1. South West Public Health Observatory Ethnicity & health – “Realities & Rationales” Alice Walsh alice.walsh@swpho.nhs.uk

2. South West Public Health Observatory Overview The SWPHO Association of Public Health Observatories (APHO) report –some of the findings What more needs to be done to understand ethnic health inequalities? Action points

3. South West Public Health Observatory Part of a network of nine public health observatories, one in each region. Created in 2005 as a result of a merger between: –Public Health Information Team (PHIT) –South West Cancer Intelligence Service (SWCIS) Incorporating: –Drug treatment monitoring system for the South West (NDTMS)

4. South West Public Health Observatory What we aim to do Make it easier to access data about public health in the region Provide support and help to people wanting to use such information in appropriate ways Provide analysis in order to improve our understanding of health and the factors which influence health in the region.

5. http://www.swpho.nhs.uk/

7. South West Public Health Observatory Ethnicity and health Indications of Public Health in the English Regions Association of Public Health Observatorys APHO report: www.lho.org.uk

8. South West Public Health Observatory Why is this topic important? Myths around health inequalities The Race Relation Amendment Act 2001 Importance of involving people in decisions that affect them. Need for evidence to help inform debate Policy makers need to understand what it is about belonging to an ethnic minority group that makes it good or bad for health.

9. South West Public Health Observatory Report contents: Includes indicators of: Ethnic monitoring – how good is it? Distribution ethnic minority groups across the regions The determinants of health (or causes of ill health) Health status Public health interventions Effectiveness of partnership Patient experience and workforce

10. Ethnicity monitoring: the cycle of invisibility Invisible ethnic inequalities Data not collected e.g. vital statistics Data collected /analysed but doesn’t fully reflect the diversity of ethnic minorities e.g. most data Data collected but not analysed or used e.g. most data Data analysed but needs more research e.g. most data Some data collected – but unhelpful/outdated e.g. country of birth Data collected but incomplete e.g. HES

11. South West Public Health Observatory Transition from old to new ethnic groups 2001 Census Ethnic Groups White (British, Irish*, Other White background) Mixed (White and Black Caribbean, White and Black African, White and Asian, Other Mixed background) Asian or Asian British (Indian, Pakistani, Bangladeshi, Other Asian background) Black or Black British (Caribbean, African, Other Black background) Chinese or Other Ethnic Group (Chinese, Other ethnic group) 1991 Census Ethnic Groups White Black Caribbean Black African Black Other Indian Pakistani Bangladeshi Chinese Other Asian Other

12. South West Public Health Observatory Ethnicity data: (% incomplete) by region Data sourceEngSWLondon Free primary school meals (2004) 2.32.91.6 Free secondary school meals (2004) 3.44.82.5 Hospital admissions (2002/03) 36.042.034.0 Drug treatment (2003/04) 15.622.99.5 AIDS/HIV (2003) 3.00.54.0 TB surveillance (2000/02) 6.61.55.0 Children in need (February 2003) 8.0 Non-medical workforce (Sept. 2004) 11.79.016.8 Medical workforce (Sept 2004) 2.02.51.9

13. South West Public Health Observatory Ethnicity monitoring Incompleteness of data varies across data sets There is no relationship between density of the ethnic population and completeness of ethnic coding The fact that different classifications of ethnic minority populations are still being used presents barriers to analysis which are now unacceptable.

14. South West Public Health Observatory Demography: Population from an ethnic minority group by region 2001 Source: 2001 Census

15. South West Public Health Observatory Percentage of South West population from “White British” and Ethnic minority groups

16. South West Public Health Observatory Demography: Distribution of ethnic groups across the South West What are the next two largest ethnic groups in the South West? - “Other white” (1.6%) & “Irish White” (0.6%)

17. South West Public Health Observatory Composition of ethnic minority populations in South West Region (Total = 4.6%)

18. South West Public Health Observatory Health Status indicators Mortality Self assessed health

19. The influences on health: Dahlgren & Whitehead 1991

20. Health Status: Mortality by country of birth, England & Wales 1999- 2003

21. South West Public Health Observatory Health status: Standardised “Not Good” Health ratios by region Source: 2001 Census

22. Health status: Standardised “Not Good” Health ratios for South West Source: Census 2001

23. South West Public Health Observatory Determinants of health Indicators The National Statistics Socio-Economic Classification (NS-SEC) Eligibility for free school meals Educational attainment

24. South West Public Health Observatory The National Statistics Socio-economic Classification (NS-SEC) 1. Managerial & Professional Occupations (e.g.: lawyer, doctor, senior manager) 2. Intermediate occupations (e.g.: junior managers, secretaries, small non-professional employers) 3. Routine & manual occupations (e.g.: cleaner, waitress, labourer, driver) 4. Long term unemployed 5. Never worked 6. Not classified (inadequately described occupations / not stated) 7. Full time students

25. Percentage of population within NS-SEC group 1, 2 & 3 in South West by ethnic group (2001) Source ONS data

26. Percentage of population within other NS-SEC categories in South West by ethnic group (2001)

27. Percentage of children in Primary & Secondary Schools eligible for free school meals in the South West by ethnic group 2004 Source: DfES

28. Determinants of health: % South West children achieving 5 GSCE s A*-C, 2003 N.B: For “White Irish”, “White & Black African” & “Asian other” = data suppressed due to small numbers Source: DfES

29. South West Public Health Observatory Priority Public Health Intervention Indicators Smoking cessation Coronary heart disease (CHD) admissions Coronary revascularisation procedures Diabetes admissions Cataract procedures

30. Number of people setting a quit date per 1000 smokers by ethnic group & gender England 2002-03 & 2003-04 Source: smoking cessation data, GHS & 2001 Census

31. Proportional ratios for coronary heart disease admissions - Indian Source: Hospital Episode Statistics

32. Proportional ratio for Revascularisation – Indian Source: Hospital Episode Statistics

33. South West Public Health Observatory Effectiveness of partnership indicators Children in need Drug misuse HIV / AIDS Gonorrhoea Tuberculosis

34. All children in need per 100,00 population aged 0-19 by ethnic group & region 2003 Source DfES Children in need Census, ONS 2001 Census

35. South West children in need per 100,00 population aged 0-19 by ethnic group 2003 Source DfES Children in need Census, ONS 2001 Census

36. Effectiveness of partnerships: Number of people in drug treatment per 1000 population aged 15-44 by ethnic group 2003/04 Source NDTMS and ONS census 2001

37. South West Public Health Observatory Patient experience / workforce surveys

38. South West Public Health Observatory Patient experience Main findings: Nationally: The Asian ethnic group has the worst experience across all regions All ethnic groups generally have a poor experience in London (except the mixed group) and a better experience in Midlands and the North.

39. South West Public Health Observatory NHS workforce compared to general population by region, Sept 2004 Source: NHS workforce survey Sept 2004 & ONS Census 2001

40. Hospital Medical Staff by ethnicity & grade September 2004 Source: Medical workforce survey

41. South West Public Health Observatory What more needs to be done to understand ethnic health inequalities? 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. 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.

42. South West Public Health Observatory Action points Identify community assets as well as community needs Build partnerships and encourage participation Ensure political commitment to tackle ethnic health inequalities Evidence based health promotion practices – focus on poverty, disempowerment & discrimination rather than on changing individual behaviours Ensure local service providers are aware of the demography & diversity of the populations they serve Ensure service providers have monitorable standards in terms of ethnic minority access to high quality health care Issues of rurality in SW mean that innovative models of service delivery need to be considered