17 May 2005
A new National Screening Committee (NSC) report (available from the National electronic Library for Screening) has recently been released following an NSC project to review ethnic issues in screening, with reference to the Race Relations (Amendment) Act 2000, which underlined the commitment of healthcare providers to provide equality of access to high quality health care, and to promote good race relations. Ethnic minorities comprise 9% of the total population of England and Wales; the most common ethnic groups are Chinese, Afro-Caribbean and Asian from India, Pakistan and Bangladesh. The NSC Ethnic Issues Review set out to investigate potential barriers and solutions to the provision of equitable access to screening programmes, including the legal obligations of the NSC and guidance available from the Department of Health and elsewhere. This was achieved by literature searching and review, and by consultation with key individuals.
One key observation from the interviews conducted was that race and health are frequently perceived as being separate issues, except in those areas with large ethnic minority populations. Problems relating to recruitment into screening programmes and obtaining informed consent due to language barriers and lack of cultural sensitivity were underlined, as were misconceptions among healthcare staff about certain ethnic communities; an example cited was that Muslim women were frequently not given the opportunity to discuss family planning although many would be happy to do so. Literature searches revealed a significant body of work on ethnic minority access to cancer screening programmes, but little had been done to meet the needs of ethnic minorities with respect to other programmes. In particular, there was relatively little research from the UK as opposed to countries such as the US and Australia. Barriers to the uptake of screening were found to include linguistic and cultural difficulties (such as embarrassment about personal issues) as well as a lack of knowledge and understanding about the conditions being screened for. Effective interventions to improve uptake by minority groups included various means to improve understanding by providing multilingual and culturally sensitive information, particularly aimed at local communities.
Key points from the Race Relations Act proposed in the report to be relevant to screening include the need to monitor the effects of policies and to assess the likely impact of proposed policy changes on the promotion of race equality. The report concludes that there is a legal and professional requirement for the health service to ensure equitable access to services for ethnic minorities, and proposes that individual screening programmes should eventually develop their own Race Equality Scheme. No specific recommendations are made for these schemes, but hope is expressed that the evidence available on effective interventions to improve uptake will be of use in developing solutions. A draft pilot Race Equality Scheme (for the national Down Syndrome Screening Programme) is provided as part of the report, in which five key areas are identified: production and delivery, accessibility and monitoring of information, along with staff training and research.
Comment: This report poses a significant challenge to UK screening programmes in terms of developing equitable access for ethnic minorities, particularly since there are often greater differences between different ethnic groups than between minority ethnic population as a whole and the general population. Moreover, the uneven distribution of ethnic minorities across the UK (concentrated primarily in urban centres, with almost half of the total ethnic minority population living in London) means that national screening initiatives will have to consider specialised regional approaches to adequately address this brief. However, as the ethnic minority population continues to rise, the importance of ethnic issues in healthcare is likely to become increasingly prominent.