Transforming the health system for the UK’s multiethnic population

Salway, Sarah; Holman, Daniel; Lee, Caroline; McGowan, Victoria J; Ben‐Shlomo, Yoav; Saxena, Sonia; Nazroo, James

doi:10.1136/bmj.m268

Cited by 39 publications

(47 citation statements)

References 19 publications

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“…Differences in patterns of guideline recommended drug treatment, including drug prescription, optimization, and adherence, especially for hypertension, likely contribute to racial disparities in heart disease morbidity and mortality 35363738. Race is used in this analysis according to categorization from death certificates and is commonly reported in research studies in the US, but it is important to recognize that race is a social construct that incorporates more than biological differences resulting from ancestral origin and is used variably throughout the world 39. A growing body of evidence suggests that racial differences in cardiovascular health and heart disease mortality are in large part representative of avoidable differences in many other factors, including a range of social determinants of health, socioeconomic status and access to care,40 burden of the drug misuse epidemic in the US,41 and structural and systemic racism that require individual and policy level changes to target and reduce persistent health inequities 4243.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

Shah

Molsberry

Rana

et al. 2020

BMJ

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Objective To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. Design Serial cross sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography. Setting United States, 1999-2018. Participants 12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old). Main outcome measures Age adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change. Results Deaths from total heart disease fell from 752 192 to 596 577 between 1999 and 2011, and then increased to 655 381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost. Conclusions Trends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.

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Section: Discussionmentioning

confidence: 99%

Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

Shah

Molsberry

Rana

et al. 2020

BMJ

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“…Primary care has risen to the challenges posed by covid-19 by enforcing triage to ensure safe distancing and by introducing hygiene measures and protective equipment to reduce infection risk. Some general practices have adopted drive-in vaccine clinics to reduce face-to-face contact with parents 17…”

Section: Time For Actionmentioning

confidence: 99%

Routine vaccination during covid-19 pandemic response

Saxena

Skirrow

Bedford

2020

BMJ

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128

119

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“…Despite growing awareness in the UK and internationally of the need to support BME populations in health and social care (Dawson et al, 2018;NHS England, 2018) that includes a call for stronger action in the NHS Long Term Plan (2019), it is still a largely underresearched area and health inequalities in diverse care settings remain (Fenton and Draper, 2014;Krishnagiri et al, 2012;Salway et al, 2020). Furthermore, there are currently no existing studies exploring the culturally specific needs of the population in terms of occupational therapy service provision.…”

Section: Literature Reviewmentioning

confidence: 99%

Occupational Therapy for South Asian Older Adults in the United Kingdom: Cross-Cultural Issues

Yam

Murphy

Thew

2020

British Journal of Occupational Therapy

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Introduction There is limited understanding of the cultural needs of diverse Black and Minority Ethnic populations such as South Asian older adults, which may be perpetuating occupational injustices and health inequalities faced by these groups. Although cultural considerations are intrinsic to person-centred occupational therapy and increasingly relevant to the changing landscape of health and social care, the profession is criticised for its western-centric focus. This study aimed to gain understanding of the current cross-cultural issues in supporting South Asian older adults in the UK, as perceived by occupational therapists. Method A constructivist qualitative design supported by thematic analysis was used, involving seven occupational therapists in the United Kingdom who participated in semi-structured interviews via Skype/telephone. Findings Cross-cultural issues were illustrated through the following themes: ‘when the barriers go down’ – cultural mismatch in individualist vs. collectivist worldviews; ‘invasion of the family home’ – cultural inappropriateness of standard interventions; and ‘I go into every assessment assuming nothing’ – recognition of and response to challenges. Conclusion This study provides insight into cross-cultural issues in occupational therapy for South Asian older adults, revealing a gap between theory and practice in integrating cultural humility. It highlights the need for a more inclusive, person-centred approach to support culturally diverse populations.

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Transforming the health system for the UK’s multiethnic population

Abstract: The UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people, say Sarah Salway and colleagues

Cited by 39 publications

References 19 publications

Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

Routine vaccination during covid-19 pandemic response

Occupational Therapy for South Asian Older Adults in the United Kingdom: Cross-Cultural Issues

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