An overview of the research evidence on ethnicity and communication in healthcare

• The aim of the present study was to identify and review the available research evidence on 'ethnicity and communication' in areas relevant to ensuring effective provision of mainstream services (e.g. via interpreter, advocacy and translation services); provision of services targeted on communication (e.g. speech and language therapy, counselling, psychotherapy); consensual/ participatory activities (e.g. consent to interventions), and; procedures for managing and planning for linguistic diversity

The unavoidable costs of ethnicity : a review of evidence on health costs

This report was commissioned by the Advisory Committee on Resource Allocation (ACRA), and prepared by the Centre for Health Services Studies (CHESS) and the Centre for Research in Ethnic Relations (CRER) at the University of Warwick. The NHS Executive does not necessarily assent to the factual accuracy of the report, nor necessarily share the opinions and recommendations of the authors. The study reviews the evidence concerning the degree to which the presence of populations of minority ethnic origin was associated with ‘unavoidable additional costs’ in health service delivery. While local health authorities retail full autonomy in their use of funds allocated to them under the Hospital and Community Health Services formula, the size of that budget is governed by a set of weightings applied to their population, to allow for factors known to influence levels of need, and the costs of providing services. The study began by considering the definitions used in describing ‘ethnicity’ and ethnic groups in relevant medical and social policy literature. It is clear that no fixed set of terms can be adopted, and that flexibility is required to respond to social changes. The terms used in the 1991 Census, with additions to allow for local and contemporary developments, provide a suitable baseline but require additional information on religion language and migration history for clinical and health service delivery planning. There have been notable developments in health service strategy to meet the needs of black and minority ethnic groups which have been encouraged by good practice guidelines and local initiatives. Together with research into epidemiology and ethnic monitoring of services, these have enlarged understanding of the impact of diversity. A conceptual model is developed which explores the potential for such diversity to lead to variations in the cost of providing health services to a multi-ethnic population. The research team reviewed the existing published evidence relating to ethnic health and disease treatment in medical, social science, academic and practitioner literature, using conventional techniques. Additional evidence was located through trawls of ‘grey’ literature in specialist collections, and through contacting all English health districts with a request for information. A number of authorities and trusts provided written and oral evidence, and a bibliography of key materials is provided. Key issues considered include the need for and use of, interpreter and translation services, the incidence of ‘ethnically-specific’ disease, and variations in the prevalence and cost of treating ‘common’ conditions in minority ethnic populations. Sources of variation are discussed, and a ‘scoping’ approach adopted to explore the extent to which these variations could be adequately modelled. It is clear that while some additional costs can be identified, and seen to be unavoidable, there are other areas where the presence of minority populations may lead to lessened pressures on budgets, or where provision of ‘ethnic-specific’ facilities may be alternative to existing needs. The literature provides a range of estimates which can be used in a modelling exercise, but is deficient in many respects, particularly in terms of precise costs associated with procedure and conditions, or in associating precise and consistent categories of ethnic group with epidemiological and operational service provision data. Certain other activities require funding to set them up, and may not be directly related to population size. There is considerable variation in the approaches adopted by different health authorities, and many services are provided by agencies not funded by NHS budgets. The study was completed before the announcement of proposed changes in health service commissioning which may have other implications for ethnic diversity. The presence of minorities is associated with the need to provide additional services in respect of interpreting and translation, and the media of communication. In order to achieve clinical effectiveness, a range of advocacy support facilities or alternative models of provision seem to be desirable. Ethnic diversity requires adaptation and additional evidence in order to inform processes of consultation and commissioning. Minority populations do create demands for certain additional specific clinical services not required by the bulk of the majority population: it is not yet clear to what extent the reverse can be stated since research on ‘under-use’ is less well developed. Some variations in levels of need, particularly those relating to established clinical difference in susceptibility or deprivation, are already incorporated in funding formulae although it is not clear how far the indicators adequately reflect these factors. Costs are not necessarily simply related to the size of minority populations. The provision of services to meet minority needs is not always a reflection of their presence, but has frequently depended upon the provision of additional specific funds. There is a consensus that the NHS research and development strategy should accept the need for more work to establish the actual levels of need and usage of service by ethnic minority groups, and that effort should be made to use and improve the growing collection of relevant information through ethnic monitoring activities. A variety of modelling techniques are suggested, and can be shown to have the potential to provide practical guidance to future policy in the field. Current data availability at a national or regional scale is inadequate to provide estimates of the ‘additional costs of ethnicity’ but locally collected data and the existence of relevant policy initiatives suggest that a focused study in selected districts would provide sufficiently robust information to provide reliable estimates. The review has demonstrated that there are costs associated with the presence of minority ethnic groups in the population which can be shown to be unavoidable and additional, but that others are either ‘desirable’ or ‘alternative’. It would be wrong to assume that all cost pressures of this nature are in the same direction. Our study has drawn attention to deficiencies in data collection and budgeting which may hinder investigation of the effectiveness of the service in general. The process of drawing attention to ethnic minority needs itself leads to developments in services which are functional and desirable for the majority population

Setting standards for preventative services to reduce child health inequalities in Greater Manchester

Recent policy documents such as Every Child Matters and the National Service Framework for Children, Young People and Maternity Services have indicated a fundamental shift in ways of thinking about child health, emphasising the crucial role of preventative action as well as treatment for ensuring that children have the best possible chance to reach their full potential. This is paramount in deprived areas, where child poverty translates itself into social disadvantage that affects the life chances of children from birth onwards. Whilst the NHS cannot tackle the fundamental drivers of child poverty, it can make a substantial contribution to improving the health and life chances of children living in deprived areas through making sure that parents have access to the services they need and have the information and support to make the best choices about the health and development of their children. The World Health Organisation (WHO) in its strategy on equity in health states that disparities in health status between different groups in the population should be reduced by improving the health of the disadvantaged. Hence, the National Service Framework for Children, Young People and Maternity Services set down 11 standards that define, in general terms, the aims and objectives of services for all children (standards 1-5), services for particular groups of children and young people (standards 6-10) and maternity services (standard 11). These standards underpin a more generic health inequalities target that sets the goal of a reduction of at least 10% in the gap in infant mortality between manual groups and the population as a whole in 2010

Improving further education provision for learners from minority ethnic groups: a review of the evidence

This paper summarises the findings from a review carried out by the National Research and Development Centre for adult literacy and numeracy (NRDC) for the Quality Improvement Agency (QIA) between April and September 2007. The study sought to summarise what is known about the participation of those from minority ethnic groups in Further Education (FE) and to identify effective practice in helping them to achieve

Ethnicity : UK colorectal cancer screening pilot : final report

27. In summary, the overall evaluation of the UK Pilot has demonstrated that key parameters of test and programme performance observed in randomised studies of FOBt screening can be repeated in population-based pilot programmes. However, our study provides strong evidence of very low CRC screening uptake for ethnic groups in the Pilot area. This is coupled with a very low uptake of colonoscopy for individuals from ethnic groups with a positive FOBt result. 28. It has long been acknowledged that a diverse population may require diverse responses. Following the implementation of the Race Relations Amendment Act 2000, there has been a statutory duty laid upon all NHS agencies to ‘have due regard to the need to eliminate unlawful discrimination’, and to make explicit consideration of the implications for racial equality of every action or policy. 29. Because the observed overall outcomes in the UK Pilot generally compare favourably with the results of previous randomised trials of FOBt screening, the main Evaluation Group has concluded that benefits observed in the trials should be repeatable in a national roll-out. 30. However, our study indicates that any national colorectal cancer screening programme would need to very carefully consider the implications of ethnicity for roll-out, and develop a strategic plan on how best to accommodate this at both a national and local level. Based on our findings, consideration will clearly need to be given to improved access and screening service provision for ethnic minorities. 31. In order to ensure adequate CRC screening provision for a diverse UK population, and to address the explicit implications for racial equality highlighted by our findings, interventions now urgently need to be evaluated to improve access for ethnic minorities. This work should be undertaken as part of the second round of CRC screening currently underway in the English Pilot

Neighbourhood inequalities in the patterns of hospital admissions and their application to the targeting of health promotion campaigns

For many years indicators of deprivation have played a pivotal role in the processwhereby government assesses the relative level of resources require to meet local healthneeds. The formulae that have been developed for this purpose recognise that the locallevel of need for health resources varies among different population groups, such as theelderly or people with young children1. The formulae also recognise the strength of therelationship between health and deprivation. O ver a hundred years ago public healthofficials first recognised differences in the rates of mortality among different occupations.Likewise today?s funding formulae recognise the especial needs of local areas with highproportions of particular ly deprived groups such as overcrowded households, personswithout access to a car or people who are unemployed. As the focus of the health serviceincreasingly extends beyond the treatment of patients to an attempt to improve the healthof local populations through preventative campaigns, the focus of targeting extendslikewise to the identification of neighbourhoods at highest risk of particular diagnoses.To this end the National Health Service has recently commissioned a number of pilotexercises2 to assess the effectiveness of postcode classification systems in the targettingof health promotiona l material. In order to assess which types of neighbourhood are mostsuitable for specific communications programmes, the Hospital Episode Statistics haverecently been coded by Mosaic, the UK?s most widely used postcode classificationsystem. This paper summarises the key differences that have been found to exist betweenthese Mosaic types, both in terms of overall level of admissions and type of diagnosis.The paper also evaluates the extent to which the classification system may be an efficientmethod not just of targeting specific health campaigns but also for assessing levels ofneed by type of service at a highly local level

Researching Bradford: A review of social research on Bradford District

A synthesis of findings from social research on the District of Bradford. This report synthesises the findings from a wide range of social research undertaken on the District of Bradford, primarily between 1995 and 2005. The researchers reviewed almost 200 pieces of work. The key results are summarised under thematic headings: - The social, economic and institutional context - Community cohesion - Housing, neighbourhoods and regeneration - Business and enterprise - Health, disability and social care - Children and young people - Education, skills and the labour market - Crime and community safety It also identifies a future research agenda. The main purpose of the review was to provide the Joseph Rowntree Foundation and local organisations in Bradford with a firm basis upon which to build future work in the District

Combating Trafficking in Persons: A directory of organisations

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.ASI_2003_HT_UK_Combating_Trafficking.pdf: 445 downloads, before Oct. 1, 2020

The ‘Skills Drain’ of Health Professionals from the developing World:a Framework for Policy Formulation

This paper examines policy towards health professionals’ migration from economic and governance perspectives