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Ethnicity

Introduction

The Equalities Act 2010 legally protects individuals from discrimination in the workplace and in wider society. Under the act, public sector organisations like Local Authorities have an obligation to take notice of the need to reduce inequalities that result from socioeconomic disadvantage (Equality Act, 2010). Reading has an ethnically diverse population and Reading Borough Council has a responsibility to ensure that no groups face disadvantage as a result of their ethnic identity.

What do we know?

The main and most reliable indicator of the ethnic background of residents within a local authority is the national census. The most recent Census information (2011) is shown in Table 1 and has been compared with the previous Census (2001) to illustrate population change in a ten year period.

In 2011 the largest proportion of the population (66.9%) identified themselves as 'White British'. This proportion had decreased from 86.8% in the previous census and was considerably lower than the national figure of 80.9%, suggesting greater diversity in Reading in recent years and in comparison with other local authority areas. Those identifying as 'Other White' (encompassing a number of nationalities, including Polish) account for 7.9% of the population, an increase from 4.2% in the previous census. South Asian groups (Indian, Pakistani and Other Asian) accounted for 12.6% of all residents in 2011, an increase from 5.2% in 2001. The other increase of note is the proportion of people identifying themselves as Black African, which increased from 1.6% to 4.9%).

Table 1: Ethnicity in Reading - Census data 2001 and 2011

Ethnicity Group

Reading 2001

Reading 2011

England 2011

White British

86.8%

66.9%

80.9%

Other White

4.2%

7.9%

4.6%

Mixed

2.4%

3.9%

2.2%

Indian

1.7%

4.2%

2.6%

Pakistani

2.7%

4.5%

2.1%

Other Asian

0.8%

3.9%

2.3%

Black Caribbean

2.2%

2.1%

1.1%

Black African

1.6%

4.9%

1.8%

Black Other

0.4%

0.7%

0.5%

Chinese

0.7%

1.0%

0.7%

Other ethnic group

0.7%

0.9%

1.0%

Source: Office for National Statistics, 2001 Census KS06. SASPAC Version 6. 2011 Table KS201EW

The 'Other White' category includes many different nationalities both from within the European Union (EU) and elsewhere in the world. The largest of these is Polish, with 3,495 people resident in Reading in 2011, or 2.3% of the population. 3,919 people who lived in Reading in 2011 were born in Poland. A further 890 people are classified as 'White - Other Eastern European' (0.57% of the population) and may include those who identify as Hungarian, Lithuanian, Slovakian, Romanian and Bulgarian. 2,495 people identified as White - Western European (including 496 who identified themselves as Italian), equivalent to 1.6% of the population and 1,594 people identified as White - European Mixed (1% of the population).

Indian and Pakistani residents accounted for 4.2% (6,514 people) and 4.5% (6,967 people) of Reading's 2011 population respectively. 2,617 people identified as Asian - Nepalese, some 1.68% of the population. There is evidence of an increasing number of people migrating to the UK from Nepal following changes in legislation between 2007 and 2009 which granted greater residency and pension rights to former Ghurkha soldiers and their families (Office of National Statistics (ONS), 2013a). No further breakdown is available for those identifying themselves as Black/Black British - Black African in Reading. However, ONS analysis describes a large percentage increase in the number born in Nigeria migrating to the UK between 2001 and 2011, related to restoration of democracy in 1999, civil conflict and rapid population growth (ONS, 2013). Since Nigeria is one of the ten countries in which the highest number of non-UK born Reading residents were born, it seems likely that this may have contributed to this trend (RBC, 2012). It should be noted, however, that ONS also discusses large numbers of UK residents in the 2011 census who were born outside of the UK who migrated from South Africa, Zimbabwe, Rwanda, Somali and Ghana between 1991 and 2001 (ONS 2013), and may have moved to Reading in the intervening period.

Changes to Reading's population have been largely driven by international migration (see migration module). In the 2011 Census, the largest numbers of residents born outside of the UK were born in India, Poland and Pakistan, and these populations are clearly reflected in the ethnicity profile of the population described above.

There are geographical variations in ethnic diversity across Reading with central areas having higher proportions people from ethnic minority groups.

Figure 1: Percentage of population who identify as White British by Ward

image1

Source: Office for National Statistics, Census 2011

Figure 2: Percentage of White (British, Other) residents by ward (Census 2011)

image2

Source: Reading Borough Council and University of Reading, Census Statistics, Detailed Factsheets, 2012

Analysis of the largest BME populations by ward suggests some trends across the Borough (See Figure 3).

Figure 3: Analysis of BME populations by ward (Census 2011)

image3

Source: Office for National Statistics, 2011 Census: Quick Statistics for wards and output areas in England and Wales

Abbey, one of the two most central wards and the most diverse ward, had much larger proportion of British Indian/Indian residents than was seen in the rest of the borough (11.9% of those resident in the ward, 1,503 people - almost a quarter of all British Indian/Indian people living in Reading). Katesgrove had the second largest population (827 people, 6.5% of the ward population).

Park ward (to the East of the town centre) had the largest number of British Pakistani/Pakistani and Nepalese residents (1,370 and 877 people respectively, 10.8% and 6.9% of those living in the ward). Abbey and Battle ward also had high numbers of British Pakistani/Pakistani and Nepalese residents (734 British Pakistani/Pakistani residents, 5.8% of the ward population in Abbey and 930, 7.4% of the ward population in Battle; 336 Nepalese residents in Abbey, 2.7% of the ward population, and 356, 2.8% of the ward population in Battle).

Battle ward, part of the Oxford Road area to the West of the town centre and the second most diverse ward in the Borough, had the largest Polish population (761 people, 6% of those resident in the ward). Abbey and Katesgrove wards also had high proportions of Polish residents (434 people, 3.4% of the ward population in Abbey and 364 people, 2.9% of the ward population in Katesgrove), but much smaller numbers than in Battle ward.

Battle also had a high proportion of African residents, although the number of residents (729, 5.8% of the ward population) was similar to the numbers in Minster (town centre - 720 people, 5.7% of the population), Redlands ( 611 people, 4.8% of the ward population) and Abbey (town centre, 604 people, 4.8% of the ward population).

National & Local Strategies (Current best practices)

The Equalities Act 2010 legally protects individuals from discrimination in the workplace and in wider society. Under the act, public sector organisations like Local Authorities have an obligation to take notice of the need to reduce inequalities that result from socioeconomic disadvantage (Equality Act, 2010). Reading has an ethnically diverse population and Reading Borough Council has a responsibility to ensure that no groups face disadvantage as a result of their ethnic identity. Reading Borough Council refers to this obligation in its Equality Objectives (RBC, 2015) and describes the Local Authority's ongoing commitment to celebrating and respecting diversity in Reading as a key to the Borough's success. In addition, as part of their public health responsibilities, Local Authorities are required to consider wider factors that will impact on their communities' health and wellbeing (DH, 2013).

The concept of 'cultural competence', initially developed in the 1980s in response to the growing recognition that cultural and linguistic barriers between healthcare providers and practitioners and service users could affect the quality and accessibility of healthcare, is a broad way of referring to techniques and approaches used by healthcare services to ensure equity of accessibility and effectiveness regardless of cultural background. These techniques may include reviewing organisational culture to ensure that cultural diversity is understood and respected; ensuring practitioners are aware of potential cultural differences and how these may affect dynamics in their interactions with patients and considering how barriers can be overcome; valuing diversity in the workplace; and encouraging practitioners to take an interest in their patient's 'world view' and experience (Cross et al, 1989; Truong, Paradies and Priest, 2014; Schouler-Ocak et al, 2015). Although the concept is widely observed in health services, it should be noted that the concept is loosely defined and evidence for effectiveness is moderate (Truong, Paradies and Priest, 2014).

What is this telling us?

Reading has an increasingly diverse population with those from BME groups most likely to live in central areas of the borough. Significant groups for consideration are likely to be:

  • Polish and other Eastern European nationalities - many are likely to be non-UK born economic migrants. By far the largest number of Polish residents were resident in Battle ward, with smaller but significant populations also in Abbey and Katesgrove wards.
  • South Asian groups - large Indian and Pakistani populations and, since 2007, growing Nepalese population. Likely to encompass recent migrants (especially Nepalese residents), those resident for many years and those born in the UK. A high proportion of British Indian/Indian people were resident in Abbey ward in 2011, while the highest proportions of Pakistani and Nepalese residents lived in Park ward.
  • African groups - Census data shows that the population has grown since 2001, but it is unclear whether this is related to migration to the UK or within the UK. The highest proportions of those who identify themselves as African in 2011 were in a number of wards central to the Borough.

What are the key inequalities?

Evidence suggests that differences in health status between some ethnic groups appear to be mainly related to socioeconomic inequality, rather because of ethnicity itself. The picture is complex, with ethnic origin, place of birth and norms and behaviours associated with particular cultures not consistently related to one another (Darlington, Norman, Ballas, and Exeter, 2015).

Differences in self-reported health in the UK 2011 census data suggest that health differences between ethnicity groups across the UK are mainly related to the age profile of each group, with those with older populations tending to report worse health, while those with populations of working age reported better health (ONS, 2013b). The most significant outlier for this trend is the White: Gypsy or Irish Traveller group and this is considered to be likely to be connected to a transient lifestyle which may affect access to health care.

In some instances, conditions may be associated with having lived abroad in areas where the condition is more common. Incidence of tuberculosis and HIV, for example, are much more common in people from certain minority ethnic groups or who are born in particular areas outside of the UK (NICE, 2016; 2014).

One of the key factors in health and wellbeing status may be ability to access health services (Jayaweera, 2014), especially for recent immigrants. For example, research into Polish immigrants in the UK found a tendency to present to emergency departments for conditions that are usually treated in primary care settings (Leaman et al, 2006). This may suggest lack of cultural knowledge (e.g. not knowing how to register with a GP) or institutional or cultural barriers to health services (e.g. refused GP services).

What are the unmet needs / service gaps?

As the population becomes more ethnically diverse, organisations will need to continue to be mindful of the need to provide culturally competent and culturally sensitive services to ensure that health services remain accessible and responsive to the people who need them (see population change module). As mentioned above, some migrant populations may have specific health needs that require specific targeted interventions. Further investigation is needed to determine where this is the case.

This section links to the following sections in the JSNA

Population Change

Migration

References

Cross, TL, Bazron, BJ, Dennis, KW, Isaacs, MR. (1989). Towards a culturally competent system of care. A monograph of effective services for minority children who are severely emotionally disturbed.Washington DC: CASSP Technical Assistance Centre, Georgetown University Child Development Center.

Darlington, F, Norman, P, Ballas, D, Exeter, DJ (2015). Exploring ethnic inequalities in health: evidence from the Health Survey for England, 1998-2011. Diversity and Inequality in Health and Care, 12 (2), pp.54-65.

Department of Health (DH) (2013). Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies.[Online].London: HMSO. Available at: [ARCHIVED CONTENT] Statutory guidance published on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies | Modernisation of health and care

Equality Act(2010). London: HMSO.

Leaman, AM, Rysdale, E and Webber, R. (2006). 'Use of emergency department by Polish migrant workers'. Emergency Medicine Journal, 23 (12), pp.918-919.

Jayaweera, H. (2014). 'Briefing: Health of Migrants in the UK: What do we know?' Migration Observatory, Oxford: University of Oxford. Health of Migrants in the UK: What Do We Know? | The Migration Observatory

Office of National Statistics (ONS). (2013a). Immigration Patterns of Non-UK Born Populations in England and Wales in 2011.[Online]. London: HMSO. Available at: http://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/internationalmigration/articles/immigrationpatternsofnonukbornpopulationsinenglandandwalesin2011/2013-12-17

ONS (2013b). Ethnic Variations in General Health and Unpaid Care Provision. [Online]. London: HMSO. Available at: http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/ethnic-variations-in-general-health-and-unpaid-care-provision/rpt-ethnic-variations-in-general-health-and-unpaid-care-provision.html

National Institute for Health and Care Excellence (NICE) (2016). Tuberculosis: Prevention, diagnosis, management and service organisation (NG33): Evidence, methods and recommendations. [Online]. London: NICE.  Available at: http://www.nice.org.uk/guidance/ng33/resources/tuberculosis-prevention-diagnosis-management-and-service-organisation-2910851744965. [Accessed: date].

NICE (2014). HIV Testing: NICE Advice (LGB21) [Online]. London: NICE. Available at: https://www.nice.org.uk/advice/lgb21/chapter/introduction#. [Accessed: date].

Reading Borough Council and University of Reading (2012) Census 2011 - Detailed Factsheets. [Online].  Available at: http://beta.reading.gov.uk/media/1289/Census-Factsheets/pdf/Census-Factsheets.pdf

Reading Borough Council. (2015). Equality Objectives. [Online]. Available at: http://www.reading.gov.uk/media/1245/Equality-Objectives/pdf/Equality-Objectives.pdf [Accessed 09/02/2016]

Schouler-Ocak, M, Graef-Calliess, IT, Tarricone, I, Quershi, A, Kastrup, MC, and Bhugra, D. (2015). 'EPA guidance on cultural competence training'. European Psychiatry, 30, pp.431-440.

Truong, M, Paradies, Y and Priest, N. (2014). 'Interventions to improve cultural competency in healthcare: a systematic review of reviews'. BMC Health Services Research, 14:99.

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