Mike Spencer Assistant Director Patient Experience Cardiff and Vale University Health Board

1. Supporting the Health Needs of Black and Minority Ethnic Communities in Cardiff and the Vale of Glamorgan Mike Spencer Assistant Director Patient Experience Cardiff and Vale University Health Board

2. Conflicts of Interest The Health Fair is supported by a wide range of voluntary and statutory organisations. These include Cardiff and Vale University Health Board, Sight Cymru, BAWSO, BRG Communities First, the Mentor Ring, Marie Curie Cancer Care, Cardiff Council, Diverse Cymru and C3SC, This presentation is given on their behalf. The presenter has not received fees for talks and research advice related to this topic. Support for attendance has been provided by Cardiff and Vale University Health Board.

4. Cardiff Old and New

5. Cardiff’s Tradition of Diversity • Cardiff is home to one of the oldest multi-racial communities in Britain • The coal trade and associated shipping led to over 50 nationalities living in the docks area in the 1950s • Yemeni seafarers introduced the annual march through the streets of Butetown at the turn of the last century

6. Ethnicity Summary – Census 2011 • In 2011 the population of Wales was 96% White –higher than any of the regions in England – and Wales is the least diverse area • One local authority in Wales is amongst the 5 in England and Wales with the highest proportions of white British population • Cardiff has the highest proportion of minority ethnic groups in Wales (15.2%) and the proportion has doubled over the last 10 years • More than 40% of Wales’s non white population lives in Cardiff

7. Ethnic Diversity in Wales 2001 to 2011 Cardiff and Vale UHB

8. Diversity in Cardiff • Of the 29 electoral divisions in Cardiff, four have the highest non white population • The highest black population is in Butetown and Grangetown • Those of Asian origin are concentrated in 3 divisions • Chinese and mixed race are more evenly spread across the city • Cardiff also receives over half of the total asylum seekers dispersed to Wales

9. Ethnicity in Cardiff Source: 2011 census

10. Diversity in Cardiff • 50% of the Welsh Iranian population live in Cardiff • Over 50% of the Malaysian • Over 50% of the Greek • 94% of the Somalis • 50% of the Pakistanis • 71% of the Afghans

11. Cardiff and Vale University Health Board • The Health Board provides the full range of primary, secondary, tertiary and community services to the population of Cardiff and the Vale of Glamorgan and beyond • This includes: Dental, Mental Health Services, General Practice and Public Health • The Health Board is addressing the issues of health equity in collaboration with its clinical teams, partners and the voluntary sector • The annual health fair for minority ethnic communities is a key component of the approach

12. Implications for the Health Board • Wide range of ethnic groups, languages and religious beliefs • Large, well established ethnic communities, supplemented by changing groups • Concentration in certain areas of the city for some ethnicities, but others are dispersed • Well established community groups for some ethnicities • Significant implications for delivery of services

13. Ethnicity and Health And Social Care in the UK • Variations in health

14. Which ethnic groups have the poorest health?Ethnic health inequalities 1991 to 2011 http://www.ethnicity.ac.uk/census/CoDE-Health-Inequalities-Briefing.pdf

15. Which ethnic groups have the poorest health?Ethnic health inequalities 1991 to 2011 • Persistent inequalities are seen in the health of Pakistani and Bangladeshi women. • The White Gypsy or Irish Traveller group has particularly poor health. • The Chinese group report persistently better health http://www.ethnicity.ac.uk/census/CoDE-Health-Inequalities-Briefing.pdf

16. Which ethnic groups have the poorest health?Ethnic health inequalities 1991 to 2011 Ethnic inequalities in health are most pronounced at older ages: • 56% of all women aged 65 or older reported a limiting long-term illness, but over 70% of Pakistani, Bangladeshi and White Gypsy or Irish Traveller women at this age reported a limiting long-term illness • Arab and Indian older women also reported high percentages of limiting long-term illness • 69% of Bangladeshi older men reported being ill. http://www.ethnicity.ac.uk/census/CoDE-Health-Inequalities-Briefing.pdf

17. Ethnicity and Health And Social Care in the UK • Variation in health • Variation in incidence and prevalence of disease • Cultural awareness and understanding • Access to services • Understanding of the systems • Language issues • Communication • Variation in reported experience

18. Ethnicity and Health and Social Care in Wales • Much of the literature on health and social care in Wales refers to health inequalities in general rather than equality strands • The limited evidence shows that ethnic minority groups tend to have poorer health than the population as a whole and poorer access to health care • There is little evidence on different groups within minority communities • Little is published about lifestyles amongst minority communities

19. Key Issues for the Health Board • Multiple barriers to accessing preventative and treatment services, e.g. language, health awareness, lifestyle, culture • Poor cultural awareness amongst healthcare staff • Individual life choices (i.e. accessing health facilities or undergoing health screening) • Understanding and interpretation of chronic conditions and ill health (such as perceptions of mental ill-health) • Individual and families diet and nutrition • Family structures and care responsibilities • Language support including interpreters and translated resources • Gendered services

20. Aims of the Health Fair • To allow health providers and voluntary agencies to reach the communities to disseminate information • To raise awareness of health services and healthy lifestyles within the minority ethnic community (MEC) • To offer a range of health checks using medical and nursing students working alongside trained staff • To provide lifestyle information and advice based on the results of health checks • To increase understanding of MEC health issues among healthcare staff and students • To provide health and relaxation taster sessions

22. Cardiff City Hall

23. What do we Offer? • 2014 was the 5th annual Health Fair • 250 – 300 people attend each year • Health related exhibitors’ stands from the statutory and voluntary sectors (including cancer support, carer support, primary care services, dental services, asylum seekers service, medicines management, mental health services and screening services) • Health checks including blood pressure, HbA1c and cholesterol, height, weight and BMI, hearing checks, visual acuity, diabetic retinopathy and glaucoma screening

24. What do we Offer? • Advice on smoking cessation, alcohol intake, lifestyle and diet, CPR, stroke recognition and prevention and mental health • Taster sessions in Head Massage, Reiki, Yoga, Pilates and Baby Massage. • Expert presentations on Stroke, Diabetes, Depression, Osteoporosis and Heart Disease and self management support • Pampering sessions

25. What do we Offer? • Support and attendance from the Minister for Health and Social Care • Support from senior Health Board staff • Crèche • Lunch • Support and involvement from medical and nursing students • Volunteer guides and interpreters

26. Stalls

27. Health Checks

28. Health Checks

29. Presentations

30. Pampering Advice Massage Crèche

31. The Impact – Facts and Figures (1) • Between 250 - 300 people have attended each year since 2009 • The ethnic mix at each event has been diverse - main attendees have been of Indian, Pakistani, Bangladeshi, Somali and Chinese origin – but over 15 different nationalities in 2014 • Feedback surveys show that the event is well regarded; suggestions for improvement have been acted on in subsequent years

33. The Impact – Facts and Figures (2) • Exhibitors consider the Fair gives them access to communities who may not routinely access services; it also provides an opportunity for networking • Over 30 medical and nursing students were involved in providing the health checks • In 2013, 117 people undertook one or more health checks and of these around 30% indicated they intended to make lifestyle changes – including diet, weight loss and increased exercise • Advice to visit a General Practitioner was given where needed

34. Learning • The involvement of students has worked extremely well, they gain valuable clinical and communication skills, support the delivery of the health checks and learn about health needs of the minority ethnic community in a practical way. • The mix of advice, information and health checks works well delivered by a mix of statutory organisations, voluntary organizations and volunteers • The event only works if the communities concerned are fully involved, this enables awareness of the fair to be promoted and also helps to ensure attendance

36. Learning • The health checks do raise issues that need to be followed up. At present advice is given to attendees in this regard, however increased links with primary care and general practice are being explored • We need to address the issue of getting more males and younger people to the event • We need to explore ways of maintaining engagement with the communities throughout the year • We need to ensure consistency of communication to ethnic groups to ensure awareness and attendance

37. Conclusions • The Health Fairs are a community initiative and work well with the communities leading and statutory organisations supporting • Healthcare students are willing to become involved and learn much from their involvement • The fairs have multiple benefits but need to be seen as part of an overall approach to meeting the needs of minority ethnic communities