Scottish Government Equality Outcomes: Ethnicity Evidence Review

12 Health

12.1 This section addresses health outcomes, health behaviours, and experience of healthcare services.

12.2 The information on health outcomes and health behaviours is all taken from the Scottish Health Survey¹¹⁹ (2012).

Health outcomes

12.3 The Scottish Health Survey reports that those who reported their ethnic group as Pakistani were least likely to rate their health as good or very good (66%), although due to small sample sizes this was not significantly different from the national average of 76%. Chinese respondents were the most likely to rate their health as good or very good (91%), and this was significantly different from the national average.

12.4 Mental wellbeing is measured on the WEMWBS scale, where lower scores indicate less good wellbeing. White British respondents had the lowest levels of wellbeing of all ethnic groups, with a mean WEMWBS score of 49.8. This was significantly lower than that the scores of the white other (51.2), African, Caribbean or black (53.7), and Asian other (53.5) ethnic groups.

12.5 Psychological ill-health is measured by means of a GHQ12 score, where higher scores indicate ill-health. High GHQ12 scores (indicating psychological ill-health) were recorded for a large proportion of other ethnic groups (25%), Pakistani (23%) and African, Caribbean or black groups (18%), but none of these was significantly different from the Scottish average (15%). Chinese and other Asian ethnic groups had the lowest proportion of scores suggesting ill-health (both 10%) but again, these were not significantly different from the national average.

12.6 Regarding dental health, the white British and white Irish ethnic groups had the lowest proportion of adults with twenty or more natural teeth (both 71%). Indian (93%), Chinese (88%), African, Caribbean or black (87%) Pakistani (86%), mixed ethnic groups (86%), and white other (78%) all had significantly higher proportions of adults with twenty or more teeth than the national average. In terms of toothache, there were few significant differences between ethnic groups. Pakistani respondents had a significantly higher prevalence of toothache (24%) than the national average, whilst white Irish respondents had a significantly lower prevalence (8%) of toothache. The Survey reports that previous studies of dental health in Scotland had found that African and African-Caribbean people were more likely than the general population to brush their teeth twice a day and to have their own teeth.

12.7 The highest prevalence of obesity was among African, Caribbean or black respondents (35%), but this was not significantly different from the average. Previous research had found that Asians in Britain were almost four times as likely to be obese than white ethnic groups, but these findings have not been replicated in the Scottish Health Survey results as they show no significant difference between white British and Asian ethnic groups - and this may be due to small sample sizes. Chinese and Asian other respondents had the lowest prevalence of being overweight (41% and 45% respectively) and obesity (4% and 9% respectively), and this was significantly lower than the national averages (of 64.3% for overweight and 27.7% for obesity.

12.8 Pakistani (18%) and Indian (14%) respondents had the highest prevalence of diabetes, although only the Pakistani figure was significantly higher than the average. The high prevalence of diabetes among south Asians living in the UK has also been noted in a report by Diabetes UK¹²⁰. Chinese, Asian other, mixed, and African, Caribbean or black ethnic groups, all had low levels of diabetes (ranging from 3% to 4%) although none of these were significantly different from the national average.

12.9 Chinese respondents were the least likely to have a doctor-diagnosed cardio-vascular disease condition (4%), significantly lower than the national average (15%). No Asian other respondents reported a cardio-vascular disease condition, although this may be due to the relatively small number of people surveyed in this category (103 over the four years). Although South Asians have previously been found to have an increased risk of coronary heart disease compared to European ethnic groups¹²¹, the Scottish Health Survey data do not bear this out, as the prevalence of cardio-vascular disease among Indian and Pakistani respondents was not significantly different from the average. This may, again, be partly due to small sample sizes being unable to identify significant differences. African and Caribbean ethnic groups were found to have a lower than average prevalence of cardio-vascular disease (8%), although this was not statistically significant.

Health behaviours

12.10 The Scottish Health Survey found that white ethnic groups (Scottish, Irish, other British, and other) were broadly similar to each other in terms of weekly alcohol consumption. Pakistani (3%), Chinese (4%), other Asian (4%), and African, Caribbean or black respondents (7%) were all significantly less likely to drink at hazardous or harmful levels than the national average (23%). The white other group (27%) and African, Caribbean or black respondents (19%) were significantly less likely to drink above daily limits than the national average (39%). Previous studies have found similar ethnic differences in drinking behaviour; for example, alcohol-related mortality is higher in men and women born in the UK than those born in Pakistan¹²².

12.11 Respondents from Pakistani and Asian other ethnic groups were significantly less likely to smoke than the national average, with a prevalence of 13% and 9% respectively compared to the national rate of 25%. Because of the smaller sample sizes available (as analysis is restricted to current smokers only), it is not possible to provide robust estimates of the mean number of cigarettes smoked by any of the non-white ethnic groups. White British smokers smoked an average of 14.4 cigarettes a day, significantly more than those from other white ethnic groups (12.1). The only significant difference between ethnic groups in the age of starting smoking, was among the white other group where respondents started smoking at an average age of 19.3, significantly older than the national average of 17.5.

12.12 There was a significant association between fruit and vegetable consumption and ethnic group. White British respondents were the least likely to eat five or more portions per day, with a prevalence of 21% compared to the national average of 22%. Conversely, white other (40%, eating on average 4.6 portions per day), Pakistani (48%, 4.8 portions), Chinese (49%, 5.2 portions), Asian other (51%, 5.0 portions) and Other ethnic groups (46%, 5.0 portions), were all significantly higher than the national average (22%, 3.2 mean portions) in terms of their consumption of five or more portions per day.

Access to, and experience of, health services

12.13 The report of the 2010 Scottish Inpatient Survey¹²³ examines the variations in the self-reported experiences of Scottish inpatients, from different groupings including by ethnicity. The survey did not find clear differences in experience based on ethnicity: these results may have been affected by the fact that the analysis combined people from many different ethnic groups into a single non-white category, because of the small number of respondents from individual ethnic groups.

12.14 The Scottish Inpatient Survey addressed language in addition to ethnicity: patients were asked whether they needed an interpreter or any other help to communicate. Patients who required an interpreter or any other help to communicate were compared against patients that did not. Patients requiring an interpreter or any other help to communicate generally gave less positive responses than other patients: for 40 questions they were less likely to report a positive experience and they were never more likely to report a positive experience. Three questions particularly stand out where those requiring an interpreter or any other help to communicate were less positive:

• I understood what my medicines were for
• I was confident I could look after myself when I left hospital
• I understood what was happening to me.

12.15 The report of the 2010 Scottish Inpatient Survey observes that good communication has been found to be an important contributory factor in the promotion of positive patient experience: it may not be surprising, therefore, that patients with translation, interpreting and communication support needs are less likely to report a positive experience as communication requirements may not be adequately addressed in the hospital setting.

12.16 Regarding access to health services by refugees and asylum seekers, the Scottish Refugee Policy Forum policy conference in 2012¹²⁴ addressed many issues including access to health care. The reported problems include unclear procedures for registering with a GP, GP registrations that can be complicated by individual circumstances (such as receiving Section 4 support for failed asylum seekers), receiving information from GPs that is difficult to understand (including language barriers), difficulty in receiving information due to frequent changes of address, and reluctance to seek help with mental health issues.

12.17 A large-scale epidemiological study of 293 Gypsies/Travellers across five locations in England (2004)¹²⁵ found a higher birth-rate among Gypsy/Traveller women than in a settled comparator group matched by age. In terms of maternal health outcomes, there were no significant differences in the number of women reporting problems with pregnancy or childbirth including morning sickness, pre-term birth, breech presentation, or post-natal depression. However, more Gypsies/Travellers experienced one or more miscarriages, Caesarean sections, or had suffered the death of a child.