1. Ethnic inequalities in men’s health in London Justine Fitzpatrick London Health Observatory Making men’s health matter, 9 th March 2006

2. The role of the Public Health Observatories To work in partnership with researchers, regional and local health policymakers and practitioners To work in partnership with researchers, regional and local health policymakers and practitioners To monitor trends in health and its determinants To monitor trends in health and its determinants Highlight future health problems Highlight future health problems Assess the health impact of potential and past policies Assess the health impact of potential and past policies Draw together information from different sources and to identify gaps in information Draw together information from different sources and to identify gaps in information Adapted from “Saving Lives - Our Healthier Nation”

3. Presentation contents Size of the population of ethnic minority groups in London Size of the population of ethnic minority groups in London Ethnic differentials in: Ethnic differentials in: Determinants of health e.g. socio-economic status and educationDeterminants of health e.g. socio-economic status and education Health status e.g. mortality, self assessed health, TB, HIV, sexual healthHealth status e.g. mortality, self assessed health, TB, HIV, sexual health Priority public health interventions e.g. smoking cessation and hospital admissions for proceduresPriority public health interventions e.g. smoking cessation and hospital admissions for procedures What are our gaps in knowledge and what more needs to be done? What are our gaps in knowledge and what more needs to be done?

4. Demographics and health determinants - Questions What % of London’s population are from an ethnic minority group? What % of London’s population are from an ethnic minority group? What are the largest 3 ethnic groups in London (excluding white British)? What are the largest 3 ethnic groups in London (excluding white British)? Boys from which ethnic group have the highest education attainment in London? Boys from which ethnic group have the highest education attainment in London? Men from which ethnic group are most likely to be employed in professional occupations in London? Men from which ethnic group are most likely to be employed in professional occupations in London? White British White British White Irish White Irish White Other White Other Mixed: White & Black Caribbean Mixed: White & Black Caribbean Mixed: White & Black African Mixed: White & Black African Mixed: White & Asian Mixed: White & Asian Mixed Other Mixed Other Indian Indian Pakistani Pakistani Bangladeshi Bangladeshi Asian Other Asian Other Black Caribbean Black Caribbean Black African Black African Black Other Black Other Chinese Chinese Other Other

5. Number of people in each ethnic group, London 2001 Source: 2001 Census

6. Percentage of working age men in professional occupations, London 2001 Source: 2001 Census

7. Percentage achieving 5 GCSEs A*-C, boys London 2004 Source: DfES

8. Summary – health determinants 40% of London’s population are from an ethnic minority group. 40% of London’s population are from an ethnic minority group. The largest ethnic minority groups in London are White Other 8%, Indian 6%, Black Caribbean and Black African 5%. The largest ethnic minority groups in London are White Other 8%, Indian 6%, Black Caribbean and Black African 5%. The White Other ethnic group has the largest proportion of men in professional occupations and the Bangladeshi group the smallest. The White Other ethnic group has the largest proportion of men in professional occupations and the Bangladeshi group the smallest. Chinese boys have the highest GCSE achievement and Black Caribbean boys the smallest. Chinese boys have the highest GCSE achievement and Black Caribbean boys the smallest.

9. Health Status - Questions Men from which ethnic group are most likely to say their health is ‘not good’? Men from which ethnic group are most likely to say their health is ‘not good’? Men from which ethnic group have the highest Men from which ethnic group have the highest Number of people in contact with drug treatment rates?Number of people in contact with drug treatment rates? Number of people seen for HIV care?Number of people seen for HIV care? New cases of tuberculosis?New cases of tuberculosis? White British White British White Irish White Irish White Other White Other Mixed: White & Black Caribbean Mixed: White & Black Caribbean Mixed: White & Black African Mixed: White & Black African Mixed: White & Asian Mixed: White & Asian Mixed Other Mixed Other Indian Indian Pakistani Pakistani Bangladeshi Bangladeshi Asian Other Asian Other Black Caribbean Black Caribbean Black African Black African Black Other Black Other Chinese Chinese Other Other

10. Age-standardised ‘not good’ health ratios, men London 2001 Source: 2001 Census

11. HIV patients seen for care by ethnic group, London 2004 (70% men) Source: SOPHID

12. HIV patients seen for care, rate per 100,000 resident population, London 2004 (70% men) Source: SOPHID

13. New cases of tuberculosis, London 2000-02 (approx 50% men) Source: Enhanced TB surveillance, HPA

14. Number in contact with drug misuse treatment services, rate per 100,000 resident population, men London 2004/05 Source: NDTMS

15. Gonorrhoea case reports by ethnic group, men England 2004 Source: GRASP Heterosexual malesMen who have sex with men

16. Age-standardised mortality ratios by country of birth, men in England & Wales 1999-2003 Source: ONS death registration data and 2001 Census

17. Age-standardised mortality ratios by country of birth, men in England & Wales 1999-2003 Source: ONS death registration data and 2001 Census

18. Summary – health status Within E&W, men born in Ireland and Scotland have the highest death rates. Within E&W, men born in Ireland and Scotland have the highest death rates. However men born in Pakistan and Bangladesh have the highest cardiovascular disease death rates. However men born in Pakistan and Bangladesh have the highest cardiovascular disease death rates. Bangladeshi men have the poorest self assessed health status and Chinese men the best. Bangladeshi men have the poorest self assessed health status and Chinese men the best. Men from the mixed ethnic group have the highest drug treatment rates Men from the mixed ethnic group have the highest drug treatment rates Men from the Black African group have the highest HIV treatment rates Men from the Black African group have the highest HIV treatment rates Men from the Black African and the other ethnic group have the highest TB notification rates Men from the Black African and the other ethnic group have the highest TB notification rates Black Caribbean men account for a disproportionately large proportion of gonorrhoea cases among heterosexual men. Black Caribbean men account for a disproportionately large proportion of gonorrhoea cases among heterosexual men.

19. Health interventions - Questions Men in which ethnic group are most likely to attend smoking cessation services and set a quit date? Men in which ethnic group are most likely to attend smoking cessation services and set a quit date? Men in which ethnic group have the highest admission rates for Coronary Heart Disease? Men in which ethnic group have the highest admission rates for Coronary Heart Disease? White British White British White Irish White Irish White Other White Other Mixed: White & Black Caribbean Mixed: White & Black Caribbean Mixed: White & Black African Mixed: White & Black African Mixed: White & Asian Mixed: White & Asian Mixed Other Mixed Other Indian Indian Pakistani Pakistani Bangladeshi Bangladeshi Asian Other Asian Other Black Caribbean Black Caribbean Black African Black African Black Other Black Other Chinese Chinese Other Other

20. Rate of people setting a quit date per 1000 smokers by ethnic group, England 2002-04 Source: GHS and smoking cessation data

21. Standardised ratios for CHD admission, London 2003/04 Source: Hospital episode statistics

22. Standardised ratios for revascularisation admissions, adjusted for CHD prevalence, London 2003/04 Source: Hospital episode statistics

23. Summary – health interventions The white and other ethnic groups are more likely to set a quit date than other ethnic groups with men being less likely than women. The white and other ethnic groups are more likely to set a quit date than other ethnic groups with men being less likely than women. Among men the Black ethnic group are least likely to set a quit date. Among men the Black ethnic group are least likely to set a quit date. The Mixed White & Asian, Pakistani and Bangladeshi groups are most likely to be admitted for CHD. The Mixed White & Asian, Pakistani and Bangladeshi groups are most likely to be admitted for CHD. Adjusting for CHD prevalence the Bangladeshi group have lower access to revascularisation procedures than other ethnic groups. Adjusting for CHD prevalence the Bangladeshi group have lower access to revascularisation procedures than other ethnic groups.

24. What more needs to be done to understand ethnic inequalities in health? Analysis is restricted to those data sources where ethnicity is recorded e.g. little information on mental health, primary care, death registration. Analysis is restricted to those data sources where ethnicity is recorded e.g. little information on mental health, primary care, death registration. Where data are collected, analysis and interpretation are hampered by poor coding. Where data are collected, analysis and interpretation are hampered by poor coding. Health inequalities by ethnic group are complex and more needs to be done to understand the reasons. Health inequalities by ethnic group are complex and more needs to be done to understand the reasons. More work needs to be done to understand the contribution of deprivation/poverty to ethnic differentials in health. More work needs to be done to understand the contribution of deprivation/poverty to ethnic differentials in health.