How is ethnicity relevant to health and health inequalities
In England, the term ‘health inequalities’ is generally understood to mean differences in health status between different population groups that are unfair and avoidable.
The UK has long been recognised as a multi-ethnic society, and the ethnic diversity of the population is continuing to increase.
Ethnicity is a multidimensional concept with numerous links to health and a salient social identifier in modern Britain, shaping community dynamics and people’s social and economic opportunities.
According to the Centre of Dynamics of Ethnicity (CoDE), diversity is associated with higher social cohesion and a greater tolerance of each other’s differences. Moreover, diversity brings about variety in abilities, experiences, and cultures, which can lead to innovation in local economies and therefore benefit local communities.
By further recognising the role that ethnicity plays in our society, we can have a bigger impact on supporting healthier populations, not just in the UK but across the globe
Engaging with ethnic inequality
As ethnic identities have implications for health independent of other socioeconomic factors, incorporating an explicit focus on ethnicity and inequalities in health in everything we do is important for driving positive improvements for diverse communities. Without this explicit consideration, there is a risk of partial understanding of the factors leading to poor health outcomes.
Increased awareness and understanding of the ethnic mix of a local population can improve the delivery of health and wellbeing services, through better engagement from diverse communities and a targeted use of resources. However, research indicates that public health and healthcare commissioners in England often feel uncertain about engaging with ethnic inequality, as it is an issue that can be seen as contentious and complex. As a result, there is not enough action, particularly at a local level, of reducing ethnic inequalities in health.
Action to reduce ethnic inequalities
Action to reduce inequalities lies at the heart of our mission. As such, PHE’s Health Equity team – in collaboration with partners in the Institute of Health Equity (IHE) and the University of Sheffield – led on producing the first national resource to help public health professionals, commissioners and local decision-makers engage in action to reduce ethnic inequalities. This aims to:
- provide evidence on the patterns and causes of ethnic inequalities in England;
- promote an integrated approach to reducing health inequalities;
- inform discussion and action on health inequalities, both on a local and national level;
- provide material on ethnicity and health for use in local joint strategic needs assessments and local health and wellbeing strategies; and
- identify key gaps in data by ethnic group and areas in need of better evidence for action.
As part of this resource, an overview paper identifies some general approaches that can help to embed attention to ethnicity within health inequalities work, and covers a wide range of information including:
- key indicators of health status by ethnic group, including mental ill-health, cancer incidence, obesity and tuberculosis;
- ethnic inequalities in the social determinants of health, including education, employment, income and housing;
- health-related practices including smoking, alcohol consumption, physical activity and healthy eating;
- access to services and interventions including health promotion and preventive interventions, and primary care and community health services; and
- ways to incorporate ethnicity within action on health inequalities.
The resource also includes practice examples of promising local action aimed at addressing ethnic inequalities in health and healthcare, and improving the lives of different ethnic communities. These examples can provide other local areas who want to embed a focus on ethnicity within their health inequalities work with information and inspiration as to how to get going.
The World Congress on Migration, Ethnicity, Race and Health
We had the privilege of hosting an invited workshop and presenting the findings of the resource at the first World Congress on Migration, Ethnicity, Race and Health (MERH) in May 2018 in Edinburgh.
The workshop stressed PHE’s role in helping to protect and improve the health of migrant and ethnic minority populations. It was very well received and led to a stimulating discussion among an international audience of academics, public health professionals and decision-makers from a range of organisations. They welcomed insights on patterns and determinants of health by ethnic groups in England, as well as effective approaches to inform action on ethnic health inequalities.
Effective action in this area will help meet the legal duty the Secretary of State for Health, NHS England and Clinical Commissioning Groups have regarding the need to reduce health inequalities and to comply with the Equality Act 2010. The need for action in this area was also recently highlighted by the Prime Minister’s Race Disparity Audit (RDA), which confirmed that a concerted effort by Government, multiple partners and communities working collaboratively is required to address disparities and ethnic inequalities.
We hope to see this resource being used widely moving forward to help meet the legal duty and RDA’s call to address disparities.
We also hope it helps to inform local joint strategic needs assessments and health and wellbeing strategies, as well as local discussions among members of Health and Wellbeing Boards.
Lastly, we’d like to see it change perceptions around the challenge of engaging in this agenda, ultimately inspiring joint local action to improve both the quantity and quality of action on reducing health inequalities within ethnic minority populations.