Ethnic Minorities, Refugees and Migrant Communities: physical activity and health

Ethnic Minorities, Refugees and Migrant Communities: physical activity and health July 2007 Introduction This briefing paper was put together by Sporting Equals. Sporting Equals exists to address racial inequality in sport, and is the only organisation in the UK to do so. Set up by Sport England, and previously in partnership with the Commission for Racial Equality, it is now at the forefront of racial equality provision in sport in Britain. This briefing paper pulls together a variety of research and consultation documents to provide a synopsis of the key issues for ethnic minorities in relation to physical activity and their health. Demographic Trends. Britain s ethnic minority population was recorded as 4.6 million (7.9% of the population) in the 2001 census. The largest minority group within the UK in 2001 were Indians, followed by Pakistanis, those of Mixed ethnic backgrounds, Black Caribbeans, Black Africans and Bangladeshis. Over 45% of people in ethnic minority groups in England & Wales live in London. 1 The age structure of ethnic minority groups is different to the White population with 38% of the Bangladeshi community; 35% of the Pakistani community; and 30% of the Black African population aged under16 years, compared to 20% of the White British population. 1 Greater London Authority (2005) Focus on London s Population, London, GLA 1

The UK has a growing population. The population grew by 7.7% between 1971 and 2004 with growth being faster in more recent years. Between mid-1991 and mid-2004 the population grew by an annual rate of 0.3 per cent and the average growth per year since mid-2001 has been 0.5 per cent. 2 A growth in population is projected to continue with an estimated increase to 67.0 million by 2031. Longer term projections suggest growth will continue beyond 2031 but at a lower rate. The growth of the population is, in part due to an excess of births over deaths and partly due to the level of net inward migration. 57% of the projected increase in the population between 2004 and 2031 is attributable to the assumed level of net inward migration. 3 The UK has experienced increasing levels of inward and outward international migration with migration into the country increasing from 314,000 in 1994 to 582,000 in 2004. In 2004 an estimated 223,000 more people migrated to the UK than migrated abroad representing an increase on previous years. This is the equivalent of adding over 600 people to the UK population per day. A key reason for the increase seen in 2004 was the expansion of the EU in May of that year. Citizens of the ten EU accession countries made up an estimated four fifths of the increase between 2003 and 2004. 4 The long-term net inward migration assumption to the United Kingdom is 145 thousand persons per year from 2007 08 onwards. Grants of settlement in 2005 rose by 29% to 179,120. Of the total number of grants in 2005 58% were dependant related categories including children (25%) wives (17%) and husbands (9%). 30% of grants settlement were from Africa, 25% from the Remainder of Asia, 16% from the Indian Subcontinent, 12% Europe, 8% from the Americas, 5% from the Middle East and 4% from Oceania. 5 Physical Activity The Government recommends at least 30 minutes a day of at least moderate intensity physical activity on 5 or more days a week based on evidence that this reduces the risks of premature death from cardiovascular disease and some cancers and significantly reduces 2 ONS (2006) Mid Year Population Estimates [accessed online http://www.statistics.gov.uk/cci/nugget.asp?id=6 on 22 nd July 2007] 3 ONS and GAD (2005) National Population Projections 2004- based. London, ONS 4 Office for National Statistics (2005) Focus on People and Migration, London, ONS 5 Home Office (2006) Control of Immigration Statistics London, HMSO 2

the risk of type 2 diabetes. For some sections of the population this rises to 45-60 minutes a day and for children and young people this rises to 60 minutes. 6 It is however clear that different sections of the population participate in physical activity to varying degrees with ethnic minority groups generally being less likely to meet this recommended level. The Health Survey for England 2004 7 identified levels of participation in different forms of physical activity amongst ethnic minority groups as compared to the general population. Key findings were: Levels of physical activity of at least moderate intensity was lower in all ethnic minority groups than in the general population apart from Irish men and women and black Caribbean men Participation in any activity at least once a week increased between 1999-2004 for Bangladeshi men and Chinese men and for men and women in the general population but reduced among Pakistani men. Participation in 30 minutes brisk walking was lower for all ethnic minority groups that for the general population apart from Irish communities. Indian, Pakistani, Bangladeshi and Black African men and women were less likely to have participated in sports and exercise than the general population. Asian men and women were less likely to meet physical activity recommendations than the general population. The Active People Survey 8 undertaken by Sport England also demonstrates lower levels of participation among ethnic minority groups when compared to the general population. 18.6% of Black and other ethnic minority groups and 21.2% of adults of white origin regularly participate (this is defined as taking part on at least 3 days a week in moderate intensity sport and active recreation for at least 30 minutes continuously in any one session ) in sport and active recreation 6 Dept of Health (2004) At least 5 a week; evidence on the impact of physical activity and its relationship to health. A report from the chief medical officer. London, Dept of Health 7 Sproston K and Mindell J (2006) Health Survey for England 2004; the health of minority ethnic groups. 8 Sport England (2006) Active People Survey. [accessed online at http://www.sportengland.org/index/get_resources/research/active_people.htm on 22nd June 2007] 3

17.5% of Black Caribbean s and 17% of Asians regularly participate in sport and active recreation. The different levels of participation in physical activity is supported by other research 9 10 with one study undertaken by Sport England in 2000 11 showing: For ethnic minority groups overall the participation rate in sport is 40% compared with a national average of 46%. On average Black Caribbean (39%), Indian (39%) and in particular Pakistani (31%) and Bangladeshi (30%) populations have rates of participation in sport below those of the national average (46%). Only the Black Other group (60%) has participation rates higher than found in the population as a whole. Black African men (60%) and Black Other men (80%) have higher participation rates than the national average for all men (54%) while Indian (47%), Black Caribbean (45%), Bangladeshi (46%) and Pakistani (42%) men are less likely to participate in sport than men generally. National participation rates for women (39%) were matched or exceeded by women from Black Other (45%), Other (41%) and Chinese (39%) ethnic groups while women who classified themselves as Black Caribbean (34%), Black African (34%), Indian (31%), and Bangladeshi (19%) had participation rates below the national average for all women. Physical Activity Summary The data available on participation in physical activity shows clearly that activity levels vary considerably amongst different population groups. All of the data sources show that ethnic minority groups are generally less likely to participate in sports and physical activity than the general population. There is not a consensus across the data sources regarding the participation of Black Caribbean and Black African groups in comparison to the rest of the population. There is however agreement that those least likely to participate in physical activity and meet recommended levels are Bangladeshi, Pakistani and Indian men and 9 Dept of Culture, Media and Sport (2007) Taking Part: the national survey of culture, leisure and sport annual report 2005/6. London, DCMS 10 Health Development Agency (2000) Black and Minority ethnic Groups in England; second health and lifestyle survey. London, HDA 11 Rowe N and Champion R (2000) Sports Participation and Ethnicity in England, national survey 1999/2000 headline findings. London, Sport England 4

women. No data was found that related specifically to participation by refugee communities in physical activity and this is an area that requires further research. Health The evidence regarding the importance of physical activity for health is well established and it has been demonstrated that increasing activity levels can contribute to the prevention and management of over 20 conditions and diseases. 12 People who are physically active reduce risks of developing major chronic diseases such as coronary heart disease, stroke, type 2 diabetes by up to 50%, and reduce the risk of premature death by 20-30%. 13 The link between physical activity as a form of prevention and treatment of mental illness as well as a way of promoting mental health and well being has also been evidenced and continues to be researched. 14 There continues to be inequalities in health in the UK, with some sections of the population experiencing significantly worse health outcomes than others 15. There is evidence of ethnic minority groups, migrants and refugees experiencing greater health inequalities than the general population. In terms of self reported health status in 2004: Bangladeshi and Pakistani men and women and Black Caribbean women were more likely to report bad or very bad health than the general population and Pakistani women and Bangladeshi men were more likely than the general population to report a limiting long standing illness. 16 In a measure of psychological well being Pakistani men and women and Bangladeshi men were more likely to have a high score of psychiatric morbidity than the generals population 12 Department for Health (2005)Choosing Activity; a physical activity action plan London, Dept of Health 13 Department of Health (2004) At least 5 a week; evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London, Department of Health 14 Biddle SJH, Fox KR, and Boutcher SH (Eds.) (2000), Physical activity and psychological well being,london, Routledge. 15 Wanless D (2002) Securing our Future Health; Taking a long term view. London, HM Treasury 16 Sproston K and Mindell J (2006) Health Survey for England 2004; the health of minority ethnic groups. 5

in2004 17 while one in five mental health in-patients come from a black and minority ethnic background as compared to one in ten of the population as a whole 18. Other key health conditions that are directly linked to levels of physical activity and which also affect different ethnic groups disproportionately are cardiovascular disorders, diabetes, obesity and high blood pressure; Cardiovascular disorder diagnosed by a doctor was most prevalent among Irish men and among women in the general population in 2004 while Black African men and Chinese women were significantly less likely than the general population to have any CVD condition Black Caribbean women showed the highest rates of angina symptoms Black Caribbean men showed the highest rates of symptoms of possible myocardial infarction. 19 Prevalence of diabetes is notably high among Bangladeshis 20. Doctor diagnosed diabetes in 2004 was almost four times as prevalent in Bangladeshi men and three times as prevalent in Pakistani and Indian men as men in the general population. 21 Doctor diagnosed diabetes among women in 2004 was more than five times as likely in Pakistani women and at least three times as likely in Bangladeshi and Black Caribbean women and two and a half times as likely in Indian women compared with women from the general population. 22 Prevalence of high blood pressure did not differ significantly among men of different ethnic groups with the exception of Bangladeshi men who were significantly less likely to have high blood pressure. 23 17 ibid 18 Dept of Health (2005) Delivering Rave Equality in Mental Health Care. London, DoH 19 Sproston K and Mindell J (2006) Health Survey for England 2004; the health of minority ethnic groups. 20 Health Development Agency (2000) Black and Minority Ethnic Groups in England; second health and lifestyle questionnaire, London HDA 21 Sproston K and Mindell J (2006) Health Survey for England 2004; the health of minority ethnic groups. 22 ibid 23 ibid 6

Black Caribbean, Black African and Bangladeshi women were significantly more likely 24 25 to have high blood pressure than women in the general population. Black Caribbean and Irish men had the highest levels of obesity in 2004 while Bangladeshi men were almost five times and Chinese men almost four times less likely to be obese than men of the general population. 26 Among women, Black Caribbean and Black African and Pakistani women were more likely to be obese and Chinese women were less likely to be obese than the general population of women. 27 Policy and Targets The Department of Health has made a clear commitment to tackling and reducing the inequalities in health that exist across society including the inequalities experienced by ethnic minority groups 28. Commitments have also been made to ensure that the design, delivery and development of NHS priorities and services are done within a framework of consideration of race equality 29. Particular focus has been placed on the development of appropriate mental health services and prevention work with ethnic minority groups 30 and working with ethnic minority groups through community settings 31 Commitments to addressing physical activity is also a key priority for the Department of Health. The Public Health White Paper Choosing Health 32 identifies physical activity as a key area for focusing public health work. The physical activity action plan Choosing Activity 33 that was developed as a result of Choosing Health makes a commitment to raise 24 ibid 25 Health Development Agency (2000) Black and Minority Ethnic Groups in England; second health and lifestyle questionnaire, London HDA 26 Sproston K and Mindell J (2006) Health Survey for England 2004; the health of minority ethnic groups. 27 ibid 28 Department of Health (2004) Choosing Health London, HMSO 29 Department of Health (2005) Race Equality Scheme 2005-2008 London, DoH 30 Department of Health (2005) Delivering Race Equality in Mental Health Care. London, DoH 31 Department of Health (2007) Communities for Health; Learning from the Pilots. London DoH 32 Dept of Health (2004) Choosing Health; Making healthier choices easier London, HMSO 33 Department for Health (2005) Choosing Activity; a physical activity action plan London, Dept of Health 7

participation in sport by 3% by 2008 from people over the age of 16 in underrepresented groups including: Black and ethnic minority groups Women Physically or mentally disabled people Socio economic groups C2, D and E In addition, it can be seen that there are two Public Service Agreements that relate to the health and physical activity of minority groups are: By 2008, increase the take-up of cultural and sporting opportunities by adults and young people aged 16 and above from priority groups (that is those with a physical or mental disability, black or minority ethnic groups, women and those from socio economic groups C2, D and E) by increasing the number who participate in active sports, at least 12 times a year by 3%, and increasing the number who engage in at least 30 minutes of moderate-intensity-level sport, at least three times a week by 3% Substantially reduce mortality rates by 2010 from heart disease and stroke and related diseases by at least 40% in people under 75, with at least a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole. Given this policy framework alongside the specific theme of promoting health and well being within the Dept of Health s recent white papers 34 35 and the strategic cross cutting theme identified by Section 64 General Scheme of Grants 2008-9 36 of proposals that enable third sector organisations to contribute their expertise to the development of improved health and social care service, work by the voluntary sector to promote physical activity among ethnic minority, refugee and migrant communities must clearly be key. Summary and Recommendations 34 Dept of Health (2006) Our Health, Our Care, Our Say London, DoH 35 Dept of Health (2007) Commissioning Framework for Health and Wellbeing. London DoH 36 Dept of Health (2007) Section 64 General Scheme of Grants 2008-9London, DoH 8

Sporting Equals is committed within its business plan 2007-12 to focus on 3 priority policy areas. One of these is to increase the health of ethnic minorities through physical activity. This briefing paper indicates several areas where attention should be focused, and will form the basis of our health based policy and activity work. Information regarding the health of ethnic minorities is comprehensive. In terms of activity levels, the data is fairly top level and would benefit from more detailed segmentation and some qualitative analysis of behaviour patterns. The Sport for Communities project will produce some of this information and this will be augmented if necessary by further research. More information is needed on the physical activity habits and health needs of migrant communities and refugees and this should be a research priority. Although there are specific issues that go across all ethnic minority groups, Bangladeshi and Pakistani groups come out with very clear needs in terms of both health and lack of participation in physical activity. Some targeted work around these specific groups is recommended. The incidence of diabetes II in the Pakistani and Bangladeshi communities is of clear concern and as a robust evidence framework for the benefits of physical activity as a prevention and treatment method exists for this disease some targeted work in this area is recommended. 9