This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information
Towards an epidemiology of diversity
Ethnic minority demography, disease patterns and pathways to care
Section three: Other service delivery issues
Before concluding this module, it is worth spending a little time to reflect on some of the implications of ethnic and cultural or religious diversity for the provision of health care services, and the practice of health care professionals. The following are only a few short thoughts, but they should stimulate the learner to consider how what they have learned in the preceding sections may affect them when they are responsible for delivery of care.
Culture and religion
Differences in religious beliefs and practices mean that there is a need to provide suitable religious support for members of minority faiths. This might include quiet rooms, mortuary or prayer space which is not dominated by the symbols of the majority (Christian) religion and is suited to religious observance by other faiths. People often turn to their faith more strongly at times of death or bereavement, and find it helpful: even those who are not practising members of a religion will try to observe the traditions associated with a faith on behalf of a relative who has died. Therefore, there needs to be a suitable space and facilities for preparation of the dead.
Diet
It is well established in ‘good practice’ literature that a variety of ethnic dietary patterns exist. Even when sick, many people will find it difficult to eat foods which are ‘not permitted’ by their religion, and unfamiliar foods may also be hard to eat. Many health districts and trusts have reported making arrangements to provide for cultural and religious diets, having tested caterers products for religious acceptability. Some may even translate or otherwise adapt menus. In one case, a pictorial menu was in use, although this might also have been useful for illiterate members of the majority community. Indeed, the provision of a greater diversity of food may help stimulate the appetite of many patients, and this must be beneficial to recovery!
Tissue Types
There is a growing literature on the differences in tissue type found in a society formed by migration. Chances of successful matching across ethnic groups are significantly reduced - but there have been considerable difficulties in recruiting donors from minority groups - so that while 25% of Birmingham waiting lists for kidney transplants are Asian, only 12% of matches, and 1% of donors, are from this group. Similar problems are reported by the Anthony Nolan Trust (bone-marrow) which has fewer than 1,500 African-Caribbean and 4,000 Asian donors on its register of over 280,000 names. Ethnic origin may be an essential element in seeking a suitable match, and equally, when possible, organ donation co-ordinators need to make special efforts to ensure that suitable donors from minority ethnic groups are offered the opportunity to donate, when this is not contra-indicated by their religion. Specialist advice is available in respect of this, and if in doubt, matters can be discussed with chaplaincy staff.
Table F: Summary of major (significant) differences in risk of certain diseases
Note: All are compared to ‘National’ UK population (approx. 95% White) unless otherwise noted, and based on age/sex-adjusted data where appropriate and available.
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Key
- diabetes here refers only to NIDDM ‘Type II’ Non-insulin dependent Diabetes.
- estimated risks, data from Lupus UK sources; no information on Chinese.
- for Sickle Cell and Thalassaemia, see Table (above) in text
- reported variations: no risk rates available: Fenton & Wellings 2001
- note that certain cancers are MORE common in specific groups e.g, Cervical and Prostate (African-Caribbean), Oral, Liver & Gall Bladder (Bangladeshi)
Source: Health Survey for England 1999 (published 2001) unless otherwise noted. Note: Only ‘significant’ variations from average shown.
Factors that may affect the consultation and the likelihood of using health services
This is a brief summary of the themes in this module.
The following are all factors which may relate to differences in minority ethnic people’s use of services, both in their likelihood to use a service, and in the way in which the consultation may develop.
- ethnic Differences in Patterns of Disease
- cultural Variations in Presentation of Symptoms of illness
- perceptions of Health, Body and Disease
- cultural and Language differences in Descriptions
- accessibility of Services (time and place)
- (previous experiences of) Encounters with Services
- alternative Treatment Options
- lifestyle, Religion and Cultural practices
- socio-Economic Status
- racism direct, personal, indirect or institutional
- language
- education and the Availability of Information
- attitude, Awareness and Skill of Clinical staff
Of course, some of these may be ‘common’ to all health care users. Equally, you need to remember that minority ethnic populations are made up of men and women, young and older people, and they are also affected by geography, pollution, epidemics, and the media!
Exercise 3.1 Point for reflection
Think of the last time you had to go the GP or another health clinic.
Why did you go and what was your experience? Work through the list above, and see how you remember the event.
Information or knowledge about diversity:
A health warning repeated
A little knowledge is a dangerous thing - and the risk of stereotypes is that they are all at least partly true. The problem for the nurse or any health professional working in the UK is that they may meet people from any cultural background, and from any ethnic group. Even so, knowing all there is to know about (say) Islam, and the genetic makeup of people from the specific country (say, Sweden), they will still not be in a position to know whether the particular client they are working with fits all the knowledge they have! Just as many Christians or Jews may describe themselves as ‘lapsed’ or ‘non-observant’, there are degrees of observance in people from all religious groups, and many small differences between regions and families. Epidemiology is a science of averages. It only provides a basis from which you can begin to ask intelligent, well-informed, questions about the needs of your patient. This is especially true when we consider the development of medical technology, which may raise new questions for moral judgement, which should be properly discussed with the individual, so that they can make decisions in the light of their own interpretation of the facts and their beliefs.
It is also necessary to observe that while the focus of this module has been on the recognised ‘ethnic minorities’, sometimes described as BMEG (Black and Minority Ethnic Groups), everyone has an ethnic origin and identity, even if they may not always recognise this! The principles laid out here apply to any social group and treating people of (say) middle-class origin from north Kent/South London as an identifiable ‘ethnic group’ may make them much easier to understand, compared to (say) another group of Glaswegians, or rural people from Lincolnshire or Norfolk, or one of the ‘classic’ ethnic groups described in conventional social science texts. Equally, for those people who work in that mythical place where ‘we don’t have any minorities’, it is to be hoped that after reading this, they may recognise that indeed they do themselves!