Race

1  Introduction

This is one in a series of needs assessments regarding protected characteristic groups to support compliance with the public sector Equality Duty (The Equality Act 2010).

The document is intended to raise awareness of the key public health, and health and social care considerations relevant to people with disabilities; and to provide a starting point to inform the development of Equality Impact Needs Assessments (EINAs).

Race is a protected characteristic under the Equality Act 2010, and refers to a group of people defined by their race, colour, and nationality (including citizenship), ethnic or national origins[1].

As outlined in the definition above, race is a complex concept requiring consideration of a number of related characteristics, some of which are based on personal subjective perception. Also, for many people from different ethnic backgrounds, religion, belief and language are core components of ethnicity and all should, where possible, be considered together, in order to obtain an effective understanding of ethnicity in the borough.

Consistent with this, adopted standard demographic categorisations, such as used in the Census are a complex mixture of race, ethnicity and nationality. The relevance of different local groups means that Richmond has adopted its own sub-categorisation for equality monitoring. Table 1, shown below, reconciles the ONS (n=18) and Richmond (n=21) ethnic group, and aggregate ‘broad’ (n=6) and ‘top level’ (n=3) sub-groups.

Table 1: Ethnic group categories

Given the inevitably limited ability of categorisations to fully reflect the complexity of race and ethnicity, it is important to recognise that gaining true holistic local understanding of groups and their characteristics and needs, can only be achieved by complementary consideration of associated characteristics including language, religion, and other socio-economic factors such as age, gender, income, education, occupation, and their variation across neighbourhoods and other geographic areas.

For ease of reference and due to the fact that much of the source data adopts the term ethnicity to encompass these characteristics, including race collectively, the terms ethnicity has been adopted as an over-arching term of reference in this report.

2  Background

While the health issues facing particular ethnic groups vary, overall, people from BME and some non-British white ethnic groups (e.g. Irish, Gypsy/Travellers) are more likely to have poorer health than the White British population. This represents an important health inequality.

A well-documented body of evidence demonstrate that the reasons for this are multiple, and likely to be influenced to varying degrees by the following determinants of health:

• Genetically inherited susceptibility to particular health risks and diseases.
• Socio-economic disadvantage (e.g. income, employment, housing).
• Health related lifestyles and behaviours (e.g. exercise, diet, smoking).
• Difficulties with access (e.g. language, awareness, isolation, inadequate cultural sensitivity, discrimination) to and lower utilization of disease prevention and health care services.

Little health outcome data is available on Richmond’s residents from different ethnic groups. However, insight into the health and needs of ethnic groups in Richmond can be provided by national data and research from elsewhere. Key example health issues are summarised below by main ethnic groups.

2.1.  Health outcomes

2.1.1.  Irish

• 27.8% of the Irish ethnic group consider their health to be fair, bad or very bad; compared to 20.0% of the White British group.[2]
• The Irish population in the UK have a history of higher rates of mental ill-health than the general population, are substantially over-represented as users of psychiatric services, and have the second highest rate of schizophrenia by ethnic group.[3]
• Disproportionately high levels of hypertension, coronary heart disease and stroke are reported in those of Irish descent.5
• Irish men are more likely to smoke and have higher rates of lung cancer mortality.[4]

2.1.2.  Gypsy/Irish travellers

• The Gypsy/Irish Traveller group have the highest percentage (29.8%) of people who consider their health to be fair, bad or very bad; compared to 20.0% of the White British group.[5]
• Research shows that Gypsy/Traveller communities are twice as likely to report anxiety and respiratory problems (e.g. asthma & bronchitis) as health problems, and five times more likely to report chest pain.[6]

2.1.3.  Other white groups

• The UK has experienced an increase of migrants from Eastern Europe in recent years. Research suggests that new migrants are likely to experience higher rates of communicable disease, occupationally linked disease, and poor mental health.[7]

2.1.4.  Asian groups

• South Asians are at increased risk of cardiovascular and renal complications, with a 50% higher complication rate.[8]
• South Asian people have higher rates of liver cancer and south Asian women have higher rates of mouth cancer.[9]
• The largest proportion of tuberculosis cases in 2011 in the UK were Indian (26%). There is a strong stigma attached to TB in many minority communities which may stop individuals seeking help from health services.
• The prevalence of learning disability is three times higher than average for the South Asian population. However, it is thought that they are underrepresented in the uptake of specialist services.
• There is a greater risk of developing cataracts in Asian populations.[10]
• Bangladeshi men are more likely to smoke.[11]
• Women from BME groups have lower uptake of cervical screening services, and South Asian women aged over 65 years have higher incidence of cervical cancer.[12]

2.1.5.  Black groups

• While 22.9% of the Black Caribbean group consider their health to be fair, bad or very bad, compared to 20.0% of the White British group, the Black African group have the lowest level of all ethnic groups (8.4%).[13]
• African and Caribbean people are at substantially higher risk of stroke and consequently the number of people affected by stroke is higher than in any other BME group.[14]
• Black people are at higher risk of stomach, liver, and prostate cancers[15].
• Severe maternal health problems are more than twice as common in women of African and Caribbean origin.[16]
• Black Caribbean men are more likely to smoke.[17]
• Women from BME groups have lower uptake of cervical screening services, and Black women aged over 65 years have higher incidence of cervical cancer. [18]

2.1.6.  All BME groups

• Rates of detention under the Mental Health Act are higher than average for Black Caribbean, Mixed, Other White, and Pakistani groups.[19]
• Rates of supervised community treatment orders are higher than average in Indian, Bangladeshi, and Black groups.[20]
• Young people from BME groups have disproportionate exposure to the risk factors associated mental health problems, such as school exclusion, being in care, homelessness, and involvement with the criminal justice system.[21]
• Women in BME groups aged over 65 years suffer high incidence of dementia and depression.[22]
• Service users from BME groups are reported to be dissatisfied with the opportunities, modes and levels of influence they have in user involvement activities.[23]

• It is acknowledged that a range of evidence exists suggesting that people from a range of BME groups, perhaps especially more recent immigrants experience high levels of mental health problems.
• Sickle cell and thalassaemia are inherited blood cell disorders which cause anaemia are more common in a range of BME groups.

3  Local picture

As shown in Table 2 below, according to responses to the 2011 Census, 160,725 (86.0%) of Richmond’s residents categorise themselves as belonging to a White ethnic group, and 26,265 (14.0%) to a Black and minority ethnic (BME) group.

Also, 75.7% of Richmond’s population were born in the UK. Consequently almost a quarter of Richmond’s residents were born outside the UK, with 14.3% of the population born outside Europe[24].

Among White groups, other than White British, the largest resident ethnic groups are Other White (22,282, 11.9%) and Irish (4,766, 2.5%). Richmond’s White Other population is composed of substantial numbers of people from Australia, New Zealand, South Africa, and western and eastern Europe.

Richmond’s BME groups are made up of 13,607 (7.3%) Asian/British Asian, 6,780 (3.6%) Mixed/multiple ethnic groups, 3,062 (1.6%) Other ethnic groups, and 2,816 (1.5%) Black groups.

Table 2: Ethnic group profile among Richmond residents (2011)

Source: 2011 Census data, ONS

In many ways, Richmond’s ethnic make-up has more in common than the England average than with London. London has a far higher proportion of population from BME groups (40.2%) compared to Richmond (14.0%). Richmond also has the lowest proportion of BME population compared to its SW London neighbours.

Despite these comparatively lower levels of ethnic diversity consideration of the health needs of BME and non-British White groups in Richmond remains important for a number of reasons including:

• The proportion of Richmond’s resident population from BME groups has increased from 9.0% to 14.0% since the 2001 Census, and growth is expected to continue.
• The proportion of the Richmond population represented by BME groups is higher in particular age groups. For instance, BME groups make-up 18.8% of Richmond residents aged 0-19, compared to 14.0% in all age groups.
• Substantial local variation in patterns of ethnicity among areas and educational institutions within the Borough which need to be taken into account in the commissioning and delivery of public health, programmes and health and social care.
• The particular recognised needs and experiences of different ethnic groups in relation to health and use of health and social care services.

• As shown in Figure 1, important variations in ethnic diversity are seen between Richmond’s wards.
• In particular, Heathfield and Whitton wards have higher proportions of BME populations, mainly from Asian groups.
• Richmond has one authorised socially-rented travellers’ site in Hampton North. As shown in Table 2, the 2011 Census reported that 95 people considered themselves to be Gypsy or Irish Travellers, though it is possible that this under-represents the total actual number of people in this group.

Figure 1. Percentage of individuals in each broad ethnic group at Ward level

Source: 2011 Census data, ONS

• The site is managed by Richmond Family Housing Partnership (RHP) and has 12 pitches for chalets/temporary homes. This site houses 51 of the 95 Gypsies and Travellers living in Richmond borough. The community living on the site is a relatively stable and settled one with many of the families having held licenses for the pitches for over 10 years.
• Gypsies and Travellers in the borough are able to access primary care by either registering as a permanent patient with a local practice or a temporary patient if they are visiting the area.
• Health Visitors undertake home visits to new mothers on the site, and in addition, they have recently delivered educational sessions on healthy eating, feminine hygiene, and health and safety.
• A detailed needs assessment considering Gypsy/Travellers is available on the JSNA website.

These issues are considered more fully in the following sub-sections.

4  Service Provision

A comprehensive range of public health programmes[25], and health and social care services are designed, planned and delivered to meet the needs of Richmond’s population.

The following mechanisms are in place to ensure that consideration is given to the diverse population and individual needs of residents, including those of protected characteristic groups.

• Development of needs assessments to research local population health and wellbeing needs.
• Liaison with a range of local community organisations, including the Richmond Ethnic Minorities Action Group (EMAG).
• Tailoring of the design and delivery of services to maximise their appropriateness and accessibility to all residents, including the targeting of services and initiatives at populations with diverse needs, including protected characteristic groups. For example:
• The NHS Health Check assessments of disease risks include the additional level of risk experienced by some ethnic groups, in order to ensure early preventive action or treatment. Also, monitoring of the use of the service and the disease risk levels that are found in the population are considered by ethnicity.
• The Richmond LiveWell healthy lifestyle service is delivered by ethnically diverse staff speaking a range of local community languages. Interpreter services are also available. Services are targeted to groups in greater and particular needs, including BME communities and the service has been asked to do more in to engage these communities.
• Richmond’s National Child Measurement Programme (NCMP) service enables ethnic monitoring of measurement outcomes, ensuring that BME groups benefit from this programme.
• Richmond’s stop smoking services are provided by a specialist provider Kick It targets a number of priority groups including particular BME communities in where smoking is more common.
• Audits, reviews, and evaluations of existing services including consideration of equality and diversity issues.
• Equality Impact Needs Assessments (EINAs) of new services and changes to existing services.
• Monitoring of service use by key population characteristics, including some protected characteristic groups.
• Adoption of equality requirements in service specifications and monitoring processes as part of contracting requirements for services and their providers.
• Annual reviews of compliance with the Public Sector Equality Duties.
• Implementation of the NHS Equality Diversity System by local NHS commissioners and providers.

The council has undertaken an audit of provisions for protected characteristic groups in public health programmes and the findings are under consideration.

5  Conclusion

A number of further actions are underway or being considered by Richmond Borough Council, including:

• Development of a detailed Equalities Profile for the Borough based on the results of the 2011 Census. This will further support general consideration of protected characteristic group equality issues across council responsibilities and beyond.
• Work to support Richmond CCG in their planned update of their Public Sector Equality Statement and implementation of the NHS Equality Diversity System.
• Review of service specifications for the commissioned services included in public health programmes, to ensure an adequate and consistent approach equality issues relating to the protected characteristic groups.
• Review of access to data essential to undertake adequate equality monitoring of key public health services, particularly immunisation and screening.

6  References

[1] Equality & Human Rights Commission (EHRC) website www.equalityhumanrights.com accessed 10/03/2014

[2] Office for National Statistics, Trends in general health and unpaid care provision between ethnic groups, 2011. http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/ethnic-variations-in-general-health-and-unpaid-care-provision/sty-trends-in-health.html

[3] State of Health: Black And Other Minority Groups. BHA Contribution to the Development of a Joint Strategic Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[4] Stewart et al. 2002. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[5] Office for National Statistics, Trends in general health and unpaid care provision between ethnic groups, 2011. http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/ethnic-variations-in-general-health-and-unpaid-care-provision/sty-trends-in-health.html

[6] Parry et al. 2004. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[7] Bernd et al. (eds). 2011. Migration and health in the European Union.

[8] Department of Health. 2008. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[9] National Cancer Intelligence Network. 2009. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[10] “State of Health: Black And Other Minority Groups”. BHA Contribution to the Development of a Joint Strategic Needs Assessment (JSNA). 2013

[11] Stewart et al. 2002. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[12] Moser et al. 2009 & National Cancer Intelligence Network 2009. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[13] Office for National Statistics, Trends in general health and unpaid care provision between ethnic groups, 2011. http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/ethnic-variations-in-general-health-and-unpaid-care-provision/sty-trends-in-health.html

[14] www.nhs.uk/conditions/stroke/pages.introduction (accessed 1 March 2010). Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[15] National Cancer Intelligence Network. 2009. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[16] Knight et al. 2009. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[17] Stewart et al. 2002. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[18] Moser et al. 2009 & National Cancer Intelligence Network 2009. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[19] Care Quality Commission. 2010. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[20] Care Quality Commission. 2010. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[21] Kurtz & Street. 2006. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[22] Shah. 2008. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[23] Kalathil. 2009 & Belgum 2008. Quoted in Afiya Trust. Achieving equality in health & social care: a framework for action. 2010.

[24] Office for National Statistics, Census 2011 – Country of birth (detailed) % (QS203EW).

[25] NHS Health Checks, LiveWell Richmond health lifestyle service, Kick It stop smoking service, School nursing and the National Child Measurement Programme, Sexual health and contraception services, Substance misuse services, Screening programmes, Immunisation programmes.

The Equality and Diversity pages of DataRich provide further data and analysis on each of the protected characteristics under the Equality Act 2010.

Document information

Published: July 2014
For review: July 2017
Topic Lead: Jane Bailey, Public Health Lead