Race equality impact assessment
Statistics: Health care services
Research shows that ethnic minority groups generally have poorer health, lack access to some form of health provision, and have lower levels of satisfaction with health provision.
The findings here are drawn from the 1999 Health Survey for England, the 2001 census, the 1999 Ethnic minority Psychiatric Illness Rates in the Community (EMPIRIC) report, NHS Patients Surveys undertaken in 1998 and 2000, and other studies.
Scotland: Analysis of ethnicity in the 2001 Census:
Key points about health and ethnicity
General
- The incidence of coronary heart disease and diabetes is higher than average in ethnic minority groups.
- Asians are more likely than others to have worse reported health and also have long-term illness or disability that restricts daily activities.
- The recent Ethnic Minorities and Mental Health report highlighted ethnic differentials in the incidence of common mental disorders, physical health, use of services and social and support networks.
- The National Survey of NHS Patients, a series of surveys carried out between 1998 and 2002 and more recent surveys carried out locally by NHS trusts under the auspices of Commission for Health Improvement show that, generally, people from ethnic minorities have lower levels of satisfaction with health services.
In more detail
The 1999 Health Survey for England found that:
- Pakistani and Bangladeshi people generally reported having worse health than the general population.
- Asians and Black Caribbeans were more likely to suffer from diabetes than the general population.
- Pakistani and Bangladeshi men had higher rates of cardiovascular disease.
- In all ethnic minority groups except the Irish, people were less likely to drink alcohol, or consumed smaller amounts, than in the general population.
- Bangladeshi and Irish men were more likely than the general population to smoke, and both Bangladeshi men and women were more likely to chew tobacco than other Asian groups.
- Rates of hospital attendance were the same for all ethnic minority groups in comparison to the general population, with the exception of Chinese men and women who had lower rates of inpatient, outpatient and day patient attendance rates.
The 1999 Ethnic Minority Psychiatric Illness Rates In the Community (EMPIRIC) survey found that:
- Pakistani and Bangladeshi women had higher rates of common mental disorders, such as anxiety and depression, than the white group.
- Pakistani and Bangladeshi people were more likely to have worse ‘social functioning’, and higher levels of chronic strain, than the general population. The findings suggest, though, that this may be related to socio-economic factors.
- Asian men, and Pakistani and Bangladeshi women were the most likely to have spoken to a doctor within the last six months
Data from recent surveys of NHS patients in 1998 and 2000 show that:
- People from ethnic minority groups are significantly more likely than average to report unfavourably on their experiences of health services.
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Self-reported health
The 1999 Health Survey for England, whose results have been standardised to take account of age differentials between different ethnic groups, found that:
- Pakistani and Bangladeshi men and women reported worse general health than the general population. Risk ratios (in relation to a value of 1.0 for the general population) for bad and very bad health for men and women were 2.94 and 3.57, respectively, for Pakistanis, and 3.91 and 3.31 for Bangladeshi men and women, respectively.
- Corresponding risk ratios for Black Caribbean women (1.81), Indian men (1.64) and Indian women (2.63) were also higher than in the general population.
The 2001 Census found that:
- Asians aged 50 or over have higher rates of limiting long-term illness than members of any other ethnic groups.
Table 1: Percentage of people with a limiting long-term illness by age and ethnic group, England and Wales Census 2001)
| Age |
White % |
Asian/Asian British % |
Black/Black British % |
Mixed % |
Chinese/Other ethnic group % |
| 0-15 |
4 |
4 |
5 |
5 |
3 |
| 16-49 |
10 |
10 |
10 |
11 |
5 |
| 50-64 |
26 |
40 |
34 |
32 |
22 |
| All people aged 65 and over |
51 |
60 |
54 |
49 |
48 |
The fourth National Survey of Ethnic Minorities, carried out in 1994, found that reported health varied according to housing tenure. Across all ethnic groups, those who owned their own homes were less likely than those who rented to report fair or worse health.
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Physical health
The 1999 Health Survey for England and Wales found that:
- Pakistanis and Bangladeshis of both sexes were more than five times as likely as the general population to have diabetes, and Indian men and women were almost three times as likely.
- Rates of diabetes among Black Caribbeans were also significantly higher than in the general population (risk ratios 2.51 for men and 4.19 for women).
- Rates of diabetes among the Chinese and Irish groups were not significantly different from the general population.
- Pakistani and Bangladeshi men had rates of cardiovascular disease (CVD), about 60% to 70% higher than men in the general population, while Chinese men had lower rates (risk ratio 0.63). The picture was similar for women, with Chinese women having lower rates of CVD conditions (0.71) than women in general, while Pakistani (1.45) and Bangladeshi (1.43) women had higher rates. Prevalence of CVD conditions was also higher among Black Caribbean women (1.33).
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Infant mortality
The only available data regarding ethnic differences in rates of infant mortality is from the register of infant deaths in England and Wales (Office of National Statistics). The register only provides breakdowns of rates of infant deaths by mother’s country of birth, which is not a certain indicator of ethnic group.
The figures for 2002 show that the rates of perinatal deaths (within three months of birth) per 1,000 live births and still births were:
- 7.8 for mothers born in the United Kingdom;
- 8.8 for mothers born in the Irish Republic;
- 10.5 for mothers born in Bangladesh;
- 10.6 for mothers born in India;
- 14.5 for mothers born in Pakistan; and
- 15.4 for mothers born in the Caribbean.
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Mental health
The most recent major survey of rates of mental illness among ethnic minorities is the 1999 Ethnic Minority Psychiatric Illness Rates in the Community study (EMPIRIC). Its findings contradict two key assertions that have been based on previous research: first, there are apparently high rates of schizophrenia and other forms of psychosis among African Caribbean people; and second,there are low rates of mental illness among Asian people.
The EMPIRIC survey found that:
- The prevalence of common mental disorders (CMD – anxiety and depression) was very similar in all groups, with the exception of the Irish, for whom this rate was higher than in the White group.
- The pattern among women was more complex. White, Irish and Black Caribbean women had similar rates of CMD, while Indian and Pakistani women had significantly higher rates of CMD. Bangladeshi women had very low rates of CMD.
- Rates of pyschosis among Black Caribbean men were the same among white men after adjusting for age. However, rates of psychosis were twice as high for Black Caribbean women as for white women. The survey did not find any significant differences in rates of psychosis among other groups.
- People of Pakistani or Bangladeshi origin experienced worse ‘social functioning’ than people from other ethnic groups, and Bangladeshis experienced greater chronic strains compared with all other groups. However, other findings from the survey suggest that factors such as age and employment status may have influenced these findings.
The 1999 EMPIRIC survey included a qualitative study of 116 people, from six ethnic groups, who had some form of mental illness or experienced some form of mental distress. Key issues that emerged from the respondents’ own accounts of their circumstances included:
- Family problems, family bereavement, employment issues and racism as recurring themes.
- Indications that tools for diagnosing mental illness may not be culturally appropriate for some groups, and may lead to misdiagnosis.
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Alcohol consumption
The 1999 Health Survey for England found that men and women from all ethnic minority groups (except White Irish) were less likely to drink alcohol than the general population and consumed smaller amounts. Overall, the findings show that:
- Some 7% of men from the general population were non-drinkers, compared with 5% of Irish men, 13% of Black Caribbean men, 30% of Chinese men, 33% of Indian men, 91% of Pakistani men and 96% Bangladeshi men.
- Higher proportions of women than men were non-drinkers, both in the general population and among ethnic minority groups. Of the general population, 12% of women reported being non-drinkers compared with 10% of Irish women, 18% of Black Caribbean women, 41% Chinese women, 64% Indian women, 97% Pakistani women and 99% Bangladeshi women.
- 46% of men in the general population drank more than the government recommended guideline of no more than 3 to 4 units per day.White Irish men were more likely than any other ethnic group to drink in excess of the recommended limit (58%). All other ethnic minority groups were much less likely than the general population to have consumed alcohol in excess of the daily guidelines.
- The proportion of women drinking more than government recommended guidelines (no more than 2 to 3 units per day) was 29% for the general population, and 37% for White Irish women. The next ethnic group most likely to exceed the guidelines was Black Caribbean (17%). The proportion of women from other ethnic minority groups exceeding this limit was much lower – only 5% on Indian women, 1% of Pakistani women, and less than one percent of Bangladeshi women.
- Among 8 to 15-year-olds, 40% of boys and 32% of girls in the general population reported ever having drunk alcohol. Indian and Chinese children were much less likely to report ever having drunk alcohol, and reported rates of alcohol use were particularly low among Pakistani and Bangladeshi children.
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Tobacco use
The 1999 Health Survey for England found that smoking was more common among certain ethnic groups.
- 27% of men in the general population reported being smokers compared with 44% of Bangladeshi men, 39% of Irish men and 35% of Black Caribbean men. Indian (23%) Pakistani (26%) and Chinese (17%) men were less likely to report being smokers.
- 27% of women in the general population reported being smokers compared with 33% of Irish women, 25% of Black Caribbean women, 9% of Chinese women, 6% of Indian women, 5% of Pakistani women and 1% of Bangladeshi women.
- In the 8-15 age group, among the general population, 19% of boys and 21% of girls reported ever having smoked a cigarette. Compared with the general population, Irish girls were more likely and Indian, Pakistani, Bangladeshi and Chinese children less likely to report ever having smoked.
- The survey found that Bangladeshis (both men and women) were more likely than other South Asian groups to report chewing tobacco. 19% of Bangladeshi men and 26% of Bangladeshi women reported chewing tobacco compared with between 2% and 6% for Indian and Pakistani men and women, respectively.
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Access to health care services
This section draws together quantitative data on patterns of accessing services among different ethnic groups and findings from qualitative studies that examine barriers to accessing services for ethnic minority groups, and ethnic minorities’ views of services.
Patterns in accessing health services
Consultation with a GP
- The 1999 Minority Psychiatric Illness Rates In the Community (EMPIRIC) study found that:
- Women from every ethnic group were more likely than men to have spoken to a doctor within the last six months.
- Bangladeshi individuals were the most likely to have seen or spoken to a doctor within that time (77% of men and 85% women).
- White individuals were the least likely to have done so (58% of men and 71% of women).
- After adjusting the results for age differences, Asian men and Pakistani and Bangladeshi women were more likely than other groups to have spoken to a doctor within the last six months. However, the fact that certain groups access services more does not indicate that services are adequately meeting their needs. See the section on perceptions of services below.
Hospital attendance rates
- The 1999 Health Survey for England found that rates of hospital attendance were the same for ethnic minority groups as for the general population, with the exception that Chinese men and women had lower rates of inpatient, outpatient and day patient attendance than the general population.
Access to mental health services
- The 1999 EMPIRIC survey found that the level of access to counsellors and psychologists was highest among the White, Irish and Black Caribbean groups.
Barriers to accessing health services
The Centre for Health Studies at Warwick University conducted a systematic review of the evidence regarding the issues surrounding access to health services for ethnic minority groups in London, an area with a high ethnic minority population.
Key issues that the review identified as leading to differential rates in accessing health services among different ethnic groups included:
- user ignorance
- language and literacy difficulties
- cultural differences (relating to religion, gender or work patterns)
- the different needs of different populations
- the location of service delivery
The review yielded the following findings:
Primary care services
There appear to be no major barriers to the use of GPs.
Women’s health services
Some studies have indicated a low uptake of maternity services by ethnic minority women. Access to these services may be obstructed by a lack of cultural sensitivity in service provision, and by language barriers.
Services for sexually transmitted diseases
There is evidence of a need for improved information and raising awareness among ethnic minority communities.
Cancer treatment services
Although access rates are similar among different ethnic groups, there is evidence that low levels of awareness regarding cancer among ethnic minority populations could be an important barrier to access.
Mental health services
The Black Caribbean population is more likely to be admitted to psychiatric units and more likely to be locked in wards or detained under the Mental Health Act.
Specialist management treatment services for heart disease
There is some evidence that Asian patients experience particular delays in accessing these services.
Services for the elderly
Poor knowledge and experience of services were barriers that obstructed access to services by elderly people.
Services for children
The factors inhibiting access by women to maternity services inevitably affect children, as do adult problems in accessing services generally.
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Perceptions of health services
The NHS has carried out several National Surveys of NHS Patients designed to contribute to monitoring the performance of the NHS as it is seen by patients. The first survey covered General Practice (1998), the second covered Coronary Heart Disease (2000) and the latest has covered Cancer (2000).
In each of the surveys the sample groups varied in size. Bearing this in mind, a clear message from all three surveys has been that ethnic minority groups were more likely than average to report unfavourably on their experiences in respect of:
- waiting times;
- understanding explanations;
- trust in doctors and nurses;
- being treated with respect and dignity; and
- help with pain relief.
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References
- Office for National Statistics, Health Statistics Quarterly, Issue 20, Winter 2003.
- Sproston and Nazaroo (eds.) (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) – Quantitative Report, London: HMSO
- Erins et al (eds) (2001), Health Survey for England – The Health of Minority Ethnic Groups 1999, London: HMSO
- Centre for Health Studies, Warwick University, (2001), Systematic review of ethnicity and health service access for London, unpublished
- NHS Patients Surveys
- Modood et al, (1997), Ethnic minorities in Britain: Diversity and Disadvantage, London: Policy Studies Institute
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http://www.cre.gov.uk/duty/reia/statistics_health.html
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