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  1. School of Nursing, Midwifery and Social Work Rahul Alam Professor Kinta Beaver Stacey Body Dr Saima Latif Charlotte Wilson Dr Susan Williamson Steering Group Dr Stephen Campbell Professor Karen Luker Dr Chris Roberts Professor Martin Roland

  2. CLAHRC project Ethnic minority groups Literature Review Overview

  3. Collaboration for Leadership in Applied Health Research and Care The NIHR CLAHRC for Greater Manchester University of Manchester and: • All 10 Primary Care Trusts • 6 Acute Trusts • All 3 Mental Health Trusts • Ambulance Trust

  4. Four Research Themes • People with Long Term Conditions • Health Care Practitioners • Health Care Services • Health Information Systems

  5. Focus on CVD Focus on vascular conditions: • Stroke • Diabetes • Kidney disease • Heart disease All PCTs now called “NHS …”

  6. Health Care ServicesResearch Theme 3 • Develop patient-led access to specialist care for people with diabetes and kidney disease. • Adapt these to the needs of people from ethnic minority groups.

  7. Why is ethnicity a health issue? • 7.9% U.K population • 4.6 million * • Disproportionate incidence of disease • Rates of diabetes over 6 times higher in Bangladeshi, Pakistani and Indian groups ǂ • Rates over 5 times higher among Black African-Caribbean groups • 20% and 17% respectively compared to 3% of the general population Source: * http://www.statistics.gov.uk ǂ Diabetes and the disadvantaged: reducing health inequalities in the UK, World Diabetes Day 14 November 2006. A report by the All Parliamentary Group for Diabetes and Diabetes UK

  8. Chronic Kidney Disease • Black and South Asian people are up to five times more likely to have kidney failure than the general population* • 7.9% of the UK population • 20% are waiting for transplants • only 1.3% are registered on the Organ Donor register ǂ * Source: NHS Choices, Your health, your choices http://www.nhs.uk/Livewell/Kidneyhealth/Pages/BlackandAsiankidneyhealth.aspx ǂ NHS Blood and transplant. 2006-2007. Transplant Activity in the UK

  9. Inappropriate health care services The Health of Ethnic Minorities Earlier onset (up to 10 years earlier) Environmental influences (i.e. lifestyle issues) Genetic predisposition

  10. Appropriate health care services i.e. Improved self-management i.e. earlier detection The Health of Ethnic Minorities Earlier onset (up to 10 years earlier) Environmental influences (i.e. lifestyle issues – diet, PA) Genetic predisposition

  11. Providing appropriate services Fundamental Human Right * • Can be done • Must be done! * http://www.who.int/hhr/en/ http://www.who.int/hhr/HHRETH_activities.pdf

  12. Legal Framework • NHS: Legal and moral obligation • Age • Gender • Social class • Religious beliefs • Cultural beliefs • Ethnic background • Race Relations Amendment Act 2000 • Promotion of race equality across all activities • Need to understand different ethnic groups • Beliefs and values • Barriers and facilitators in accessing health care

  13. Country/Origin * Bangladesh * Eastern Europe * Pakistan * Caribbean * India * Sri Lanka * China * Ireland * Travellers * East Africa * Israel *Asy Seekers (var) Language and Dialects * Bengali * Irish Gaelic * Swahili * Cantonese/Mandarin * Mirpuri * Sylheti * Gujarati * Polish * Tamil * Hindi * Punjabi * Urdu Major Religions * Buddhism * Hinduism * Judaism * Christianity * Islam * Sikhism Generations * 1st Generation * 2nd Generation * 3rd Generation * 4thGeneration

  14. Source: 2001 Census tables S101 & KS06; www.manchester.gov.uk

  15. Susceptible groups • Black African • Black Caribbean • Bangladeshi • Indian • Pakistani • Sri-Lankan Form the bulk of U.K minorities Worst CVD outcomes

  16. Literature review

  17. Literature review

  18. Literature review

  19. Hierarchy of evidence Source: www.lib.nus.edu.sg/mlb/g/pyramidevid2.JPG

  20. Results - WISE Model * • Effective support in the self-management of chronic conditions • A whole system perspective • Patient • Practitioner • Organisation * Kennedy A, Rogers A, Bower P. Support for self care for patients with chronic disease. BMJ 2007;335(7627):968-970

  21. Preliminary results – WISE model

  22. Triangulation of data

  23. Example of good practice • Apnee Sehat project in Warwickshire • Educational DVD on lifestyle issues (addressing patient needs) • Yoga classes for women in local temples (practitioner involvement) • Local restaurants encouraged to produce healthier menus (public service involvement) ǂ Diabetes and the disadvantaged: reducing health inequalities in the UK, World Diabetes Day 14 November 2006, A report by the All Parliamentary Group for Diabetes and Diabetes UK

  24. HRH Prince of Wales

  25. CLAHRC contacts Rahul Alam (Research Associate) Email: rahul.alam@manchester.ac.uk Tel: +44 (0)161 306 7796 Stacey Body (CLAHRC Research secretary) Email: Stacey.Body@manchester.ac.uk Tel: +44(0)161 306 7860 Professor Kinta Beaver (Research Theme Lead) Email: kinta.beaver@manchester.ac.uk Tel: +44 (0)161 306 7779