Published: 24/02/2005, Volume II5, No. 5944 Page 26 27

Initiatives to target specific health inequalities in South Asian communities are increasingly in the spotlight. Stuart Shepherd looks at the lesssons that can be learned

There are a great number of innovative and successful schemes across the country that endeavour to meet the health needs of disadvantaged black and minority ethnic communities. Yet much more is still to be done - as the Home Office's recent race equality strategy document, Improving Opportunity, Strengthening Society, makes clear .

In the NHS, work will now begin on a nationally integrated system of BME data collection. Some specific prevention and treatment aims have also been devised. Reducing the disproportionately high levels of coronary heart disease among people of a South Asian background will be one such target.

The Department of Health's December publication Heart Disease and South Asians shows how local projects have prompted healthrelated interventions for a particular ethnic minority group.

It also highlights the careful step-by-step considerations that any initiative requires, from original concept to evaluation.

The Peterborough healthy living partnership project, for example, won the health inequalities category at last year's HSJ Awards for its innovative work in encouraging young South Asian women to lead more active lives. As project manager, Shakeela Abid identified a lack of culturally sensitive resources to allow women and girls from the local Pakistani community to participate in sporting activities.

This had implicit health consequences for later life. So a young woman's sports leadership scheme was developed that was sensitive to religious and gender issues and also addressed health concerns.

Liaising with the council's community sports team, the project team arranged for a female instructor to lead a nationally recognised activities training programme. This was devised to turn participants into leaders and offer employment prospects. 'The role of the instructor was pivotal.

They must be excellent motivators and know how to establish a rapport and build trust. We got just the right person. We were very lucky, ' says Ms Abid.

Language was one of several barriers to recruiting for the scheme.

'The majority speak a dialect of Punjabi that is not written. Some write and read Urdu, but there is usually an English-speaker in the house.' So a range of promotional tools are used, including leaflets and drop-ins at English language classes. 'And never underestimate the value of word-of-mouth, ' adds Ms Abid.

The first intake of 12 women went on to lead after-school sessions for girls and form their own society, the Gladstone Women Sports Association. 'The venue and times of these sessions is really important, ' says Ms Abid. 'It has to be within walking distance and culturally appropriate. The sessions run from 6pm-7.30pm to avoid clashing with Arabic classes. We attract about 40 girls at any one time.' The success of the scheme has meant that Greater Peterborough primary care partnership is now considering using the same techniques to create similar services for refugees in the local community.

Diabetes research dietician Dr Trudi Deakin of Burnley, Pendle and Rossendale primary care trust managed the setting up of the X-Pert programme, which also won an HSJ Award category as well as the overall Secretary of State's Award. It is a good example of how diseasespecific patient empowerment can be adapted to suit the needs of a minority group.

Breaking the language barrier The PCT includes areas of severe deprivation and a population that includes 10 per cent from a South Asian background. It was clear that any success on tackling diabetes as a chronic disease would have to improve access for this group.

Urdu is the most widely spoken home language among the area's community. 'We send out bilingual mail shots to candidates for the study, ' says Dr Deakin 'following up with calls from an Urdu speaker.' The six-week programmes are delivered to small, single-sex groups by a trainer and translator. Visual prompts make up part of the general X-Pert package that helps individuals learn from personal experience. 'All it needs is to change some of the images, such as those of the different food groups, to make them more culturally attuned.

Otherwise It is exactly the same programme.' Sub-group analysis of outcomes across ethnicities bare this out.

Dr Deakin says: 'Programme participants now sit on patient empowerment groups that help reshape health services.' The South Asian client base has direct representation, and a voice that struggled to be heard in the past.

Last November, a healthy living centre opened in Burnley. The centre's café sells ethnic dishes, but all with less salt and fat than is often found in traditional South Asian cooking.

The food is prepared from local produce by women from the community trained as health workers. Jenny Slaughter, also a dietician, played a part in their training and is now based at the centre where further X-Pert programmes will be delivered.

What Dr Deakin found particularly pleasing was how the X-Pert education was passed on, at home and beyond.

'Other members of the family, including the children, show an interest in the leaflets. A lot of information also filters out by word of mouth.' Initiatives are not restricted to tackling heart disease. Luton and Dunstable Hospital trust clinical midwifery manager Martina McIntyre has been working with colleagues at Luton teaching PCT to reduce the incidence of stillbirths in the local south Asian community.

Bangladeshi women, members of one of the area's largest ethnic minorities, are over-represented in this distressing neonatal incident and steps were taken to discover the reasons behind it.

Ms McIntyre and colleagues met with Asian women's groups to discuss experiences of maternity care, and a panel of experts analysed the local stillbirth data.

These strategies identified two key and related problems: language and delays in accessing care. 'We realised that routine information, such as the use of folic acid, for instance, wasn't getting through.

And if the foetus stopped moving, the young women were waiting for their husbands to come home before calling for advice, ' claims Ms McIntyre.

Pregnant Bangladeshi women are now given a phone number on first contact with midwifery services.

This allows them to speak to a Bengali interpreter who works alongside a midwife from 9am-5pm, Monday to Friday.

A HIGH-RISK GROUP

Heart Disease and South Asians is published by the Department of Health, together with the British Heart Foundation. The document emphasises the need for diversity and equal access in health and social care, 'so that it produces faster, fairer services that deliver better health and social care and tackle inequalities'.

More than 110,000 people a year die of heart conditions, with South Asians 50 per cent more likely to die prematurely. Although this rate is falling it has failed to keep pace with the rest of the population. And when South Asians receive a diagnosis, their survival rate does not match those from other groups.

The risk factors associated with coronary heart disease appear to be more prevalent among this group.

Diets high in fat and low in fruit, poor levels of exercise and a high incidence of smoking in men compound difficulties arising from living in areas of relative social deprivation.

There are a number of case studies in the guide which demonstrate joint working between professionals and community groups to match service provision to local need. As well as prevention strategies targeted at risky activities such as smoking, there are sections on diabetes, a significant contributor to developing heart disease, and treatment access.

Find out more

Improving Opportunity, Strengthening Society www. homeoffice. gov. uk

Heart Disease and South Asians www. dh. gov. uk