Health advice fails to reach ethnic groups

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HEALTH messages about smoking, diet and weight, now well understood by the white population, have not been assimilated by Britain's ethnic minorities.

Unexpectedly high numbers of people do not speak English sufficiently well to benefit from such information, and the health of minority groups is being significantly damaged by cultural barriers and illiteracy, as well as by economic disadvantage, accor d ing to two new reports being published this week.

The unrelated studies reveal a depressing picture of neglect, ignorance and failure of health providers to address the ethnic communities' special needs.

The first report, from the King's Fund, an independent health research organisation, shows, for instance, that the babies of women of Pakistani origins are nearly twice as likely to be stillborn or die in the first week of life as those of whites.

The second report, from the Health Education Authority, the first survey of the health and lifestyle of ethnic minorities in England - published exclusively today in the Independent on Sunday - reveals the extent to which cultural barriers combine with poverty to create an ill-health trap.

Both reports are set against a background of increasing ill health among ethnic minorities. Concern has been growing since the Department of Health published its Ethnicity and Health report in 1993. It showed that deaths from heart disease among men and women born in India were up to 46 per cent higher, with a two to three times greater risk in young men aged 20 to 39; people from the Indian sub-continent were the only group in the population to experience an increase in heart disease.

It reported that cervical cancer was more common in Afro-Caribbean women, and early evidence that other cancers were increasing in Asians. Risk of strokes is double the average for the general population in England and Wales in Afro-Caribbeans, who are are three to six times more likely to be diagnosed as having schizophrenia than the white population.

The HEA £330,000 study was among 3,500 adults living in England, identified in four ethnic groups: Afro-Caribbean, Pakistani, Indian and Bangladeshi.

Dr Ngozi Uduku, a GP in Lewisham, south London, with a special interest in minority health issues, said: "What is really crucial about this survey is that it shows us for the first time what is happening here and now in England. In the past, most of the

data has had to be extrapolated from US studies, which are not appropriate to Britain."

The first problem encountered by the researchers from MORI, the opinion pollsters, who conducted the interviews, was language. They discovered a fundamental inability to understand English.

While 85 per cent of people of Indian origin, 72 per cent of Pakistani and 59 per cent of Bangladeshi said they could speak English, when it came to the survey 70 per cent of the Bangladeshis, 50 per cent of Pakistanis and 30 per cent of Indians had to be interviewed in their mother tongue. Among older Pakistani women, one of the most established communities, 68 per cent could not read in any language. A quarter of Indians and almost half the Bangladeshis could not read English.

A key finding of the survey is that health information about diet, weight and smoking has not been received or not accepted. A quarter of Indians and two in five Bangladeshis said they had not come across any health education at all. There was little interest in information about alcohol, drugs or contraception.

While only 15 per cent of UK women have never had a cervical smear, 30 per cent of Indian women, 46 per cent of Pakistani and 60 per cent of Bangladeshi have never been screened for signs of cervical cancer.

Knowledge about smoking risks was very poor, said Kai Rudat, the MORI social scientist who headed the survey. "Generally, levels of smoking in the groups are lower than in the general population. About 28 per cent of the general population smoke but we found high levels in Bangladeshi men: 40 per cent.

While 24 per cent of the UK population has a preoccupation with being overweight, only 7 per cent of the Bangladeshi people questioned thought it had anything to do with their health.