Why we need the Office for Minority Health

Background

According to the census in 2011, of the total 56.1 million population of England and Wales, 86% are White and of the remaining Black, Asian and Minority Ethnic population, 7.5% are of Asian heritage and 3.3% are black, 2.2% mixed ethnicity and 1% are other minorities. ¹ In the decade since 2001, the percentage of the population of England and Wales that was White British decreased from 87.4 to 80.5%, while the Other White group saw the largest increase in their share of the population, from 2.6% to 4.4%. In the same period, among the specific ethnic groups, people from the White British ethnic group made up the largest percentage of the population (at 80.5%), followed by Other White (4.4%) and Indian (2.5%). The number of black Africans doubled over the same period, from 0.9 to 1.8%. ²

The current COVID-19 pandemic and tragedy of the murder of George Floyd in Minneapolis and subsequent campaign around the world on Black Lives Matter have further highlighted the differences among ethnic and racial groups on a number of parameters and for a number of reasons.^3,4 There is no doubt that minority ethnic groups and minorities in general have faced and continue to experience tremendous discrimination in a number of fields including education, employment and health in particular. Death rates among Black, Asian and Minority Ethnic populations are strikingly high in the pandemic and concerns have been raised both for general population and NHS frontline staff dying as a result of infection. A number of explanations have been put forward varying from poverty, overcrowding, high ethnic density, pre-existing chronic co-morbid conditions to other less known factors. ⁴

Research in health, including mental health, over the past five decades in the UK has shown high rates of various physical and mental illnesses in Black, Asian and Minority Ethnic groups. Some Black, Asian and Minority Ethnic groups have shown elevated rates of schizophrenia (3--7 times), ⁵ whereas others show high rates of depression and self-harm (2–3 times higher) ⁶ than the native White population. Similarly, Black, Asian and Minority Ethnic groups show variation in rates of physical illnesses. Prevalence of type 2 diabetes is substantially higher among Bangladeshi, Pakistani, Indian, Indo-Caribbean, black African, black Caribbean and Chinese populations. ⁷ Prevalence of angina is higher among Pakistani men at all ages, and for Indian women; and Pakistani men and women aged 55 years and older have a higher prevalence of heart attacks, ⁸ the prevalence of hypertension is highest in black Caribbean groups, while Pakistani women have among the lowest prevalence. ⁸ Rates of all sexually transmitted infections, including HIV, are highest among black ethnic groups. ⁹ The prevalence of longstanding illness also varies across different ethnic groups. ¹⁰ Some groups like the Chinese have shown better health than their white counterparts. ¹¹ There are also clear gender differences in the incidence and prevalence of physical and psychiatric disorders. To complicate matters further, not surprisingly there are cultural differences in behaviours. For example, smoking rates remain high in some Black, Asian and other Minority Ethnic groups, such as black Caribbean and Bangladeshi men and black Caribbean women. ¹² Pakistani and Bangladeshi groups report low levels of physical activity. ¹³ Alcohol consumption is far lower among black, Asian and other minority ethnic groups – but, of those people who do drink, a large proportion of men from Indian, black Caribbean, black African and Chinese populations do consume above recommended levels. ¹⁴ There are also clear religious differences in consumption of alcohol and drugs. Diet is generally similar or better among Black, Asian and other Minority Ethnic groups, except for the use of salt in cooking, which is high among black African and Bangladeshi men and black Caribbean and Indian women, which may explain some of the variation in rates of hypertension. ¹⁵ Some Black, Asian and other Minority Ethnic groups in the UK are more likely to be overweight or obese, ¹⁶ and they are at greater risk of ill health at higher body mass index levels as has also been seen in relation to deaths due to COVID-19. ¹⁷ Thus there are clear social and cultural factors in differential rates, access to services, response to treatment and outcomes in both physical and psychiatric disorders.

There are other factors which affect health directly or indirectly. For example, there is a clear differential attainment in education and also difficulties in obtaining employment. ¹⁸ There are clear differences in longevity across Black, Asian and Minority Ethnic groups. ¹⁹ Some of these factors may be attributable to ethnic variations but social inequalities, generational inequalities and social determinants appear to contribute a large part to this. Racism, discrimination and prejudice tend to play a major role in creating double and triple jeopardy where people from ethnic minorities choose not to seek help with delays contributing to chronicity of their conditions and resulting in poorer outcomes. ²⁰ Services in general are not culturally sensitive or competent adding another layer to the complex nature of help-seeking.

In contrast to 14% of the UK population being Black, Asian and Minority Ethnic, the numbers in prisons are 24% although there are ethnic variations. In partnership with the Department of Justice, the Office for Minority Health must extend its reach to prisons where the proportion of Black, Asian and Minority Ethnic prisoners with underlying health problems is likely to be high. ²¹ The effects of incarceration are felt far beyond prison and jail walls and impact the health not only of prisoners but also that of their families and dependents. It is well-known that the rates of incarceration among certain ethnic groups such as blacks are higher as are rates of psychiatric and physical disorders as compared with the general population and majority groups. In addition, their needs for housing, employment and educational opportunities after release are very often ignored. Thus, in order to deliver equity, there must be a joined-up thinking and planning between health, education, employment, justice and other ministerial departments.

The UK, like the rest of the world, is today facing ever-increasing global multidimensional challenges that are shaping the geopolitical landscape of health and social care like climate change, globalisation, migration, etc. These geopolitical factors have crucial links with population health at a number of levels.^22,23 As Khunti et al. ²⁴ have observed the effect of COVID-19 on ethnic minorities and have suggested five action points for the government from better data capture to accountability at ministerial level, we believe that this can occur only if there is the Office for Minority Health. We recognise that there is a danger that services and policies may become more isolated rather than mainstream but this approach also offers the focus on the special needs in delivering healthcare to ethnic minorities.

We urge the government to establish an Office for Minority Health as a matter of urgency. We know the problems and there have been many enquiries in the past looking at the issues related to health of Black, Asian and Minority Ethnic groups. We recommend that Office for Minority Health be set up as a public body within the Cabinet Office so that it gets the status it deserves. This needs to be established by an Act of Parliament to act as ‘public authority’ to deliver public duty.

Aim of the Office for Minority Health

The aim of such an Office for Minority Health will be to improve the health of racial and ethnic minority groups through the development of culturally relevant and culturally appropriate health policies across the lifespan of individual, leading to culturally appropriate services which are more likely to be used by the Black, Asian and Minority Ethnic groups. The Office for Minority Health will also focus on health promotion, illness prevention and health improvement at population, community and individual levels and also through healthcare systems thereby helping eliminate health disparities.

Its main role is to keep under review elimination or otherwise of ethnic inequalities across government, statutory organisations and bodies, social institutions and others.

Mission

The Office for Minority Health’s mission will be to act as a repository of data on health discrepancies of the Black, Asian and Minority Ethnic populations as well as examples of good practice. By helping develop evidence-based health and social care policies, the Office can help achieve health equity between mental and physical health and across ethnic groups in one generation. It is crucial that the Office generates closer working with stakeholders and research funders to ensure that studies have a true representation of Black, Asian and Minority Ethnic participants and all studies include these groups. By setting up local demonstration programmes in order to contribute to health policy and the effectiveness of strategies for improving health by outcome measurement and evaluation, it can provide a clear lead on the importance of elimination of disparities. Such an approach can improve both quality and data collection. It will be able to help develop research questions and public education programmes. It can facilitate strengthening clinical, research and policy networks, coalitions and partnerships to identify and solve health problems through working with faith, religious, community leaders, voluntary agencies, teachers and other community participants.

Functions

In fulfilling its mission, the Office for Minority Health will help monitor the life outcomes and experiences of the Black, Asian and Minority Ethnic groups by providing guidance on how to best advance life chances and achievements. It will facilitate and develop a dataset and framework to monitor, map and measure performances of institutions on a number of parameters across its statutory remit. The Office will provide educational oversight across all areas of learning, schools, undergraduate and postgraduate training.

Outcomes

The Office for Minority Health, in the first instance, will develop and deliver the resources to support health equity through setting up the repository of data, reports and examples of good clinical practice from around the world to provide a key resource for the Black, Asian and Minority Ethnic communities, researchers, policymakers, patients, their carers and families, and other healthcare professionals. It will offer capacity building and technical assistance, services designed to increase the strength and competence of healthcare professionals in delivering culturally sensitive public health and therapeutic interventions. It will help set standards and ask all the Hospital Trusts to meet these standards and a charter/kitemark to those which meet these standards. The Office for Minority Health will facilitate and help organisations to deliver culturally and linguistically appropriate services in hospitals, primary care, prisoner care, schools, universities and public health. Since the NHS Trusts are responsible for healthcare of local prisons, the Office for Minority Health has a role to play at various levels in meeting the health and social care needs. There is no doubt that access to healthcare and improved health status will lead to improved opportunities for employment, housing and family support especially if cultural variations are embedded in the rehabilitation process. By publishing regular reports to be laid before the UK Parliament, it will be answerable to the Parliament scrutiny.

The Office for Minority Health has the potential to bring everything under one roof, cut bureaucratic costs and integrate research and joined up delivery of healthcare across life span for Black, Asian and Minority Ethnic individuals who need help in different settings. It will enable creating a database and be a repository of good practice with access to examples across the NHS and from other parts of the world. It will also work with regulatory bodies like the General Medical Council, Nursing and Midwifery Council, Care Quality Commission and other bodies for other healthcare professionals to ensure uniform data and standards are applied.

Making progress against these major problems of inequalities will require dedicated work for a long time, perhaps over a generation. This progress is certainly possible if we are able to learn and understand why and how the UK is changing, what the healthcare needs of its various multicultural society are, and how best to bring about equity and fairness in research, policy and clinical services including public health.