10 Aug 2018
A guest blog from The National Institute for Health and Care Excellence.
Over the last two decades, England has become more ethnically diverse. Black, Asian and other minority ethnic groups (BAME) now make up a larger proportion of the population. With these changes in the population, it is becoming clear that certain health conditions have an increased prevalence in BAME communities and evidence suggests that there are a number of barriers to them accessing local health and mental health care services. The recently published NICE quality standard says that more needs to be done to ensure BAME communities have a voice in local health and wellbeing services. It aims to encourage public authorities to consider their equality duties when designing, planning and delivering health and wellbeing services.
One of the main health conditions with increased prevalence among BAME communities is type 2 diabetes, which is 6 times more likely in people of South Asian decent and 3 times more likely in African and African-Caribbean people. Evidence shows that lifestyle intervention programmes can significantly improve health outcomes for the disease.
A systematic review of the effectiveness of lifestyle interventions to prevent type 2 diabetes, found that there were significant reductions in type 2 diabetes incidence and weight after 12-18 months of those who received a diabetes prevention programme compared with usual care. NICE suggests that public authorities should make sure services are offering a range of lifestyle interventions, specifically when a person has a high risk of type 2 diabetes and for those who have had a cardiac event.
Another health condition that has higher rates in BAME groups is cardiovascular disease. Heart attacks are higher among South Asian groups at an earlier age – and death rates from cardiovascular disease are approximately 50% higher. Despite this, cardiac rehabilitation services in the UK have low attendance from this part of the population.
In 2017, a national audit found that patients attending cardiac rehabilitation were predominately White-British and male. The main reason for not attending was a lack of interest in both men and women of all ethnicities. NICE looked at the evidence behind this and in the quality standard they make a number of suggestions to improve attendance by considering culturally appropriate and sensitive programmes, such as having single sex programmes or staff who are bilingual. They also say that cardiac rehabilitation services should be available at a number of different settings and at times that are convenient for local people to access.
The quality standard also recommends that mental health services are made available in a variety of community-based settings. Figures show that black women are more likely to experience a common mental disorder than white women and another report, found that those from a South Asian background were reported as showing the least improvement after an Improving Access to Psychological Therapies (IAPT) referral, which provides evidence based treatments for people with anxiety and depression.
Patients from Bangladesh showed the highest deterioration for any ethnic group. Additionally, people who identify as White British were around twice as likely to be receiving some form of treatment for mental or emotional problems from 2015/2016. The NICE quality standard states that those found to have a serious mental illness should have a physical health assessment at least annually in order to pick up on early signs of physical health conditions. A regular health check will also enable action to be taken sooner to prevent worsening health.
The quality standard considers that some people may find community-based services, such as a person's home or community centres, more appealing, accessible and culturally appropriate than traditional healthcare services. To help combat the stigma and encourage people with mental health problems to access support early, the services need to be visible, accessible and responsive to the needs of the local population.
In a report on the differing understanding of cervical screening among white women and women from a Black, Asian and Minority Ethnic (BAME) community, some communities did not recognise the terms ‘cervical screening’ or ‘smear test’ and barriers to attendance included fear, embarrassment and shame and they considered themselves at low risk. This shows that people from BAME groups may not engage with services or may have a poor experience of those programmes and associated services if they are not culturally sensitive and appropriate.
It is so important that service providers take into account the views of people from BAME communities and make sure they are represented in setting priorities and in designing local health and wellbeing programmes.
They should also be represented in peer and lay roles within these programmes; involving people, community organisations and faith leaders who can represent the views of local minority ethnic groups helps to ensure that the services reflect the needs and preferences of the local population.