People from ethnic minorities
Population Outcome: People from ethnic minorities in Suffolk and North East Essex have Health Equality
People in Suffolk and North East Essex should have the same opportunity of good health and wellbeing, dignity and respect regardless of their circumstance, this should include people from ethnic minority groups who are currently disproportionately affected by socio-economic deprivation, which is a key determinant of health status, and are more likely to report being in poorer health and to report poorer experiences of using health services.
Population by Ethnic Group
A more detailed breakdown by ethnic group is available in the 2021 census data.
The Story Behind the Outcome
Check your Privilege
Culturally competent care
Culturally compassionate care
Adjusting to life in a new country
Inequalities – maternity care
The Royal College of Obstetricians and Gynaecologists highlights:
- Black, Asian, and minority ethnic women can receive a lower quality of care and experience poorer health outcomes, including higher rates of morbidity and mortality, than other women.
- Implicit racial bias from medical staff can hinder consultations, negatively influence treatment options and can ultimately result in Black, Asian and minority ethnic women avoiding interactions with health services
- Medical research must become more inclusive to ensure that all girls and women get the right advice and treatment.
NHS Race and Health Observatory review of evidence of ethnic inequalities in healthcare highlighted:
- Communication: A lack of trust, insensitive behaviour, lack of active listening by providers, and failure to bridge cultural differences. For those without English skills, a lack of accessible and high quality interpreting services.
- Experiences: Negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity. System-level factors, and the attitudes, knowledge and behaviours of healthcare staff, make some feel ‘othered’, unwelcome, and poorly cared-for. These factors undermine trust and feed fear, leading to poorer access to, and engagement with services.
- Access to community services: Ethnic minority women feel underserved by community-based services.
- Deprivation/disadvantage: The intersection of additional aspects of social disadvantage can further compromise access to, and experiences of, maternity care. Groups of particular concern include Roma, Gypsy and Traveller women, asylum seekers or recent refugees, those with mental health conditions, teenage and young parents.
Inequalities – healthy living
In September 2020, the prevalence of food insecurity in black and mixed ethnicity households with children was nearly 50 per cent higher than in white ethnicity households with children.
Health behaviours – Health Survey for England (HSE) 2019:
Drinking above recommended levels (14 or more units a week) was most common among white Irish men (45%) and women (26%) and was also high among white British men (36%) and women (18%). The groups least likely to report drinking alcohol in the last year were Pakistani men (9%) and women (2%) and Bangladeshi men (13%) and women (8%).
Those least likely to be regular smokers were men from black African (9%), Indian (12%) and Chinese (12%) backgrounds. Indian (2%), Pakistani (3%), Chinese (3%) and black African (4%) women were least likely to be regular smokers.
Chinese women (22%) and men (36%) were least likely to be overweight or obese. Women from black Caribbean (74%), Pakistani (74%) and black African (73%) backgrounds were most likely to be overweight or obese.
Dentistry and oral health
A high level of caries is experienced among preschool and school children from Pakistani, Bangladeshi, Chinese and East European backgrounds, even after controlling for levels of socioeconomic deprivation
Afro-Caribbean children generally had better or similar oral health than White children
Inequalities - living with obesity
Deprivation: in the most deprived areas in England, prevalence of excess weight is 13 percentage points higher than the least deprived areas
Disability: among people with disabilities, excess weight is 11 percentage points higher than among those without disabilities.
Ethnicity: Of all ethnic groups in the UK, Black people have the highest rates of excess weight – 67.5% of Black adults were overweight or obese – with White British people having the next highest rates of excess weight than (63.7%)
Education and socio-economic background affect the prevalence of obesity. Reciprocally, obesity contributes to reinforcing existing social inequalities – Compared with non-obese people, obese people have poorer job prospects, are less likely to be employed, have more difficulty re-entering the labour market. They also earn about 10% less than their non-obese colleagues
Among people with no qualifications, rates of excess weight are 12 percentage points higher than among people with level 4 qualifications or higher (i.e. a degree)
Inequalities – mental health
Source: Centre for Mental Health
The Race Equality Foundation’s literature review showed inequality and discrimination impacts across mental health services:
- Less likely to access mental health support in primary care and more likely to end up crisis care.
- Barriers: lack of knowledge of mental health care, different cultural attitudes or ideas about mental health, relationships with local healthcare practitioners, and institutional attitudes towards those with complex lives or needs.
- Poor physical health can lead doctors to focus on them even though some conditions are complicated by mental ill-health.
- Ethnic bias includes greater uncertainty by some clinicians in diagnosis of emotional problems and depression.
- Less likely to be referred to talking therapies and more likely to be medicated for ill mental health.
- The impact of racism and wider inequalities on their mental health is not sufficiently addressed.
- Traumatic, inappropriate and discriminatory experiences of services impact on chances for recovery.
- Eurocentric approach to recovery does not take a race equality perspective and external factors.
Gaps in evidence:
- More evidence is needed on the inequalities for Gypsy, Roma and Traveller communities; the Chinese community; and Eastern European ethnic groups including Slovak, Czech and Romanian.
The Centre for Mental Health is developing A coproduced approach to tracking young Black men’s experiences of community wellbeing and mental health programmes living in a predominantly white society:
- Feeling pressure to change your identity to fit into white-centric society.
- Feeling undervalued and unappreciated.
- Blackness: “As a Black man you have to protect your identity, otherwise no-one else will.”
- Constantly being a minority in every space being a negative feeling, which creates a constant state of “uncomfortability”.
- Always being expected to be strong, tough and to not talk about vulnerabilities or mental health.
- Always being watched and feeling unable to make any mistakes. “Failures [by Black men] are screamed out and accomplishments are whispered.”
- Feeling disappointed and disheartened by the lack of change. “I see the fanfare of equality and diversity, but at the end of the day nothing changes [at work].”
- Feeling sceptical and triggered by disingenuous support of Black Lives Matter by white people.
- Feeling hypervigilant and “paranoid of each other, which in itself is a mental health issue”.
Young Black men said they valued support which is empowering, embraces positive Black identity, strengthens strategies for dealing with racial trauma. improves connection and relationships, promotes personal ‘growth and evolving’, incorporates spirituality, improves awareness of mental health, and enables better access to resources, education and employment.
Inequalities – cancer
White people more than twice as likely to get some types of cancer, including melanoma skin cancer, oesophageal, bladder and lung cancers
Black people are more likely to get prostate cancer, myeloma (a type of blood cancer), womb cancer, stomach and liver cancers
Asian people are more likely to get liver cancers.
differences are likely largely, but not entirely, driven by non-genetic cancer risk factors.
White people are generally more likely to attend screening
Inequalities - cancer care
In 2018 the Race Equality Foundation found:
- Patients who are members of black and minority ethnic groups report more negative experiences of cancer care than white ethnic groups.
- Understanding the prevalence and experiences of cancer in black and minority ethnic groups is hindered by a lack of data relating to these communities.
- Health care providers have a poor understanding of the needs of black and minority ethnic communities.
- There is a lack of health education regarding cancer and awareness of the availability of support services is limited among black and minority ethnic communities.
- There is a lack of cultural competence education for health providers, especially in cancer awareness.
Macmillan highlights that for Gipsy and Traveller communities:
- A lack of understanding in hospitals of Gypsy and Traveller culture can result in ill-treatment, leading to many avoiding services where they have had negative experiences.
- Displaced Travellers who are forced to stop in illegal or unsafe places have difficulty registering with a GP practice, leading to overdependence on A&E and late presentations at the point of crisis.
- Levels of literacy can lead to difficulty completing forms and accessing information.
- A culture of self-reliance can impact on acceptance of a life-threatening diagnosis and mental health needs such as stress, anxiety and depression.
- Gypsy and Traveller communities need culturally sensitive support recognising their needs and preferences for the ways and places that they are cared for, the importance of family networks, and gender roles in the community.
Inequalities – ethnic minority carers
- Lack of culturally accessible services.
- ‘a mutually reinforcing cycle’ where ethnic minority carers perceive that the available services are ‘not for them’, and services do not do enough to reach out to minoritized communities if carers do not access services.
- Many ethnic minority communities feel that it is their duty to care for relatives, not seeing themselves as ‘real carers’, believing have to look after themselves, or feeling pressured to all caring themselves, making it harder to recognise they need help or to ask for it.
- If mainstream organisations don’t participate in community engagement activity or do so sporadically, this can alienate ethnic minority carers.
- In some languages there is no direct translation of ‘carer’ making it harder to explain the role and the carer’s own needs to the cared-for person or family.
- Traveller families who have no fixed address may not be accepted by local health services.
Ethnic disparities in healthy ageing
1.The health status of different ethnic groups begin to diverge at around 30 years of age, when the gap in health between ethnic minority and White majority groups gets gradually larger, particularly pronounced in later life.
2.At any given age after 30, Pakistani and Bangladeshi people experience the highest rates of poor self-rated health; their rates of poor health are equivalent to those of White people who are at least 20 years older.
3.These ethnic health inequalities have persisted, unchanged, for almost 25 years.
4.Ethnic health inequalities result from experiences of racism and racial discrimination, which directly cause physical and mental stress, and indirectly impact through their effect on socioeconomic status.
1.Close the ethnicity data gap – mandatory reporting on ethnicity, using specific categories (e.g. Pakistani, Bangladeshi, Indian) rather than broad categories (e.g. South Asian); sufficient representation of ethnic minority groups in surveys and ask about their experiences of racism and racial discrimination.
2.Produce and implement a national race equality strategy – which takes into account healthy ageing; includes recovery from the effects of the pandemic; and takes a life-course approach to prevent inequalities in later life.
3.Address inequalities in all policy activity relating to people in and approaching later life.
Inequalities in access to hospice care
Certain groups are under-represented in accessing hospice care:
- The oldest old (over 85) – though this is changing
- Ethnic groups – in particular Pakistani, Indian, Bangladeshi, Caribbean, Chinese, African
- Those living in rural areas – exacerbated by costs and time travelling
- People living in deprivation – in particular if they lack health literacy and knowledge of services
Non-cancer conditions e.g., chronic chest and heart disease, dementia, frailty, cystic fibrosis, liver disease, and learning disabilities:
- Prolonged needs and difficulties in determining when in the terminal stage leads to late or no hospice referral.
- The needs of the growing numbers with multimorbidity and frailty presents a major challenge.
Non-hospice care can be a choice, rather than an inequality:
- Where care needs are better met by other services e.g., care homes.
- For those with longstanding trusting relationships with their GP and Community Nursing Team.
- Ethnic minority people with cultural and religious needs at the end of life may prefer their community’s care.
- However, those with concerns over social prejudice may have less access to hospice care, or specific care needs.
The research concluded that these inequalities are the responsibility of the whole health and social care sector, and need a collaborative and innovative whole-systems approach.
References & Further Reading
What we know matters to people and why
|I have my race and ethnicity recognised and recorded||Recording and using information on my race and ethnicity means that my risk of health conditions e.g diabetes, heart, and some cancers, can be identified early, and may be prevented.|
|I have equality of access to health and care||Information on my rights and options for care and support, shared in the right way for me, means I can make the right decisions and know what to expect from my care.|
Understanding the impacts of race discrimination on my health, and actively tackling the barriers I face, means I have access to the right care at the right time.
Full access to interpreters and translated materials mean I can be a full partner in my care.
|I receive high quality care||High quality, culturally competent, compassionate and sensitive trauma informed care, enables me to have better outcomes for my health and wellbeing.|
Understanding my identity, and what is important to me, means my needs and choices are respected and met.
|I am seen and heard||Being treated with respect, not experiencing stereotypes, assumptions, bias, prejudice or discrimination, means I can have trust in the professionals who provide my treatment, care and support.|
Actively listening and responding to my concerns, feelings and experiences, and giving me choice and control, means my care, e.g. in mental health and maternity, and my care for others, is safe and effective.
How will things be different in Suffolk and North East Essex
|We will ensure recording of ethnicity is accurate and complete for everyone, using this information to inform evaluation of health risks and decisions on care.||We will tackle barriers in access to, and quality of care for people from ethnic minorities, in particular in maternity, mental health, cancer, healthy ageing and family carers.|
|We will co-produce information in the languages and formats that people need, taking time to explain and making sure any information is fully understood.||We will ensure care and support respects people’s lived experiences,and is delivered sensitively and flexibly.|
|We will co-produce awareness raising and training on diversity of race and ethnicities; how structures and systems discriminate against ethnic minorities and the barriers people face; conscious and unconscious bias in health and care; and culturally competent care.|