Free Health Essays - Discuss the role that ethnicity plays in health, and illustrate how UK Health policy and health promotion initiatives aim to address it. Include in your answer discussion on the likely success of such policies and initiatives.
INTRODUCTION
Health is defined as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. A sustained state of health is an elusive concept. As such, all efforts can only be geared to work towards this objective while minimising factors that decrease ill-health. There are many factors that directly or indirectly affect health. While individuals may vary in their approach to their own health and to the health services, unique health issues plague groups of individuals who constitute a community. This community could be very loosely related – for instance a group of people living in a given area – or very close knit – for instance an extended family living together. These groups can exhibit behaviours that take them away from the normal reach of the health system. Some of these groups are the ethnic minority or disabled groups who require the health system to be stretched beyond what is normal or expected. The reason this stretch is important is because these groups would otherwise be excluded from the health system and exclusion of any group from a health system leads to many other complex problems for individuals, communities and countries.
Ethnicity plays a very important role in health. Race relations are complex issues that are intertwined with culture, history, community of origin and self esteem. Ethnicity is not a single dimension of experience but a composite of identity, beliefs and expectations.
In 2003, the Prime Minister, Tony Blair mentioned in his letter to the Department of Health that ‘scientific and technological advances are helping create new opportunities and vanquish old problems, but the society still remains scarred by inequalities.
A group that is disadvantaged will almost certainly have poorer health. The reasons for this are many. A person coming into the UK from a ‘less developed’ country may not have the necessary knowledge of resources available in the new country. There may be a mistrust of Western Medicine compared to more traditional medicine of the developing countries or an antipathy to the attitudes of health staff. Many illnesses can be assumed non treatable and something to be borne stoically. If a person has already sought help and been disappointed in one’s own country or in the new country, he or she may hesitate to follow the issue further. Stigmatisation is another deep rooted fear. Some individuals may hesitate to make known diseases like tuberculosis or HIV/AIDs to a potentially threatening system. This is especially true of ethnic groups who could face discrimination if their health needs are known or repatriation if their existence in the UK is known.
A vast majority of people of ethnic groups depend on their extended family to meet their health needs – e.g. during childbirth or chronic illness. When this support is absent, the health system is unable to meet these unusual cultural needs that are inextricably linked to health. A study by the Department of Health has found that Black and Ethnic Minority (BEM) groups are at a disadvantage when accessing health services as well as in their experience of services and their outcome. Many other major illnesses like cardiovascular disease, schizophrenia, stroke and diabetes are known to have a poorer prognosis in BEM groups. Stress, unemployment, social exclusion, poor quality housing, poor social support, addictions, crime and poor nutrition are other offshoots of a disadvantaged community which further decrease their health status. They may have fewer assets, become stuck in dead end jobs, have insecure employment and are more likely to bring up their own children in difficult circumstances.
One would assume that inequalities do not require much more than the will power of individuals, but many of these health inequalities are persistent and difficult to change and will continue to widen unless active steps are taken to reverse this trend. These changes have to be in place at various levels – governments must have the active policies in place to bring about necessary changes in minimising inequalities, organisations have to develop their own protocols to address unique problems related to the ethnic groups they serve, communities have to expand their social network to include those who are different and individuals have to make a genuine effort to understand, appreciate and respect differences in those around them.
Ethnic groups may not fit into the existing society. Their numbers may be too small to form their own support groups and they may be unaware about organisations that cater to the specific needs of ethnic minorities. This in turn means that they are outside the realm of society and its benefits, thus leading to a lack or decrease of social cohesion, which may actually be the most important determinant of how these groups view their own health and the health system. Social cohesion helps to protect people and their health. Societies with high levels of income inequality tend to have less social cohesion, more violent crime and higher death rates. One study of a community with high levels of social cohesion showed low rates of coronary heart disease, which increased with the social cohesion in the community declined. Belonging to a social network of communication and mutual obligation makes people feel cared for, loved, esteemed and valued. This has a powerful protective effect on health. People who get less emotional and social support are more likely to experience a reduced sense of wellbeing, more depression, a greater risk of pregnancy complications and higher levels of disability from chronic diseases.
EFFORTS BY THE GOVERNMENT, CHARITIES AND THE NHS
The UK Government has made genuine efforts to understand and tackle issues relating to health inequalities. Some of the policies that are in existence are Tackling Health Inequalities: A Program for Action(July 2003) which lays the foundation to achieve the Public Service Agreement (PSA) target to reduce inequalities in health outcomes by 10% in 2010 as measured by the Infant Mortality Rate and Life Expectancy at Birth. It also requires that all Public authorities have to be proactive about challenging race discrimination and promoting good race relationships
The NHS recognises that we live in a diverse society and it has set out some core principles which include shaping services around individual patients, their families and carers, being responsive to needs of different groups and individuals in society and challenging discrimination. Many of these issues have to be dealt at a local level with supporting policies and protocols as well as accountability if not implemented adequately or appropriately.
Many charities have been set up that focus exclusively on the unique health needs of ethnic populations. This is a welcome move to bring together the experience and expertise of ethnic communities which can then be used to build better partnerships with the NHS.
The Muslim Health Network caters to almost 1.6 Muslims in the UK imparting Health education and Health promotion. A free and confidential Muslim youth website is also available. The refugee council is the largest organisation in the UK working with asylum seekers and refugees to meet their unique health needs. Ongoing programs of health promotion initiatives targeting specific black and ethnic minority populations in partnership with local voluntary and statutory organisations are in place and focus on exercise promotion, healthy eating, smoking cessation, sexual health, HIV prevention and mental health promotion. Similar organisations cater to different ethnic groups. The distribution of these charities is not uniform and does not yet cover all the groups that are marginalised.
There are some organisations that practice alternative forms of medicine. People from ethnic groups could be more comfortable with the approaches to health that they are used to in their own country. While it may be impractical to follow only an alternative form of therapy, the NHS could definitely include some of the proven and tested alternatives. For instance, chronic illnesses like depression and hypertension have been known to have a better prognosis if medical therapy is combined with other stress relieving measures like practicing yoga. Better efforts could be made to integrate the best from different forms of medicine into the NHS to bring in a truly holistic approach to health.
Though the NHS has put the health of minority groups as an important agenda, this has to be a constantly evolving process. There can be no one uniform protocol.
Existing outdated policies have to be re-examined to include all the local cultural and religious groups. They should be regularly updated and monitored based on data on equality of access to health services by disadvantaged groups. Health workers should be reasonably trained on identifying differences in individual patients and their families. This could be further aided by the provision of translators and interpreters. Trust and healthy respect from both patients and the health services could go a long way to creating a more positive relationship between culturally diverse groups. Positive equality is a website produced by the NHS for trusts that require training. It provides a baseline protocol which can be developed to suit local requirements.
Local Link worker services and expanded NHS interpreting services are already in place for use by Local Trusts to access telephone interpreting services.
The Government is also providing funding for Transcultural studies in Health. These studies are very important as they bring to light the changing nature of race relationships, the effect of existing systems and what future changes would be required. These studies have to be conducted on a regular basis as it is a dynamic and evolving scenario.
While the major focus in health would be on patients of ethnic origin and their relationship to the NHS, the growing number of doctors of ethnic origin in the NHS requires that this issue be addressed as well. Doctors from other cultures may have different approaches to medicine that could confuse a white patient. A different approach could be viewed as a lack of knowledge or a lack of empathy.
The Vital Connection –an equality framework of the NHS seeks to increase minority ethnic and women’s representation in executive posts and board levels. The Department of Health has also set recruitment targets for NHS organisation boards to include women, ethnic minority groups and disabled people. Targeted advertisements on NHS appointments should contain the phrase ‘applications will be welcomed regardless of gender, race, disability or sexual orientation’. Records are also required to be maintained on applications from these groups through all stages of the appointment process.
Thirdly, race relationships between professionals within the NHS have to be dealt with in an open manner with all parties being willing to listen. There is a necessary amount of learning required by everybody. Institutions that can give people a sense of belonging and of being valued are likely to be healthier places than those in which people feel excluded, disregarded and used. Evidence shows that stress at work plays an important role in contributing to the large differences in health, sickness absence and premature death that are related to social status. Jobs like those in the NHS with high demand and low control carry special risk and social support in the workplace can reduce this effect. Apart from this, receiving inadequate rewards for the effort put into work has been found to be associated with increased cardiovascular risk. The rewards can take the forms of money, status and self esteem.
The Positively Diverse program was introduced to support NHS employees to undergo a change management process through policy, practice and innovation. The MELTING Project (Multi Ethnic Learning and Teaching in Nursing) is a project to raise awareness of the multiethnic nature of nursing.
EVALUATION
All these efforts by the Government and the NHS bode well for the future of race relationships. These efforts are being constantly re-examined though further studies are required to measure the effect of the initiatives.
Indicators like Life Expectancy at birth and Infant Mortality give a fairly good indication of the health status of communities though there are some confounding factors. Some of the other sources of data are General Household Surveys, Neighbourhood Statistics, Local Authority Best Value Indicators, Public Health Mortality Files, Hospital Episode Statistics (HES), Health Surveys and Vital Statistics.
The Centre for Research into Ethnic Relationships, University of Warwick undertakes many research projects on ethnic minority health. This is funded by Government departments, health authorities and trusts, the private sector and the voluntary sector.
The Commission for Racial Equality published a review of progress made by the Strategic Health Authorities. More studies are required on illicit drug usage by ethnic groups. Since these groups are not homogenous, it is difficult to estimate the extent of drug usage by these groups. This holds good for infectious diseases as well – a potential tip of the iceberg phenomenon.
Health Equity Audit is now a requirement set out in the new NHS Planning and Priorities framework 2003 – 2006 to provide support to the Primary Care Trusts working with partners in the NHS and local strategic partnerships to undertake health equity audits. This provides a framework for systematic action. Many Department of the Government like the Department of Health, Home Office, Department for Environment, Food and Rural Affairs (DEFRA), Department of Work and Pensions, Department of Trade and Industry and Office of the Deputy Prime Minister have developed new targets to minimise socio-economic inequalities. Specific focus will be on Mental health, Cancer, Coronary Heart Disease, Health of the elderly, Teenage conception, Illicit Drug use, Physical Exercise and Accessibility to health facilities. The process involves identifying priorities and partners, doing an equity profile, identifying effective local action to tackle inequities, agreement with local partners on targets, secure changes in investment and service delivery and review progress and impacts against targets.
The London Health Observatory has developed new approaches to map and improve access to ethnicity data.
Although a good deal of research is being conducted on health issues of ethnic minorities some of them are uncoordinated and sporadic with a tendency to duplication. This makes it difficult to plan efficient and effective services.
CONCLUSION
As long as there are inequalities there will be migration of populations. This is an essential law of nature. How we approach it as a civilized society is what defines us from the fundamentalists or radicals.
The ethnic groups have to learn to hold onto essential values but be willing to relearn and readjust to a new culture. Similarly the local population have to differentiate between labelling someone a criminal because of a different attitude or a fool because of a different culture.
Children learn from their families and peers about accepting and respecting differences. Policies and politics can only provide an external scale of reference with punishment as a measure of controlling unwanted behaviour, but real changes can happen only if people genuinely understand the need to broaden their perspectives without being threatened by difference or change. A child who shares a good relationship with another child of a different culture is less likely to require an external tool of control. Good Health is but one aspect of a secure society.
REFERENCES
Tackling Health Inequalities: Summary of the 2002 cross-cutting review (HM Treasury, November 2002)
Guidance on tackling health inequalities through local Public Service Agreements (Department of Health 2002) Department of Health
Taylor L and Blair-Stevens, C (2002). Introducing Health Impact Assessment(HIA) : informing the decision making process. London: Health Development Agency
Cochrane, R. and Sashidharan, S.P. (1996) ‘Mental health and ethnic minorities: a review of literature and implications for services’, in CRD – Ethnicity and Health: Review of Literature and Guidance for Purchasers in the Areas of Cardiovascular Disease, Mental Health and Haemoglobinopathies. NHS Centre for Reviews and Dissemination: University of York
Putting race equality to work in the NHS- a resource for action Department of health 2002 Crown Copyrights
Promoting equality and diversity in the NHS: A guide for Board Members Department of Health 2002 Crown Copyright
Diversity Counts! LHO’s Ethnic Health Intelligence Programme Progress Report March 2004 Crown Copyrights
www.lho.org.uk
www.shef.ac.uk
www.cre.gov.uk
www.omhrc.gov
www.nursing-standard.co.uk
www.nhsinherts.nhs.uk
www.minorityhealth.gov.uk
