25 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Indicator data tables. Icon representing a xls filetype Download resource icon
25 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Key findings for London Icon representing a doc filetype Download resource icon
24 Oct 2005 Ethnicity and health indications report: press release Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 1 Introduction and Ethnicity monitoring, how good is it? Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 2a. Determinants of health indicators - demography, socio-economic status and economic activity. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 2b. Determinants of health indicators: education. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 3a. Population health status indicators: mortality. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 3b. Population health status indicators: ill health. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 4a. Public health priority intervention indicators: smoking cessation. Technical Report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 5a. Effectiveness of partnership indicators: drug misuse. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 5b. Effectiveness of partnership indicators: HIV/AIDS and gonorrhoea. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 5c. Effectiveness of partnership indicators: tuberculosis. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 5d. Effectiveness of partnership indicators: children in need. Technical report Icon representing a doc filetype Download resource icon
24 Oct 2005 Indications of public health in the English regions 4: ethnicity and health. Chapter 6. Patient experience and workforce indicators. Technical report Icon representing a doc filetype Download resource icon

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Ethnic Health Intelligence Programme - Resources - Set 2
Date Title Format
23 Mar 2009 Mortality by ethnicity: technical report Icon representing a pdf filetype Download resource icon
5 Mar 2009 Ethnicity and mortality in London: a discussion paper Icon representing a pdf filetype Download resource icon
18 Jul 2006 Commissioning for equity. A briefing on ethnic inequalities in access to treatments for coronary heart disease in NHS hospitals in London Icon representing a pdf filetype Download resource icon
13 Jul 2006 Analysing ethnic differentials in health, health care and the workforce: quick questions & answers Icon representing a pdf filetype Download resource icon
13 Jul 2006 How to analyse ethnic differences in health, health care and the workforce: a toolkit for the NHS Icon representing a pdf filetype Download resource icon
30 Jul 2005 Using routine data to measure ethnic differentials in access to revascularisation in London Icon representing a pdf filetype Download resource icon
3 Aug 2004 Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary Icon representing a pdf filetype Download resource icon
3 Aug 2004 Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report Icon representing a pdf filetype Download resource icon
15 Apr 2004 Health in London 2004: focus on ethnic minority groups Icon representing a pdf filetype Download resource icon
15 Apr 2004 Health in London 2004: Focus on ethnic minority groups: Good and bad news Icon representing a doc filetype Download resource icon
15 Apr 2004 Health in London 2004: Focus on ethnic minority groups: London borough facts Icon representing a doc filetype Download resource icon
15 Apr 2004 Health in London 2004: Focus on ethnic minority groups: summary Icon representing a doc filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Cardiovascular disease (ICD 10 I*) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Coronary heart disease (ICD-10 I20-I25) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Dysrhythmia (ICD-0144-149) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Heart failure (ICD-10 I50) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Hypertensive disease (ICD-10 I10) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Myocardial infarction (ICD-10 I21 - I25) Icon representing a xls filetype Download resource icon
2 Dec 2003 Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Stroke (ICD-10 I60 - I69) Icon representing a xls filetype Download resource icon
4 Oct 2003 Diversity counts. Ethnic health intelligence in London: the story so far Icon representing a pdf filetype Download resource icon

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Ethnic Health Intelligence Programme - Datasets - Set 1

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Ethnic Health Intelligence Programme - Datasets - Set 2

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