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What we know
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| What we know | |||||||||||||||||||||
People from black and ethnic minority groups have a high probability of experiencing particularly acute forms of disadvantage which exacerbate health inequalities. This may be due to policies which have often excluded people from these groups from access to welfare, employment patterns which have marginalised black and ethic minority groups into low-paid manual work, direct and indirect discrimination and the broader experience of racism in society. Unfortunately, illustrating how disadvantages experienced by minority ethnic groups feed through to poor health is not a simple matter because most of the research evidence to date has focussed on country of birth rather than ethnic identity. Recent studies show raised mortality and morbidity rates among ethnic minority groups compared to the majority white population. These indicators of poorer health status can be explained by racism and discrimination as well as by the conventional measures of socioeconomic circumstances (Benzeval et al, 1995). In the last few years a substantial amount of research including reports and surveys has been undertaken examining the needs and experiences of people from black and ethnic minority groups in Northern Ireland. This highlights how these needs often differ from those of the indigenous population. Several literature reviews have been undertaken on the subject (Connolly 2002, Bunting 2001). Key messages include difficulties accessing existing services by those who speak little or no English (that is, a language barrier) and a general lack of awareness amongst black and minority ethnic groups as to what services are available. |
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| What information do we have about the Eastern Board area? | |||||||||||||||||||||
The 2001 Northern Ireland Census was the first time that official regional information was collected on the size and composition of Northern Ireland's Black and Minority Ethnic (BME) Communities. Census figures provide a useful basis for assessment of health and social care needs of local populations. "Low participation rates however raised significant concerns regarding the accuracy of the figures". (NICEM 2004). Prior to the 2001 Census it was estimated by Northern Ireland Council for Ethnic Minorities (NICEM) and Multi Cultural Resource Centre (MCRC) that the population of BME groups was approximately 20,000 or 1.3% of the population, with the highest proportion living in the EHSSB's area. The official 2001 Census figures suggest 0.85% of the population identify with a minority ethnic background embracing eleven or more ethnic categories and comprising 14,272 individuals. This number will have changed with the increase in Eastern Europeans living within Northern Ireland. The key point in respect of cultural diversity is that BME Communities are not homogeneous. Rather they are diverse socially, culturally and in terms of religion or faith. While almost half of the population recorded in the Census were born in Northern Ireland with long histories here, over half were born outside the Province. This pattern was noted in previous discussions by Mason (1998) who suggested that there is "likely to be a sustained population growth in the black and minority population in Northern Ireland for the foreseeable future". The Chinese Community is the largest BME group. The Irish Traveller Community and Indian (Hindu and Sikh) have long histories in the Province. More recent arrivals are African and Muslim Communities. In addition, new and emerging communities such as the Latin American Community or smaller communities such as Filipino, Bangladeshi and Sikh communities have very specific health and social care needs. According to DHSS&PS and Equality Commission's A Good Practice Guide (2003) "it has traditionally been impossible for these groups to request specific services because of their size". Numbers it is suggested should not be the only determinant of "priorities as health authorities have a responsibility to meet the needs of the most vulnerable and disadvantaged, which often include people from marginalised black and minority ethnic groups". In demographic terms the population is younger than amongst the white ethnic majority, but it needs to be acknowledged that there is an increasing number of BME people who are over the age of 65. |
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| What is the result of this on our health locally? | |||||||||||||||||||||
| Ethnicity is acknowledged as a major determinant of longevity and wellbeing. The differing health status and disease patterns among BME groups are very marked in some areas. Data however on the incidences of various diseases among BME groups is limited. In the absence of ethnic monitoring in hospital admissions, outpatients, community services or screening services it is necessary to draw upon evidence from England and Wales (Rawaf and Bahl1998). This evidence includes the following:
According to Diabetes UK the prevalence of diabetes is around 2.4% in Caucasians but in some black and minority ethnic groups it can be as much as 3-5 times higher for Type 2 diabetes. The reasons for the increased prevalence are not fully known, however, it is suspected that several factors could play a role including genetic differences in how the body processes and stores fat; different levels of inactivity and physical fitness; social deprivation and a lack of educations and/or employment. Several barriers prevent black and minority ethnic people from access to some health services. These barriers include language, poor knowledge of services, difficulties with transport and cultural differences in regards to the willingness to seek medical help. The most vulnerable groups are hard to target with lifestyle interventions, as they may speak little English, are relatively isolated from mainstream society and have variable knowledge and motivation to use conventional servies. There are distinct disadvantages faced by Travellers, in particular, in relation to accessing health and social services. Low levels of literacy make GP registration and other form filling difficult. The nomadic lifestyle of Travellers has implications for registering with GPs, the issuing of hospital appointment letters and the maintenance of patient health records. Continuity of care is also problematic as Travellers may often see more than one GP in the course of a year. |
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| Policies | |||||||||||||||||||||
| The DHSS&PS and Equality Commission's Good Practice Guide (2003) indicates a number of reasons why the issue of racial equality should be addressed. These include:
For health and social care providers in particular there are a number of specific legal and policy issues to be addressed. Local and regional health strategies include the New Targeting Social Need (TSN) initiative. New TSN specifies that: 'Some groups have additional needs which, if not catered for, could place their most vulnerable members at risk due to social exclusion. Examples of such group ...are Travellers and members of other ethnic minority communities'. Promoting Social Inclusion is a specific initiative within the Government's policy of New TSN that aims to bring different government departments, agencies and voluntary organisations together to examine the problems facing particular groups and to make recommendations as to how these problems can most effectively be addressed. The Programme for Government 2001-2002 identified 'Working for a Healthier People' as one of its five priorities with a focus on, among other issues, reducing health inequalities. In its Priorities for Action guidelines, the DHSS&PS recognised the need to promote equality of opportunity and also its obligation to promote good relations between people of different religious beliefs, political opinion and racial groups. DHSSPS's Public Health Strategy 'Investing For Health' seeks to improve health while reducing health inequalities. Our Future Health - A Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025 calls for greater engagement of and greater response to the needs of marginalised groups including "Travellers and people from ethnic minorities". Race Equality in Health and Social Care Good Practice Guide DHSS&PS and Equality Commission NI (2003) required all Boards and Trusts to develop Baseline Audits and Action Plans by December 2003. These Action Plans are monitored by the DHSS&PS. The Race Relations (NI) Order 1997 placed a legal imperative on health service agencies to address the needs of their BME groups. The Order makes it unlawful to discriminate against anyone on racial grounds. This includes the groups belonging to the Irish Traveller community. The Northern Ireland Act 1998 - Section 75 of the Act requires public authorities in carrying out their functions relating to Northern Ireland, to have due regard to the need to promote equality of opportunity between persons of different racial groups and regard to the desirability of promoting good relations between persons of different racial groups. The Children (NI) Order 1996 requires Boards and Trusts to take account of the different racial groups and places an obligation on childcare agencies to consider the child's religious persuasion, racial origin and cultural and linguistic background in their dealings with families. The European Race Directive implementing the principles of equal treatment of people irrespective of racial or ethnic origin came into force in the UK in July 2003. The scope of the Race Directive includes the provision of, and access to, goods and services, including health and social care. EHSSB - Promoting Race Equality Policy adopted in 2000 had the objective of maximising our understanding of the diverse needs and aspirations of black and minority ethnic committees and individuals. This was in recognition of the distinct culture of each community and "the contribution that each makes in building a multi-cultural and multi-ethnic society. In the policy statement the Board commits itself to working towards the elimination of racism whether overt, covert or by omission" ensuring that individuals and communities have equal access to health and social care. Five areas for monitoring are identified:
The EHSSB's Contract Monitoring ensures that each area is pro-actively monitored and progress by all health and social services examined. Engagement of people from BME communities makes this monitoring more effective. |
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| What is happening in the Eastern Board area? | |||||||||||||||||||||
Section 75 requires public bodies to promote equality of opportunity and good relations across nine protected groups. These include, racial groups, gender, age, marital status, those with and without dependants, and those with and without a disability, religious belief, political opinion and sexual orientation. The Working with Diversity website was designed primarily for use by Health and Social Services staff to increase their understanding, awareness and knowledge of the needs of those covered by the legislation. It was developed and quality assured in partnership with local and national voluntary and community organisations. The quality and comprehensive nature of the website's content will significantly boost the confidence of staff in dealing with a diverse population. The accessibility of the website and the arrangements in place for its maintenance means that it contrasts with previous out of date, paper based, disparate information systems. The website was formally launched on 4 June 2004. Northern Ireland Interpreting Project A major initiative within health and social services to provide an interpreting service for people who do not speak English as a first or competent second language. The pilot service went live in June 2004. Work on developing an Equality and Human Rights Strategy and Action Plan is being developed by the Department for Health, Social Services and Public Safety. Work on developing the strategy and action plan started in September 2004. The first stage of the strategy development process involved an audit of equality issues. A key element of this was a major literature review which explored the inequities and barriers to accessing health and social services experienced by each of the nine Section 75 dimensions and identified subsequent recommendations for action. The findings of the literature review can be viewed here. |
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References Bunting, V (2001); Equality of Opportunity in Relation to the DHSSPS Draft Equality Scheme; Belfast: DHSSPS Connolly, P (2002); Race and Racism in Northern Ireland: A Review of the Research Evidence; Belfast: OFMDFM Delivering on Equality, Valuing Diversity (2004); Northern Ireland Council for Ethnic Minorities Diabetes UK (2001); Information: Increased prevalence of diabetes mellitus in black and minority ethnic groups; www.diabetes.org.uk/infocentre/inform/ethnic.htm DHSSPS (2004); Equality and Inequalities in Health and Social Care in Northern Ireland. Mason, C in Hainsworth, P (ed) (1998); Divided Society: Ethnic minorities and Racism in Northern Ireland; London: Pluto Press Race Equality in Health and Social Care. A Good Practice Guide (2003); Belfast: Equality Commission for Northern Ireland & DHSSPS Rawaf, S and Bahl, V (1998); Assessing health needs of people from minority ethnic groups; London: Royal College of Physicians For further information on this topic please contact us at publichealth@ehssb.n-i.nhs.uk
Eastern Health and Social Services Board Champion
House, 12-22 Linenhall Street, Belfast BT2 8BS Telephone: (028)
9032 1313 Fax: (028) 9055 3681 Text Phone:(028) 9032 4980 Website:
www.ehssb.org
E-mail: pr@ehssb.n-i.nhs.uk |
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