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Commissioners ‘must work with communities’ to reduce ethnic health inequalities


By Rachel Carter
Freelance Journalist
14 September 2018

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Rachel Carter speaks to representatives from two projects designed to tackle health inequalities within ethnic minority groups about what’s worked well, following the publication of a new resource from Public Health England

‘When you talk to people who use the service and ask them what it is that works for them, the response is always that they feel safe, respected and listened to,’ says Alicia Spence, director of services at the African Caribbean Community Initiative (ACCI), a counselling and therapeutic service based in Wolverhampton.

‘It’s about compassion – and that’s what commissioners need to commission.’

Mrs Spence is referring to what she feels needs to change to reduce ethnic health inequalities and improve health outcomes for people from different communities.

The organisation she heads up was featured as an example of good practice in a recent report from Public Health England (PHE), which warned that ethnicity needs to be ‘explicitly considered’ when designing local services to address health inequalities.

The report, Local Action on Health Inequalities: Understanding and Reducing Ethnic Inequalities in Health, was published last month and looked at how to recognise and reduce ethnic inequalities within local health services. It found that progress remains slow and that the need for senior leadership on the issue been ‘repeatedly highlighted’.

The report identified that health commissioners often feel uncertain about engaging with ethnic inequality, because it can be seen as a ‘contentious and difficult issue’.

Public Health England said in a blog on its website that this had resulted in ‘not enough action being taken to reduce ethnic health inequalities, particularly at a local level,’ adding that it hoped the report would help ‘change perceptions’.

‘Involve communities’

One of the key messages from the PHE report was that there needs to be ‘more meaningful engagement and involvement’ of minority ethnic groups, to ensure that people’s needs are properly understood and services can be shaped accordingly.

Mrs Spence agrees that commissioners must talk to service users, adding that she feels a ‘fundamental shift in thinking’ is needed to tackle ethnic health inequalities.

‘A lot of people don’t trust statutory services, so commissioners must try and work with communities and understand that they might have to make some adjustments.

‘They need to really talk to the user and ask what works. If something is working then it’s about ensuring the resources are there for that service to be provided.’

‘A holistic approach’  

At ACCI, the ethos is ‘to work holistically with the person who comes through the door’, rather than focusing on their mental health diagnosis, Mrs Spence says.

The organisation was set up in 1987 by a group of Rastafarians who were concerned about the ‘over-representation of their peer-group in the mental health system’.

Today, it offers a safe space and wellbeing hub where people can come during the day to access a range of services. These include a holistic counselling service, support with housing and benefits issues, an allotment gardening project, a ‘healthy cooking on a budget’ group and a range of physical activities, including football.

‘A lot of people with mental health problems don’t have many valued social relationships, so by coming here they can also mix with a peer group,’ she adds.

‘The mainstream’

Mrs Spence says local commissioners in Wolverhampton recognise that ACCI is ‘the mainstream’ for a lot of local people, because clients come to them first.

She believes this is because the service gets to know the people they are working with, and can therefore provide timely intervention when they become unwell.

‘Our clients know we will take the journey with them. If they get admitted to hospital or are being sectioned, we are there to reassure and stand by them,’ she says.

Project Polska

Another initiative recognised by the PHE report was Project Polska, a community-based organisation in Leicester. It was set up in 2010 and has five main work streams, one of which is focused on health and wellbeing.

Barbara Czyznikowska, chair of Project Polska, says the organisation had observed ‘growing health concerns’ within the local Eastern European community over a number of years, particularly around the prevention of chronic diseases.

‘In our work with local NHS providers, we were also noticing a high level of access to mental health crisis services and constant queries about how to live a healthier lifestyle, quitting smoking, how to prevent diabetes, and so on,’ she says.

In response to this, Project Polska set up an eight-week educational programme, funded by Leicester City Council. It focused on raising awareness of the risk factors for long-term health conditions, how to access services, and reducing migrants’ exposure to obesity, cardiovascular disease and poor mental health.

‘We took a very interactive approach,’ says Ms Czyznikowska. ‘There were lots of activities involved and we had a very high level of response from the community.’

‘Informal support network’

Ms Czyznikowska says that when running a programme like this, it’s important to ‘think about your clients’ and create a sense of community and peer-support.

For example, the majority of the programme was run in English, but bilingual workers were recruited to offer language support where it was needed, she says.

‘The people who attended the course were also able to have a WhatsApp group where they could share feedback and talk about the sessions,’ she adds.

‘I think that kind of informal support network really helped people get as much as they could from the programme, because they were able to carry on the conversation after the eight weeks and some of them also created friendships.’

‘Conversations and sustainability’

An important part of the programme was actually having a conversation with participants about how it should be designed, Ms Czyznikowska says, adding that commissioners should always do this when working with ethnic minority groups.

‘Before we started we obviously had an idea based on the evidence we’d collected, but we consulted people about that idea and what sort of training they would like.

‘I think that is really crucial because sometimes as a professional you might think “this will work really well”, but people on the ground might not have the same view.’

The eight-week programme, Me and My Health, ran four times and helped over 300 people, but the funding has now ended, and Ms Czyznikowska says it’s important for commissioners to consider how these initiatives can remain sustainable.

‘I think there needs to be a long-term plan, in terms of how these projects are supported, because you want to keep the momentum going,’ she says.

‘We don’t want to start something and then say “the money has dried out so just deal with it yourselves now”. I think lots of community groups like ours will probably still do the work to a certain extent – but we do need the resources to do that.’

Key messages from the Public Health England report 

The PHE report detailed a number of recommendations for health commissioners to support the focus on ethnicity within health inequalities work.

These included:

  1. Tackle racism and ethnic discrimination: The report said there was an ‘urgent need’ to build an evidence base around the central role of racism and how this can be understood and addressed.
  2. Commission culturally sensitive health intervention: Health promotion interventions need to work with cultural and religious understandings and values, and avoid stereotyping, the report said.
  3. Data collection, analysis and reporting: The report identified gaps in data collection and said there needed to be more consistent reporting of data on ethnicity, health and healthcare to ensure there is an ‘adequate understanding’ of how local needs are being met by services.
  4. Improve access, experiences and outcomes of health services: Organisations need to regularly undertake equity audits, use health impact assessments, ensure a good representation of black and minority ethnic communities among staff, and build trust with service users, the report said.
  5. Make use of evidence: The report said the evidence base on ethnic health inequalities remained ‘limited’, but organisations can make more use of what is available to inform local practice. 
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