Black and Minority Ethnic Groups Author/Key Contact: Dr Lucy Jessop, Consultant in Public Health, Buckinghamshire County Council

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1 Black and Minority Ethnic Groups Author/Key Contact: Dr Lucy Jessop, Consultant in Public Health, Buckinghamshire County Council Introduction England is a country of great ethnic diversity, with approximately 20% of people living in England describing themselves as non-white British in Some ethnic communities are well established in this country over decades and some are more recently arrived into the UK. It is therefore important to be aware of the current ethnic mix of people in Buckinghamshire to ensure that services are provided to meet the needs of the entire population. Many studies have shown that ethnicity can have an effect on people s health. This can be through genetic differences, cultural factors or socio-economic circumstances. In some cases the health issues of certain people more recently arrived in the UK can be different from those who have been in the UK for generations. Ethnicity can be associated with positive impacts on health and wellbeing as well as with increased risks of poorer health. People of different ethnicities can also be affected in different ways. Surveys commonly show that Pakistani, Bangladeshi and Black-Caribbean people report the poorest health, with Indian, East African Asian and Black African people reporting the same health as White British people and Chinese people reporting better health i. Positive impacts on health & wellbeing Non-white ethnic groups are generally more likely to start and continue breast feeding. One large study in the UK showed that ii Black, Asian and mixed ethnicity women are more likely to start and to continue breastfeeding than white women even after controlling for other socio-economic factors. Fewer Black African and Asian women smoke in pregnancy than white women. Overall, smoking rates amongst ethnic minority groups are lower than the UK population as a whole. Rates of smoking are however high in Black Caribbean men and women, Bangladeshi men and Irish women compared to the general population iii. Most minority ethnic groups have higher rates of abstinence from alcohol and lower rates of alcohol drinking than people from white backgrounds. Many people from minority ethnic groups have healthier eating patterns than the white population, however unhealthy diets and low physical activity are known to be of concern in some minority ethnic groups, in particular those of South Asian origin iv In terms of mental health disorders in children, national data suggests that Indian children have relatively low rate of mental health disorders (3% compared with 7-10% in other groups) with a similarly low prevalence of attention deficit hyperactivity disorders (ADHD) among all non-white groups. 1

2 On average in England for educational attainment, white British students both boys and girls- are more likely than other ethnic groups to demonstrate sustained underachievement v. There are differing patterns of achievement amongst minority ethnic groups: Chinese and Indian pupils are generally the most successful and African-Caribbean pupils the least. Increased risk of poorer health & wellbeing Cardiovascular disease is more common in certain ethnic groups mainly South Asian and Black ethnicities. Type 2 diabetes is more common in people of South Asian, African, Afro-Caribbean, Middle Eastern and Chinese descent. These groups tend to develop diabetes at a younger age and also to progress from pre-diabetes 1 to diabetes at more than twice the rate of white populations. South Asian people living in the UK are up to 6 times more likely to have type 2 diabetes than the white population and are likely to develop it 10 years earlier. 2 A 2007 national report Dementia UK, produced by the Alzheimer s Society estimates that people from black and minority ethnic groups (BME) have a higher than average proportion of people with early onset dementia 6.1% vs 2.2%, and also that there was limited knowledge of dementia amongst some BME groups. There are higher levels of hearing impairment in minority ethnic groups, particularly of recent immigrants who have previously experienced poverty, poor health care and low levels of immunisation against high-risk diseases such as rubella (german measles) 3 Mothers of Black and Asian ethnic origin in the UK, especially those recently arrived in the UK, are more likely to have stillbirths and neonatal deaths than mothers of white ethnic origin. Reasons for this are likely to be linked to lack of antenatal care, pre-existing medical conditions and low income. There is a higher rate of learning disability among some ethnic groups, particularly South Asians, where rates of learning disability are significantly higher. Rates of learning disability amongst South Asians aged between 5 and 32 are up to three times higher than in other communities, although it is important to note that while ethnic minority groups are disproportionately affected, the majority of people with learning disability in Buckinghamshire are of white British origins. Studies have also found that the health of Gypsy and Traveller populations are much poorer than the general population and they are more likely to report asthma, arthritis or bronchitits 4. A study in Wrexham showed they have lower levels of exercise and poorer diet in general and experienced higher levels of premature cardiovascular deaths in men. 1 Pre-diabetes is when blood sugar levels are higher than normal, but not high enough for the person to be diagnosed with diabetes 2 Preventing type 2 diabetes population and community interventions. (NICE Public Health Guidance 35, May 2011) Inequalities experienced by Gypsy and Traveller communities: a review aveller_communities_a_review.pdf 2

3 Needs in the population current and future Population information Data from the 2011 census shows that 13.6% of the Buckinghamshire population were from a non-white ethnic background, increasing from 7.9% in % were from a white ethnic group in 2011, slightly higher than 85.4% in England as a whole. The number of people from non-white ethnic groups in Buckinghamshire has increased by 82% between 2001 ( people) and 2011 ( people). 8.6% of the population in Buckinghamshire were from Asian/Asian British ethnic group in 2011, 2.4% from mixed/multiple ethnic group and 2.1% from a Black/ Black British ethnic group (Table 1). Almost one in five (19%) of people living in Wycombe District Council are from a non-white ethnic group, mainly Asian or Black ethnicities, compared to 16% in South Bucks, 10% in Aylesbury Vale and 9% in Chiltern. After White British, the next largest ethnic group in Buckinghamshire is Pakistani, with 4.2% of the population, and 7.6% of the population in Wycombe. In South Buckinghamshire the largest ethnic group is Indian with 7.1% of the population. White Other (white excluding British or Irish) ethnicities are the largest ethnic groups in Aylesbury Vale and Chiltern. Table 1: 2011 Census of ethnic group in Buckinghamshire by district council Area name White Mixed/ multiple ethnic group Asian/ Asian British Black/African/ Caribbean/Black British Other ethnic group ENGLAND 85.4% 2.3% 7.8% 3.5% 1.0% SOUTH EAST 90.7% 1.9% 5.2% 1.6% 0.6% Buckinghamshir e 86.4% 2.4% 8.6% 2.1% 0.5% Aylesbury Vale 89.6% 2.2% 5.8% 1.9% 0.4% Chiltern 91.5% 2.2% 5.4% 0.6% 0.3% South Bucks 84.3% 2.4% 11.3% 1.1% 1.0% Wycombe 81.3% 2.8% 12.0% 3.5% 0.5% Source 2011 Census, office for National Statistics 3

4 Figure 1: Ethnic Groups other than white British, 2001 and 2011, Buckinghamshire County Source: Census 2001 and 2011, Office for National Statistics Figure 1 shows that the percentage of people from every ethnic group, except Irish has increased between the census of 2001 and The largest increases are in the Indian, Pakistani, other Asian and Other White groups. 12.9% of the population of Buckinghamshire had been born outside the UK in the 2011 census, compared to 9.9% in the 2001 census. More than people born outside the UK arrived to live in Buckinghamshire between 2001 and In terms of religion, 60.5% of people in Buckinghamshire were Christian, 5.1% were Muslim and 1.2% Hindu and 23.5% had no religion. Two point five percent of households in 4

5 Buckinghamshire have no people who speak English as their main language, this rises to 3.4% in Wycombe. In Buckinghamshire more than 6000 women become pregnant every year, with 21% of births to women from non-white ethnic groups ( ). Health From the 2001 census, using age-standardised rates (which take account of the difference in age structures between the ethnic groups) Pakistani and Bangladeshi men and women were most likely to report their health as 'not good'. Proportions of Black Caribbean and Indian women reporting their health as not good were also relatively high. Chinese men and women were the least likely to report their health as 'not good'. However from the 1999 Health Survey for England, children aged 2-15, Indian and Chinese, particularly Pakistani and Indian children were less likely than children in the general population to report any long-standing illness. There is no reason to suspect that the picture in Buckinghamshire would be different from that at national level, but the data on self-rated health and ethnicity are not yet available from the 2011 census. Many studies have reported an increase in diabetes in South Asians, but in Buckinghamshire there needs to be improved referral rates to and engagement in structured group education for people with newly diagnosed type 2 diabetes, including those from South Asian backgrounds who are currently less likely to attend Preliminary data suggest that people from South Asia are less likely to attend for an NHS Health Check when invited than those from white ethnic groups. However, numbers are relatively low and ethnicity data are often missing from patients GP records. In tuberculosis services in Buckinghamshire in 2011, the highest proportion of cases were in people of Pakistani (52%), and White (20%) ethnic origin. We are working to improve recording of ethnicity in health services so services can be better targeted to the needs of all people including those of minority ethnic groups. Education In education, for key stage 1 (years 1 and 2 in primary school), results of Pakistani and Mixed White-Black Caribbean pupils improved compared to 2011, although results were lower than those achieved by White British pupils. Results for Pakistani pupils (the largest minority ethnic group 553 pupils) were above national levels for reading, the same for writing, but lower for maths. In key stage 2 (years 3-6 in primary school) results in English and Maths for all minority ethnic groups were below White British pupils and below national achievements. For key stage 4 (GCSE s: 5 or more A*-C grades, including English and Maths), results for Pakistani pupils were 1% lower than for 2011 (at 48% in 2012), while results for the smaller numbers of Mixed White-Black Caribbean and Black Caribbean pupils increased to 48% and 55% respectively. 70% of White British students achieved these results at key stage 4. Detailed analysis of the progress made for each ethnic group is 5

6 provided in the Narrowing the Gap chapters of the Children, Young People & Families section of the JSNA. Current services in relation to need All health promotion and health and social care services in Buckinghamshire are available to everyone regardless of their ethnic background. All services should take into account the needs of people in minority ethnic groups and, for example have translation services or leaflets in other languages available. Recording the ethnicity of people accessing services can help identify if any groups are underutilising the service so this can be addressed. Some services in Buckinghamshire are delivered with a particular focus on ethnic groups who may be at particular risk of ill health or who find it more difficult to access universal services. Further details can be found in the relevant chapters of the JSNA, but these include: Education The School Improvement Service has a Narrowing the Gap Strategy Group to develop provision and to support the achievement of students from minority and ethnic groups. Connexions Buckinghamshire offers targeted information, advice, guidance and support to vulnerable groups who are most at risk of losing interest in education, including black and minority ethnic groups. The Community Consultative Group, based in High Wycombe, meets to support and challenge the local authority in raising the achievement of students from minority ethnic backgrounds Health Solutions4Health delivers innovative approaches to smoking cessation support for those who are less likely to access the ordinary services. This includes, providing support in other languages, taking support into communities through the use of a mobile clinic and targeted campaigns for Ramadan using the prayer timetable. Movers and Shakers are health and wellbeing groups that meet across the county in various areas working with older adults. They work with Asian women, Caribbean and Chinese people amongst others to encourage healthier lifestyles and they have been very popular with participants. The Skilled for Health programme equips people to look after their health and is linked in with English language courses. The tuberculosis service provides leaflets in appropriate languages and translation services. Posters on recognising the signs and symptoms of TB, in various languages have been distributed across the county. 6

7 A new HIV support and prevention service in Buckinghamshire will work with communities most at risk of HIV, including Black Africans. Unmet need and service gaps Not all health and social care services systematically record the ethnicity of all their clients to ensure equitable access to services. Whilst in most Adult Social Care service areas there are less service users from BME groups compared to their proportion of the population, in Buckinghamshire it is within the Physical/sensory group where the difference is greatest as seen in table 2. Table 2: Comparative Population and Client Group percentages by ethnic group Ethnic Origin Percentage of 18+ Population Percentage of 18+ Adult and Family Wellbeing Clients with a physical/sensory disability White 89.5% 94.1% Dual Heritage 1.2% 0.2% Asian or Asian British 5.8% 3% Black or Black British 2.3% 1.9% Other Ethnic Groups 1.3% 0.4% Source: Population: PANSI (18-64) & POPPI (65+) Client data: Consequently, there is a need to engage with adults with physical disabilities from these groups to ensure they have appropriate access to the health and social care services they may need and also to identify any relevant service gaps. People from South Asian backgrounds are accessing NHS health checks less than would be expected, yet they are at greater risk of diabetes. There is limited knowledge of the health of Gypsy and Traveller communities in Buckinghamshire and whether they experience difficulty in accessing health care and preventative services like immunisations and screening. Recommendations for Commissioners Services should ensure they can meet the needs of all groups including Black and ethnic minorities. All services should record the ethnicity of their clients. This can enable services to analyse whether certain ethnic groups are accessing the service less than would be expected, so changes can be made to the service to address this. Ensure translation services and leaflets in appropriate languages are available in all services. 7

8 Improve engagement in Health Checks by those likely to be most at risk including people of South Asian origin Improve diabetic services to facilitate and support people with diabetes to make changes to their lifestyles, including people of South Asian populations Improve interventions that further support the development of teaching and learning and focus on the achievement of lower-achieving ethnic groups Consider the best way to engage with Gypsy and Traveller communities in Buckinghamshire to help them to access healthcare services appropriately and to provide culturally appropriate and understandable health messages. i Ethnicity and Health, Parliamentary Office of Science and Technology, Jan 2007, Number 276 ii Racial/Ethnic Differences in Breastfeeding Initiation and Continuation in the United Kingdom and Comparison With Findings in the United States, Y Kelly et al. Pediatrics Vol. 118 No. 5 November 1, 2006 pp. e1428 -e1435 iii Tobacco and ethnic minorities, ASH factsheet, 2011 iv Obesity and ethnicity Jan 2011, National Obesity Observatory v Kerr and West

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