Appendix 4. Initiatives in the East Midlands to Address Health Inequalities Between Ethnic Groups: Results of a survey undertaken by Champa Patel in May-July 2004 on behalf of EMPHO and Voice-East Midlands

Initiatives in the East Midlands to Address Health Inequalities Between Ethnic Groups: Results of a survey undertaken by Champa Patel in May-July 2004 on behalf of EMPHO and Voice-East Midlands.

A Rapid Mapping Study of Smoking Projects and Services Targeted at People Living on Low Income and/or Minority Ethnic Groups

This is a study concerned with community based services aimed at smokers living on a low income and/or black and minority ethnic groups.

Health monitoring for black and minority ethnic groups

This paper explores some aspects of health monitoring in relation to black and ethnic minority populations in London. It considers where research in London and elsewhere has shown evidence of inequalities between ethnic groups, and draws out the issues for recording, analysis and sharing of ethnic-specific data.

Ethnic Minorities

London is the most ethnically diverse city in the UK. Census 2001 population figures suggest that: 40% of Londoners belong to a minority ethnic group, including the White Other and White Irish groups. The White Other (8%), Indian (6%), Black African (5%) and Black Caribbean (5%) groups are the largest in London. With the exception of the Pakistani group, London has the largest population from all ethnic minority groups out of all regions of England. There are wide differences in the proportion of the population from an ethnic minority group in different London boroughs, ranging from 71% in Brent to 8% in Havering.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

More Than Words Conference Report (PDF 439KB)

Hosted by the Regional Health and Social Services Interpreting Project for Black and Minority Ethnic Groups

Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Limerick Seed to Plate

The aim of the project is to address an identified need in the community, promoting healthy eating and organic home-gardening practices. Building on the success of a pilot intergenerational project entitled "Through the Years", it became apparent that gardening related activities could be implemented and promoted on a larger scale, reaching the wider community, groups and classes. The project serves as a setting for community education and will be inclusive in helping reduce isolation by providing meeting places for all members of their local communities. Key people being targeted are older people, local families and residents, Limerick Youth Service, After School Clubs, the Garda Youth Diversion Project and the Family Resource Centre. The Limerick Seed to Plate works with gardeners whose primary focus is to develop the gardening projects further. There is a strong educational emphasis to the project and the learning is transferred to participants own homes and lifestyles. Southill has a community café and, where possible, food grown in their garden is showcased and cooked in the centre and café. The Community Food Initiative strengthens the existing healthy eating habits in the community and aims to result in increased long-term health benefits arising from a healthier lifestyle. Communities will benefit from the project which will create employment, build bridges between communities, promote social inclusion and provide a focus for the local areas. Part of theDemonstration Programme 2010-2012 Location Limerick Target Groups At risk youth Children ( 4-12 years) Children (0-4 years) Children (13-18 years) Families Lone parents Low income families Men Migrant, minority ethnic groups Older people Travellers Unemployed Women

WTID Community Garden

WTID rents allotments to members of the community which promotes grow your own. HSE West; FAS CE scheme; Involve: Senior Youth Worker; Department of Children and Youth Affairs: Childcare Service; Pobal Initiative Type Community Food Growing Projects Location Galway Target Groups At risk youth Children ( 4-12 years) Children (0-4 years) Children (13-18 years) Families Lone parents Men Migrant, minority ethnic groups Older people People with mental health difficulties Travellers Unemployed Women Funding HSE West; FAS CE scheme; Involve: Senior Youth Worker; Department of Children and Youth Affairs: Childcare Service; Pobal Partner Agencies Equal Ireland FÁS Galway County Council GCCCC GRD HSE Involve RAPID VEC Adult Education Service

KASI Community Garden

KASI acquired a site from Killarney Parish for a community garden project. The community garden provides a form of activity through volunteerism for asylum seekers in direct provisions who are not allowed to work. The participants will focus on growing crops and developing the garden which will facilitate interaction between the target groups and local communities in a very holistic and organic manner of working together, sharing and exchanging ideas, skills, crops, food and culture. KASI is developing a community garden on the outskirts of Killarney town. The sedentary lifestyle in direct provisions can cause isolation, depression and other mental health issues for asylum seekers. The community garden project provides a space for migrant workers and their families (most of whom live in flats and apartments and do not have access to a garden space) to grow their own crops. The community garden project will provide training on organic gardening, nutrition, healthy eating habits,cooking on a budget, cookery demonstrations and an opportunity for participants to exchange skills, knowledge, recipes and food. In addition, the project will enable locals to get information on nutritional values of herbs and authentic, healthy ethnic recipes. This initiative could also facilitate KASI influencing the diets and menu in direct provision centres. KASI will open a social space for training and cookery demonstrations for target groups and locals. Part of theDemonstration Programme 2010-2012 Initiative Type Community Food Growing Projects Location Kerry Target Groups Migrant, minority ethnic groups

Information sources on ethnicity and health and healthcare

This report provides a summary of work to date on a joint regional mapping project of ethnicity and health inequalities. It also covers equity of access to health care and initiatives (national and local) to address health inequalities between ethnic groups.

Ethnicity Coding

The incidence, prevalence, and mortality of many diseases are known to vary by ethnic group.There are well documented inequities in access to prevention, treatment, and palliative health and social care services based on ethnic group. There are, too, reported differences in the quality of services received by different ethnic groups and of outcomes of treatment and care. Many of these inequities are amenable to change. However, in order to address them they must, first of all, be comprehensively defined and documented. Mainstreaming ethnic monitoring/data collection is a vital step in the process. The history of such data collection in the NHS is poor, whichever of the key datasets is examined: hospital episode statistics, general practitioner data, cancer registrations, and disease registers. While steps are now being taken to remedy some of these deficiencies, the continued non-availability of ethnic monitoring data and in some cases of compatible ethnically-coded denominator data remains a problem. In particular the lack of ethnic group in births and deaths data has been the subject of widespread comment by specialists in demography and public health and is probably the single action that could most improve the evidence based for addressing ethnic/racial inequalities in health and health care.

Indications of public health in the English regions - 4: Ethnicity and health

Part 4 of the Indications of Public Health for England. This report focuses on race equality and inequality terms of health and health care between ethnic groups in England. A separate Executive Summary is available (it is included in this full version of the report).

Indications of Public Health in the English Regions 4: Ethnicity and Health: Executive Summary

This is a summary of the main report that provides a comprehensive regional analysis of inequalities in health and health care between ethnic groups in England, and also examines workforce data by ethnic group.