Page last updated: Fri, 24 Jul 2009 17:31:10 GMT
Ethnic Health Intelligence 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.
Back to top ^^
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).
Back to top ^^
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.
Back to top ^^
Ethnic Health Intelligence Programme - Resources - Set 1
Back to top ^^
Ethnic Health Intelligence Programme - Resources - Set 2
| 23 Mar 2009 |
Mortality by ethnicity: technical report |
 |
 |
| 5 Mar 2009 |
Ethnicity and mortality in London: a discussion paper |
|
|
| 18 Jul 2006 |
Commissioning for equity. A briefing on ethnic inequalities in access to treatments for coronary heart disease in NHS hospitals in London |
|
|
| 13 Jul 2006 |
Analysing ethnic differentials in health, health care and the workforce: quick questions & answers |
|
|
| 13 Jul 2006 |
How to analyse ethnic differences in health, health care and the workforce: a toolkit for the NHS |
|
|
| 26 Jan 2006 |
Population estimates by ethnic group |
 |
|
| 30 Jul 2005 |
Using routine data to measure ethnic differentials in access to revascularisation in London |
|
|
| 3 Aug 2004 |
Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary |
|
|
| 3 Aug 2004 |
Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report |
|
|
| 15 Apr 2004 |
Health in London 2004: focus on ethnic minority groups |
|
|
| 15 Apr 2004 |
Health in London 2004: Focus on ethnic minority groups: Good and bad news |
 |
|
| 15 Apr 2004 |
Health in London 2004: Focus on ethnic minority groups: London borough facts |
|
|
| 15 Apr 2004 |
Health in London 2004: Focus on ethnic minority groups: summary |
|
|
| 2 Dec 2003 |
Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Cardiovascular disease (ICD 10 I*) |
 |
|
| 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) |
|
|
| 2 Dec 2003 |
Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Dysrhythmia (ICD-0144-149) |
|
|
| 2 Dec 2003 |
Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Heart failure (ICD-10 I50) |
|
|
| 2 Dec 2003 |
Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Hypertensive disease (ICD-10 I10) |
|
|
| 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) |
|
|
| 2 Dec 2003 |
Percentage of hospital admissions, London residents, 1997/98 to 2000/01 by ethnic group and sex: Stroke (ICD-10 I60 - I69) |
|
|
| 4 Oct 2003 |
Diversity counts. Ethnic health intelligence in London: the story so far |
|
|
Back to top ^^
Ethnic Health Intelligence Programme - Datasets - Set 1
Back to top ^^
Ethnic Health Intelligence Programme - Datasets - Set 2
Back to top ^^