Race equality framework for Scotland 2016 to 2030

6. Health and Home

Our Vision for 2030:

Minority ethnic communities in Scotland have equality in physical and mental health as far as is achievable, have effective healthcare appropriate to their needs and experience fewer inequalities in housing and home life.

Health and wellbeing are strongly linked with family life and the home environment, and equality in these areas of life is vital to improving life chances. Evidence on ethnicity is lacking in many of these areas, however for health and housing in particular, we know that improvements could be made to better meet the needs of minority ethnic people.

Health and housing were considerable areas of focus for stakeholders participating in the development of the Framework, particularly in terms of improving equality in service provision across these sectors.

Through our Healthier Scotland National Conversation we also heard about what matters to people when thinking about their health and the future of health and social care services and many of the emerging common themes resonated with those identified by minority ethnic communities - in particular in relation to leading healthy lives; access to services; wellbeing, mental health and social connectedness; and person-centred care.

We aim to encourage action based on the evidence available around health and housing to improve outcomes for minority ethnic communities, and as a longer-term action will consider ways of improving the evidence base across areas such as social work and social care.

Figure 12: Women's self-assessed health 2011 ^[23]

Figure 13: Men's self-assessed health 2011

Our key goals:

26. Minority ethnic communities and individuals experience better health and wellbeing outcomes

Although minority ethnic groups are less likely to report having long-term limiting health conditions and disabilities, there are differences between minority ethnic groups with worse outcomes for some groups on particular indicators. Minority ethnic groups are also less likely to report health damaging behaviours such as smoking, excessive alcohol consumption and drug misuse; however, there is a mixed picture in relation to other health and wellbeing indicators such as participation in physical activity and obesity levels. There is also evidence that minority ethnic women in some communities report experiencing poor health to a greater degree than the men in their communities. This is especially the case for older women.

These mixed results suggest that targeted interventions are needed to tackle the inequalities which exist for particular minority ethnic groups on particular indicators of health and wellbeing.

To achieve this goal, we will:

• Promote preventative approaches through tackling unhealthy behaviours and health and wellbeing 'myths,' and encourage healthy living in ways that appeal to minority ethnic communities (including through partnership working with statutory and mainstream services, peer education and advocacy); and improve health literacy through alignment with Making it Easy, A Health Literacy Action Plan for Scotland
• Ensure effective engagement of minority ethnic communities in the Healthier Scotland engagement programme to ensure issues relevant to race equality are considered as part of this wider review
• Ensure effective engagement with minority ethnic communities in the development of the Scottish Government Mental Health Strategy to ensure issues relevant to race equality are considered as part of this wider review
• Ensure effective engagement with minority ethnic communities in the developing Our Voice framework, so that minority ethnic voices are heard and meaningfully involved in improving health and social care services

27. Minority ethnic communities and individuals experience improved access to health and social care services at a local and national level to support their needs

It's important that people are able to access appropriate services when they need them, so to ensure that needs are met, we need to have an understanding of the specific issues affecting minority ethnic communities within health and social care. There are differences in prevalence rates, health outcomes, treatment access patterns and service user needs between ethnicities and across types of impairment or health area, including mental health and both physical and sensory impairment, learning disabilities, long-term health conditions and maternity and ante‑natal care. Some health conditions disproportionately affect people of specific ethnicities, and some courses of treatment have been found to be less effective for people of specific ethnicities. There is also a need to ensure social care services are provided appropriately, especially for older people in minority ethnic communities. Feedback highlights the importance of being listened to and treated equally and fairly with respect for dignity and human rights as part of a person-centred approach.

To support this, several programmes of work are being undertaken in Scotland to improve the currently patchy evidence base on ethnic health and care inequalities, in particular through the work of the Scottish Migrant and Ethnic Health Research Strategy ( SMEHRS) group. The Scottish Government aims to support this work by working with partners to embed good practice on evidence gathering throughout the integrated Health and Social Care Partnerships.

Stakeholders who took part in the development process for the Framework felt that the Scottish health care system needs to build more specialism around these issues, and that health services in general need to be more responsive to the circumstances and needs of minority ethnic people. Taking account of the particular needs of different service-users in regard to their particular characteristics and circumstances was identified by the Scottish Government as part of the key principles underpinning health and social care integration in Scotland; this work will support those principles.

To achieve this goal, we will:

• Promote the embedding of race equality in new health and social care partnership integrated models
• Work with Health and Social Care Partnerships, NHSScotland's Information Services Division ( ISD) and other stakeholders to develop cohesive, effective practice on improving approaches to gathering, collating and publishing ethnicity data on health and social care at a national level
• Work with EHRC, Health and Social Care Partnerships and race equality stakeholders to develop recommendations around:
  • Promoting race equality from prevention to treatment and aftercare, with respect for intersectionality and individual needs (including cultural and linguistic needs)
  • Involving minority ethnic communities in developing holistic, user friendly health and social care services which recognise specific needs

28. Scotland's health and social care workers are better able to tackle racism and promote equality and community cohesion in delivery of health and social care services

In order to achieve the previous goal, workers in the health and social care sector need to have the right interpersonal approaches and knowledge to enable them to identify and meet needs. Health and social care workers understand the importance of a flexible, person-centred approach; no two people are exactly the same, and service provision must reflect this. Where service users have additional requirements linked to language, culture or understanding of services, these need to be met effectively. Additional learning and development may be required for workers to be able to confidently carry out this approach.

A good understanding of issues around racial inequality and racism is also necessary to deal with any incidents which may occur in a health and social care environment. Both service users and staff from minority ethnic backgrounds are at risk of facing both direct and subtle forms of racism; public service organisations need to be able to take appropriate action where this occurs.

To achieve this goal, we will:

• Ensure that every NHS Board can demonstrate that it requires all staff to participate in training on equality, diversity and human rights, including race equality and intercultural competency training
• Encourage social services employers to provide opportunities for their staff to participate in training on equality, diversity and human rights, including race equality and intercultural competency training

29. Scotland's health and social care workforce better reflects the diversity of its communities

National Health Service Scotland ( NHSS) Boards employ a higher proportion of minority ethnic staff in Scotland than most others in the public sector. In some cases, this may be partly boosted by international recruitment. However, the workforce profile in NHSS across occupations and grades is often still not proportionate to the number of minority ethnic people living in the relevant area.

Statistics for social care staff suggest relatively low representation; we also know that, more broadly, the local authorities for which many social care staff work generally have very low numbers of minority ethnic staff. The social care workforce is complex and spread across the public, private and voluntary sector; the Scottish Government will identify potential means of exploring workforce representation in this sector with relevant bodies.

To achieve this goal, we will:

• Work with relevant bodies to take positive action to encourage a greater representation of the minority ethnic population within the workforce of NHSScotland
• Ensure that relevant bodies who will be able to contribute to future work to encourage a greater representation of the minority ethnic population within the social services workforce are identified and engaged with

30. Minority ethnic communities experience fewer housing inequalities

The Scottish Government is committed to tackling the long-standing housing inequalities faced by minority ethnic communities, including statistically higher rates of overcrowding for some communities. Improving access to social housing is also important, as minority ethnic people are disproportionately renting accommodation from private landlords; the private rental sector is generally more expensive, sometimes of a poorer quality, and, although subject to legal obligations, in many ways less stringently controlled than social housing. Issues around immigration status may cause additional difficulties for some individuals and families.

Figure 14: Housing tenure 2011 ^[24]

Figure 15: Overcrowding 2011 ^[25]

Stakeholders involved in the development of the Framework felt that more needed to be done to identify whether minority ethnic communities are benefiting equally from the social housing system, and also wanted to see closer relationships between housing associations and their minority ethnic tenants.

To achieve this goal, we will:

• Work in partnership with the Scottish Housing Regulator and other stakeholders to make the best use of available housing data and research to identify issues affecting minority ethnic communities and promote race equality
• Strengthen minority ethnic tenant participation and influence in the housing sector by enabling effective engagement with minority ethnic communities to ensure that their experiences and views are reflected in the review of the Scottish Social Housing Charter