Transcript Ethnic inequalities in health: Findings from the London Health Observatory Dr. Jenny Mindell Deputy director London Health Observatory www.lho.org.uk.

Ethnic inequalities in health:
Findings from the London Health
Observatory
Dr. Jenny Mindell
Deputy director
London Health Observatory
www.lho.org.uk
Using ethnicity data
• Why is ethnicity important to health?
• Key ethnic differences in health in London
• What we know
• What we don’t know
• Filling the gaps
Ethnic Differences in Health Outcomes:
Mortality By Country Of Birth
Scotland
Ireland
Eastern Africa
Rest of Africa
Caribbean & West Indies
England & Wales
Bangladesh
Pakistan
Eastern Europe
India
Other South Asia
Middle East
Other Western Europe
South East Asia
Rest of World
0
20
40
60
80
100
120
140
160
Standardised Mortality Ratio (ages 20 - 69)
Bardsley et al‘ Developing Health Assessment for Black and Minority Ethnic Groups’ Health of Londoners Project/
London NHS 2000
180
Persons Reporting their Health as "Not
Good" in the last 12 months - aged 50+
ALL PEOPLE
White: British
White: Irish
White: Other White
Mixed: White and Black Caribbean
Mixed: White and Black African
ethnic group
Mixed: White and Asian
Mixed: Other Mixed
Asian or Asian British: Indian
Asian or Asian British: Pakistani
Asian or Asian British: Bangladeshi
Asian or Asian British: Other Asian
Black or Black British: Black Caribbean
Black or Black British: Black African
Black or Black British: Other Black
Chinese or Other Ethnic Group: Chinese
Chinese or Other Ethnic Group: Other Ethnic Group
0
10
20
30
40
50
% reporting 'not good' health
aged 50 to 64
aged 65 and over
60
70
Ethnic Differences in Access to Effective
Healthcare (Heart surgery)
Source: HES
Using ethnicity data
Determinants
of health
Age
Sex
Genetics
Income
Employment
Education
Housing
Social Networks
Mobility and migration
Environment
Prevalence of
ill health
and
health behaviour
Prevalence of specific
diseases e.g.
diabetes,
renal failure,
cardiovascular
disease
Limiting long
term illness
Healthy behaviour
and lifestyles
Service use
Health services:
hospitals,
primary care and
community services
Social Services
Voluntary
and
private sectors
Health and
service
outcomes
Mortality
Health status
Satisfaction
Determinants of health: risks
low income
poor quality housing
ethnicity
age
social class
unemployment
low educational attainment
geography
disability
gender
Landmarks
1991 - Census baseline ethnic data collected
1995 - Compulsory recording for NHS (01/04/1995, InPatients only)
2001 - Census new groups
2002 - Collection Targets in ‘Ethnic Monitoring Reports’
(London only)
LONDON: Ethnic composition at Census
1991
2001
40%
21%
79%
60%
LONDON: Ethnic composition at 2001 Census
LONDON: Ethnic composition at 2001 Census
1.1
5.3
0.8
1.6
4.8
1.9
2.2
2.0
6.1
0.9
0.8
0.5
59.8
1.0
8.3
3.1
White British
Irish
Other White
White and Black Caribbean
White and Black African
White and Asian
Other Mixed
Indian
Pakistani
Bangladeshi
Other Asian
Caribbean
African
Other Black
Chinese
Other ethnic group
The Cycle of Invisibility
DATA NOT COLLECTED
DATA COLLECTED /
ANALYSED BUT
DOESN’T FULLY
REFLECT LONDON’S
DIVERSE
COMMUNITIES
SOME DATA
COLLECTED –
BUT UNHELPFUL /
OUTDATED
INVISIBLE ETHNIC
INEQUALITIES
DATA ANALYSED
BUT NEEDS MORE
RESEARCH
DATA COLLECTED
BUT INCOMPLETE
DATA COLLECTED
BUT NOT
ANALYSED / USED
Ethnicity and Health
Dimensions of ethnicity
Health issues:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
nationality
birthplace
skin colour
language
religion
‘race’
migration experience
culture
infectious disease
diabetes
coronary heart disease
stroke
lung cancer
prostate cancer
Country of birth versus ethnic group in
London
Non-direct, complex relationship
• People from minority ethnic groups born in the UK
• People from ethnic groups other than BME born
abroad
• People from secondary migrant groups
– e.g. Asians born in East Africa - 22% of Londoners classified
as Indian at the 1991 census were born in East Africa
Percentage of all hospital admissions 1996/97 to 2000/01 coded
to different options for Ethnic Group
1996/67
White
35.6
Black Caribbean 2.3
Black African
1.9
Black Other
0.9
Indian
2.5
Pakistani
0.8
Bangladeshi
1.1
Chinese
0.2
Other
3.1
Not known
51.7
1997/98
42.3
2.9
2.7
4.7
3.1
1.0
1.2
0.3
4.6
37.2
1998/99
45.9
2.8
2.6
1.2
3.1
1.0
1.2
0.3
4.6
38.5
1999/00
44.0
2.8
2.8
1.3
3.0
1.0
1.3
0.8
4.9
38.5
2000/01
44.7
2.8
2.9
1.4
3.0
1.0
1.3
0.3
5.3
37.2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
Percentages
Valid Ethnic Coding Completed London Providers, 2001/02
100
90
80
70
60
50
40
30
20
10
Providers
Hospital admissions for cardiovascular disease, London
residents, 1997/98 to 2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
2000/01
1997/98
1998/99
1999/00
2000/01
White
Black Caribbean Black African
Black Other
White
Black Caribbean Black African
Black Other
Indian
Pakistani
Chinese
Indian
Pakistani
Chinese
Other
not known
Other
not known
Bangladeshi
Bangladeshi
Hospital admissions for coronary heart disease, London
residents, 1997/98 to 2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1997/98
1998/99
1999/00
2000/01
White
1998/99
1999/00
2000/01
Black Caribbean Black African
Black Other
White
Black Caribbean Black African
Black Other
Indian
Pakistani
Indian
Pakistani
Chinese
Other
not known
Other
not known
Bangladeshi
Chinese
Bangladeshi
Hospital admissions for myocardial infarction, London
residents, 1997/98 to 2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
White
Black Caribbean Black African
Indian
Pakistani
Other
not known
Bangladeshi
2000/01
1997/98
1998/99
1999/00
2000/01
Black Other
White
Black Caribbean Black African
Black Other
Chinese
Indian
Pakistani
Chinese
Other
not known
Bangladeshi
Hospital admissions for heart failure, London residents,
1997/98 to 2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
2000/01
1997/98
1998/99
1999/00
2000/01
White
Black Caribbean Black African
Black Other
White
Black Caribbean Black African
Black Other
Indian
Pakistani
Chinese
Indian
Pakistani
Chinese
Other
not known
Other
not known
Bangladeshi
Bangladeshi
Hospital admissions for dysrhythmia, London residents,
1997/98 to 2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
1997/98
2000/01
1998/99
1999/00
2000/01
White
Black Caribbean Black African
Black Other
White
Black Caribbean Black African
Black Other
Indian
Pakistani
Chinese
Indian
Pakistani
Chinese
Other
not known
Other
not known
Bangladeshi
Bangladeshi
Hospital admissions for hypertensive disease, London
residents, 1997/98 to 2000/01 by ethnic group and sex
Females
Males
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
2000/01
1997/98
1998/99
1999/00
White
Black Caribbean Black African
Black Other
White
Black Caribbean Black African
Indian
Pakistani
Chinese
Indian
Pakistani
Other
not known
Other
not known
Bangladeshi
Bangladeshi
2000/01
Black Other
Chinese
Hospital admissions for stroke, London residents, 1997/98 to
2000/01 by ethnic group and sex
Males
Females
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
1997/98
1998/99
1999/00
White
Black Caribbean Black African
Indian
Pakistani
Other
not known
Bangladeshi
2000/01
1997/98
1998/99
1999/00
2000/01
Black Other
White
Black Caribbean Black African
Black Other
Chinese
Indian
Pakistani
Chinese
Other
not known
Bangladeshi
“Diversity Counts” - The LHO Ethnic Health
Intelligence Programme
 More “one stop” access to
information
Census consortium
SKIL programme
Mapping ethnicity data sources
Hospital Episode Statistics (HES)
 Analysis of existing data
 New methods to overcome missing
NHS Direct
Injury datasets
Mapping Inequalities
data
Proportional admissions ratios
 Mapping care pathways
Refugee estimates
 Briefings/events dissemination
Sickle cell disease
Thalassemia
 Advocacy for ethnicity recording
Modernising Civil Registration
Lessons Learned
• Use what is already there
• Work in partnership to enable wider access to
information and its analysis
• Don’t make assumptions without careful
interpretation
• Make findings well known
• Campaign rather than complain for
modernising data collection on ethnicity