ETHNIC MINORITIES NEEDS ASSESSMENT FOR STOKE-ON-TRENT Public Health Department Stoke-on-Trent City Council January 2015 Report author Paul Trinder Senior Epidemiologist Public Health Department Stoke-on-Trent City Council First Floor Civic Centre Glebe Street Stoke-on-Trent Staffs ST4 1HH Email: [email protected] ii Contents Page Executive summary v 1 Introduction 1 2 Scope of the needs assessment 1 3 Demography 2 3.1 Population 2 3.2 Changes in population 3 3.3 Births 4 3.4 Age and sex 4 3.5 Geographical location 6 3.6 Time in the UK 9 3.7 Religion 10 3.8 Asylum seekers 11 3.9 Demography summary 11 4 Socioeconomic characteristics 11 4.1 Socioeconomic status 11 4.2 Industry 12 4.3 Socioeconomic summary 13 5 Social determinants of health 14 5.1 Employment 14 5.2 Housing 15 5.3 Education 17 5.4 Social determinants of health summary 18 6 Health outcomes 18 6.1 General health 19 6.2 Long-term health problems 19 6.3 Emergency hospital admissions 20 6.4 HIV 21 6.5 Smoking 22 6.6 4 week smoking quitters 23 6.7 Obesity 24 6.8 Physical activity 26 6.9 Health outcomes summary 26 7 Access to general practice 27 iii Page 8 Conclusion 28 Appendices 30 References 46 iv Executive summary According to the former Commission for Racial Equality, anyone who would tick a box other than ‘White British’ in response to an ethnicity question on a census form could be said to belong to an ethnic minority. On this basis, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent in 2011 (13.6% of the total population, compared with 20.2% in England). Health and health outcomes are known to vary by ethnic status. For instance, compared with the general population, the Health Survey for England found that: the prevalence of angina and heart attack was highest in Pakistani men and Indian men and women; doctor diagnosed diabetes was significantly higher in Black Caribbean, Indian, Pakistani and Bangladeshi men and women; Black Caribbean and Irish men had the highest prevalence of obesity; Bangladeshi and Pakistani men and women and Black Caribbean women were more likely to report bad or very bad health; Pakistani women and Bangladeshi men were more likely to report a limiting longstanding illness. Alongside differences in health status, ethnic minorities may potentially face additional difficulties in accessing appropriate, timely and effective health care services. Language and cultural barriers, lifestyle differences, potential discrimination, and poorly delivered health care can further compound the poorer health status of ethnic minorities. Scope of the needs assessment The aim of this needs assessment is to pull together and explore in detail the demographic, geographic, and health and social care needs of ethnic minority populations in Stoke-on- Trent. Five main areas are explored: • demography • socioeconomic characteristics • social determinants of health • health outcomes • access to general practice Main findings Based on the 2011 Census, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent. This equates to 13.6% of the total population (compared with 20.2% in England). The largest concentration of ethnic minorities was in the west of the city. Compared with the White British population, the Non White British population of Stoke-on- Trent tended to be younger (with a greater proportion of people aged under 40). Between the 2001 and 2011 Census, the number of people from ethnic minorities increased in the city from 15,452 to 33,786. v At Key Stage 2 (10-11 year olds), performance among all ethnic minority schoolchildren was poorer compared with White British children, and this poorer performance was mirrored at Key Stage 4 (15-16 year olds) for all ethnic minorities (apart from Other). Ethnic minorities in Stoke-on-Trent were more likely to be unemployed compared with their White counterparts. Black ethnic minorities had the highest levels of unemployment, whilst Mixed and Black ethnic minorities were more likely to be employed in semi-routine/routine occupations. Across a range of health and lifestyle indicators, outcomes for ethnic minorities in Stoke-on- Trent were favourable. However, we know from other sources that this is not always the case, and evidence presented in this report has shown differences in outcomes in regards to emergency hospital admissions, HIV, and excess weight among schoolchildren. Accessing timely and appropriate health care services is essential for maintaining and promoting good health. Findings from the General Practice Patient Survey showed that the experiences of ethnic minorities in Stoke-on-Trent differed from their White counterparts in a number of ways. These included, among others: finding it more difficult to access services (on the phone); being less likely to see their preferred GP; being less likely to ‘definitely’ have confidence and trust in their GP or practice nurse; being less likely to report having a ‘very good’ experience of their GP. vi 1 Introduction According to the former Commission for Racial Equality (now replaced by the Equality and Human Rights Commission (EHRC)), anyone who would tick a box other than ‘White British’ in response to an ethnicity question on a census form could be said to belong to an ethnic minority [Donaldson and Scally 2009]. On this basis, 20.2% of the population of England (around 10.7 million people) were from ethnic minorities according to the 2011 Census. The five largest ethnic minority groups were: Other White (4.6%), followed by Indians (2.6%), those of Mixed ethnic backgrounds (2.3%), Pakistanis (2.1%), and Black Africans (1.8%). Health and health outcomes are known to vary by ethnic status. For instance, compared with the general population, the Health Survey for England found that: the prevalence of angina and heart attack was highest in Pakistani men and Indian men and women; doctor diagnosed diabetes was significantly higher in Black Caribbean, Indian, Pakistani and Bangladeshi men and women; Black Caribbean and Irish men had the highest prevalence of obesity; Bangladeshi and Pakistani men and women and Black Caribbean women were more likely to report bad or very bad health; Pakistani women and Bangladeshi men were more likely to report a limiting longstanding illness [Health and Social Care Information Centre 2005]. Alongside differences in health status, ethnic minorities may potentially face additional difficulties in accessing appropriate, timely and effective health care services. Language and cultural barriers, lifestyle differences, potential discrimination, and poorly delivered health care can further compound the poorer health status of ethnic minorities. 2 Scope of the needs assessment The purpose of a health needs assessment is to examine the health of a particular population and to target resources towards improving the health of those most at risk or in need. Locally, information around the health and social care needs of ethnic minorities is patchy. The Joint Strategic Needs Assessment for the city routinely considers variations by ethnicity for a limited number of issues (such as school attainment, provision of carers), alongside other demographic factors such as age, sex and social class. Beyond this however, information is somewhat limited. The aim of this needs assessment is to pull together and explore in detail the demographic, geographic, and health and social care needs of ethnic minority populations in Stoke-on- Trent. Five main areas are explored: • demography • socioeconomic characteristics • social determinants of health • health outcomes • access to general practice 1 For the purpose of this needs assessment (and following the EHRC recommendation), anyone other than ‘White British’ is defined as an ethnic minority. 3 Demography 3.1 Population The most up-to-date source available to enable us to look at the demography of ethnic minorities is the 2011 Census. Based on the Census, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent in 2011 (13.6% of the total population, compared with 20.2% in England). The largest ethnic minority groups locally were Pakistanis (4.2%), followed by White Other (which included White Irish, White Gypsy or Irish Traveller, and Other White, 2.2%), Mixed (1.8%), Asian Other (1.4%), and then Black Africans (1.0%).1 Compared with England, there was a significantly higher percentage of Pakistanis locally, whilst, in contrast, there was a significantly lower percentage of White Other, Mixed, Asian Other and Black Africans (figure 1). Figure 1 Ethnicity by 2011 Census White British White Other Mixed Indian Pakistani Bangladeshi % Asian Other Black African Black Caribbean Black Other Other Stoke-on-Trent England Source: Office for National Statistics 2013 Further information on the ethnic status of people in Stoke-on-Trent (based on country of birth), shows that 4.4% (10,897 people) were born in the Middle East and Asia, 2.2% (5,405 people) were born in Other European countries, 1.1% (2,805 people) were born in Africa, whilst 0.3% (731 people) were born in the Americas and the Caribbean (table 1). 1 See Appendix 1 for more information 2 Table 1 Ethnicity by country of birth in Stoke-on-Trent in 2011 Country White Mixed Asian Black Other Total % Europe 214,439 3,822 8,607 1,152 274 228,294 91.7 Ireland 529 9 11 17 5 571 0.2 Other Europe 4,684 174 204 137 206 5,405 2.2 Africa 358 169 163 1,931 184 2,805 1.1 ME/Asia 312 241 9,419 73 852 10,897 4.4 Am/Caribbean 249 56 15 378 33 731 0.3 Oceania 141 20 23 53 68 305 0.1 Total 220,712 4,491 18,442 3,741 1,622 249,008 100 Source: Office for National Statistics 2013 3.2 Changes in population In 2001, there were 15,452 people from ethnic minority groups in Stoke-on-Trent, which was equivalent to 6.4% of the total population.