Minority ethnic groups - understanding diet, weight and type 2 diabetes: scoping review

Introduction

Scotland's population is becoming increasingly ethnically diverse. According to Scotland's Census in 2011^[1], which is the latest data we have on ethnic composition of the Scottish population, non-White minority groups form around 4% of the Scottish population. This percentage represents almost a four-fold increase from 1.3% in 1991, and the forecast is that this will increase further to 7% by 2031 (Walsh et al., 2018). According to the 2011 census, 2.7% of the population identified as Asian, Asian Scottish or Asian British, with the largest Asian group being Pakistani, followed by Chinese, Indian, Other and Bangladeshi. Just over 1% of Scottish population identified as African, Caribbean or Black. Under 1% identified as Mixed, Multiple or Other ethnicity, including Arab.

It is well known that in the UK, as well as in other countries, there is a striking persistence of health inequalities, including ethnic (or racial) inequalities in health (Marmot, 2010; Williams et al., 2019a). The relationship between ethnicity and health is extremely complex and strongly affected by socioeconomic factors (Walsh et al., 2018). However, socioeconomic factors alone do not fully explain health inequalities among different ethnic groups, and there are differences in some health outcomes even when the risk is adjusted for indicators of socioeconomic status (Fischbacher et al., 2014; Williams et al., 2019).

The Scottish Health and Ethnicity Linkage Study (SHELS) is a key source of information in relation to ethnicity and health in Scotland. By examining the links between a person's ethnic group and health outcomes, a number of important differences have been found in cardiovascular diseases, cancer, maternal and child health and other health outcomes across minority ethnic (ME) groups (Bhopal et al., 2011). While ME groups in Scotland have in general lower mortality than the general population, evidence shows that they suffer disproportionately from specific health problems, such as heart diseases and diabetes (ScotPHO, 2020).

The aim of this report is to bring together as much information and research as possible to summarise what we can reasonably say about:

• diet quality, weight status and type 2 diabetes (T2D) prevalence (and susceptibility) in minority ethnic (ME) groups;
• minority ethnic groups' experiences of accessing type 2 diabetes prevention and treatment services, weight management services (WMS) and programmes (WMP);
• evidence-based solutions to address any inequalities and recommendations arising from research and engagement work.

This is to help inform policy discussion, particularly in relation to "reinvigorating efforts on culturally competent health promotion and disease prevention of diabetes for people from minority ethnic communities", a key commitment in the 2021 Race Equality Immediate Priorities Improvement Plan (Scottish Government, 2021).

The report is structured as follows: section 2 describes the methods that have been adopted to inform this scoping work on minority ethnic diet, weight and type 2 diabetes. Section 3 focuses on diet quality and behaviours of ME groups, followed by section 4 that presents data about the weight status of ME groups, including some evidence on access to weight management services and programmes. Section 5 focuses on the higher prevalence of type 2 diabetes in some ME groups, and section 6 brings everything with a focus on the design and delivery of culturally appropriate health education programmes. Section 7 highlights some limitations of this work, and the final section summarises the main issues and provides some general final recommendations about culturally appropriate health promotion.