ETHNICITY AND HEALTH - GUIDANCE FOR PURCHASERS

Ethnicity and health: reviews of literature and guidance for purchasers in the areas of cardiovascular disease, mental health and haemoglobinopathies

Background

The aim of this project was to bring together summaries of research relevant to the provision and organisation of health care for ethnic minorities in Britain. The authors were asked to concentrate on the key areas of knowledge from both primary research and rigorous reviews, which would be of practical significance to the NHS. They were asked to draw out significant implications of this work in terms of access, treatment, prevention, targeting and health service organisation.

The aim was to provide research based information and recommendations that could be implemented by the NHS as a whole. The three areas of focus were cardiovascular disease, mental health, and haemoglobinopathies. Reviews were commissioned from experts in these three areas.

Findings

Despite the considerable research activity in the area of ethnicity and health, purchasers and providers in health care lack clear guidance on health care needs and service organization. The uncritical approach to 'race', 'ethnicity', and 'culture' in epidemiological studies leads to confusion and misinformation. The use of these categories as independent variables underplays the significance of socioeconomic conditions and health service related factors. As the three reviews make clear, care must be taken not to assume that differences between ethnic groups are somehow natural or inevitable and the result of cultural practices that therefore need to be changed. The literature suggests that although cultural, genetic and social factors are important in certain diseases, access to appropriate health services can appreciably relieve this burden of disease. However, Britain's ethnic minority populations are to be found principally in the poorer regions, and inner cities, where health services are least well developed. They may also be among the least able to take advantage of the existing services because of a variety of barriers to access, ranging from language and culture, to prejudiced views of service purchasers and providers, and discriminatory institutional practices.

It will also be clear from these reviews that the research effort is heavily skewed towards the Asian and Afro-Caribbean populations. Purchasers (and providers) will need to take into account the additional psychological and socioeconomic burdens faced by certain refugee populations (e.g. the Vietnamese), as well as the issues facing numerically large but widely dispersed minority populations (such as the Chinese), and the long established but numerically small groups (such as the Somalis and certain Middle-Eastern-origin populations). A rather different issue concerns the populations of Bangladeshi origin who, in terms of research, are often subsumed under the rubric 'Asian'. Equally neglected are the various 'white' minority groups - most notably the Irish - who also experience racism and have considerably higher prevalence than the general population of coronary heart disease and mental illness. Partly as a consequence of the skewed available literature, these reviews pay relatively little attention to these neglected communities.

Conducted by: Waqar Ahmad1, Trevor Sheldon2, Ossie Stuart1

1. Social Policy Research Unit, University of York; 2. NHS Centre for Reviews and Dissemination

Publications

NHS Centre for Reviews and Dissemination. Ethnicity and health: reviews of literature and guidance for purchasers in the areas of cardiovascular disease, mental health and haemoglobinopathies. CRD Report 5. York: University of York. 1996

Funding

Commissioned by the R&D Directorate of the NHS Executive West Midlands