NHS Forth Valley is committed to principles of equity and fairness.  We recognise that a core commitment of the NHS is toprovide services and employment that are fair for all.     

Ethnicity

Research tendsto show that ‘ethnicity’ means different things to different people, has anumber of possible meanings which can depend on the context or situation, andevolves over time.  Generally the termrefers toagroupidentitybasedonshared geographical origin, language, culturaltradition or religion or other socialcharacteristics.Collecting ethnicity statistics is not straightforward because there is noconsensus about what constitutes an ‘ethnic group’. In part, this stems fromthe absence of any legal definition in race relations legislation.

However,the 2011 Census provided the following categories for people in Scotlandto self-define their ethnic group:

Race

‘Race’ is a concept used to distinguish between different groups of people, often based on a limited range of physical factors.  In fact, there are as many differences within any of the so called ‘races’ as there are between them.

Genetically speaking there is only on ‘race’ the Human Race.

The Race Relations Act was introduced in 1976 in the UK to make it unlawful to discriminate on racial grounds and to promote relations between people of different racial groups.  This was replaced by the Race Relations (Amendment) Act 2000 extending the law to encompass ‘public authorities’, including the NHS.  This was superseded by the Equality Act 2010.

Racism

The Treaty on European Union Article 13 gives the description: ‘Racism’ and ‘xenophobia’ mean the belief in race, colour, descent, religion or belief, national or ethnic origin as a factor determining aversion to individuals or groups.’

Institutional Racism

Was defined in the Stephen Lawrence Report by Sir William MacPherson as: “The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.  It persists because of the failure of the organisation openly and adequately to recognise and address its existence and causes by policy, example and leadership. Without recognition and action to eliminate such racism it can prevail as part of the ethos or culture of the organisation.  It is a corrosive disease ”

Culturally Competent Service

A definition for the NHS is ‘a service, which recognises and meets the diverse needs of people of different cultural backgrounds.  This applies to every individual with a healthcare need.  It includes, but is not limited to, making provision for religious and cultural beliefs such as worship, diet, hygiene requirements and providing support for communication and language diversity and involving users in service development.  A key part of cultural competence is ensuring that discrimination on the basis of culture, belief, race, nationality or colour has no role in the delivery of services.

‘Business’ Case for Eliminating Discrimination and Valuing Diversity

A growing body of evidence shows that care is more effective where the patient’s needs and life circumstances are well understood by those delivering health care and that an awareness of equity and diversity is an integral part of clinically governed services and reducing health inequalities. For example, International UK wide and Scottish studies have shown that some minority communities may have worse health experience in the form of premature deaths, and long term chronic ill health and disabilities, than others.

Some examples include:

• Much higher rates of mortality from hypertensive disease and stroke among those of Black African or Caribbean heritage.
• Mortality rates almost 50% higher for Asians, from coronary heart disease.
• People of Indian, Pakistani, Bangladeshi and other South Asian descent are six times more likely to develop Type 2 diabetes than Caucasians. Those of African / Caribbean origin are three times more likely.
• Diabetic retinopathy is more common in individuals of Pakistani, Indian or Bangladeshi descent
• Some forms of glaucoma are more than three times more prevalent among people of Afro-Caribbean and Chinese descent, and are often more severe.
• People from ethnic minorities can face specific challenges to their mental health and well being. There are also cultural differences between communities in the way that mental health problems are viewed and acted on.
• Ethnic minority communities may experience difficulty in accessing health services, health promotion information and treatment, which may mean that they present late for diagnosis and treatment.
• Language barriers can present further difficulties to some people in trying to access services and information in Scotland

For further information please see: NHS Health Scotland Report Dimensions of Diversity (2010)

Useful resources

• Scottish Health and Ethnicity Research Strategy Steering Group, Health Scotland http://www.healthscotland.com/resources/networks/SHERRS.aspx
• Ethnic Monitoring Tool http://www.healthscotland.com/documents/2476.aspx