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Reaching out

As Britain becomes increasingly multi-cultural, marketers face an evergrowing challenge of reaching and communicating effectively with their ethnic patient groups

The ethnic minority population is growing and, in some groups, is educated to a higher level than the general population. Trends also indicate that the economic position of ethnic minority groups in Britain will improve significantly over the next decade. However, relatively few pharma marketers and PR practitioners address ethnic groups in healthcare communications programmes. Charities such as the British Heart Foundation are increasingly focused on addressing the communications needs of ethnic minorities.

The charity's Ethnic Strategy Co-ordinator, Qaim Zaidi, passionately believes that everyone involved in healthcare promotion should be doing more: It is really important to reach out and raise awareness of disease, particularly those diseases that have higher prevalence in ethnic minorities. We need to give clear advice on how health can be improved particularly when these can be achieved through simple lifestyle changes.

Multi-cultural Britain

In the National Census of 1991, people were asked for the first time to which ethnic group they belonged, and in the 2001 Census a question about religion was included. The latest 2001 figures give a clear picture of the UK population and makes interesting reading - 93 per cent of the UK population are White British, and the remaining 7 per cent (four million people) are from an ethnic minority.

The NHS

During the 1950s and early 1960s, there was a serious labour shortage in the UK, especially in the health service. The government therefore encouraged people to immigrate from the Caribbean and the Indian sub-continent, especially India and Pakistan to fill these job vacancies. Today, about 20 per cent of qualified nursing, midwifery and health visiting staff are from ethnic minority groups and one quarter of Britain's doctors were born overseas.

Health inequality

Black and minority ethnic populations are the highest users of primary care services, yet they are less likely to gain access to appropriate health services and treatment and report the worst health outcomes. Older people from minority ethnic groups are more likely to describe their health status as poor than the total population.

Although many elderly people from black and minority ethnic groups are registered to use primary care services, their usage of community health services tends to be low. The Race Relations (Amendment) Act 2000 means organisations have to change from a stance of not discriminating to taking positive action, not only to eliminate discrimination, but also to promote good race relations and equality of opportunity. The NHS is reacting positively to this in order to respond to population health needs, reduce health inequalities and improve overall health of ethnic minority groups through a series of initiatives and programmes. For example, NHS Direct has a confidential interpretation service, available in most languages, which can usually be reached within minutes of someone placing a call.

Health epidemiology and ethnicity

The prevalence of the conditions suffered can be markedly different and relates to genetic and physiological influences in addition to external factors such as diet, culture and lifestyle choices such as smoking. For example, compared to the general population:

ï Higher rates of ischaemic heart disease (angina and heart attack) are found in South Asian men
ï Black Caribbean and Indian men suffer higher rates of stroke
ï Higher rates of diabetes are reported by men and women from minority ethnic groups with type 2 diabetes being six times more common in South Asians
ï Bangladeshi men are 60 per cent more likely to smoke (South Asian and Chinese women were far less likely to smoke than women in the general population)

Our multi-faith society

Christianity is the most popular faith in Britain, with 72 per cent stating this as their religion in the 2001 Census. Most of the other world religions are also practised in the UK, especially in larger cities where ethnic minorities have settled. The largest non-Christian religion in the UK is Islam with an estimated 1.5 million Muslims. The other main religions are: Hinduism, Sikhism, Buddhism and Judaism.

Other smaller faith groups include Baha'is, Jains and Zoroastrians. It is important to have a good appreciation of the basis of a faith and understand the impact that this has in terms of cultural and religious practice. For example, each faith has a different calendar of religious festivals.

Muslims celebrate Ramadan, a holy month of fasting during daylight hours. This has impact for people with conditions such as diabetes that require clear management and changes to medication regimens so as not to induce hypoglycaemia.

Both Hindus and Sikhs celebrate Diwali around November each year which is a festival of feasting where again care needs to taken when managing those with diabetes, heart disease or high cholesterol.

Language, literacy and the generation gap

Some patients, especially the elderly, may not have a good grasp of English, particularly in terms of reading, even though they can speak it. The five most predominant Asian languages spoken in UK are Bengali, Gujarati, Hindi, Punjabi and Urdu.

There is a vast difference in the literacy levels of first, second and third generation people from ethnic minorities. Half of ethnic minority Britons were born in Britain, with 71 per cent of 16-19 year olds from ethnic groups in fulltime education, compared with 58 per cent of whites. Therefore, when undertaking ethnic minority communications, age is an important additional segmentation that requires consideration. In addition, it is important to remember that in many communities the younger people in a family take charge of their parents' and elderly members' health and any communications should address their questions as the carer.

Targeted media relations

As the ethnic population has expanded, so have the media outlets at both the national and regional level. These fall into the standard media categories which you would expect to cover health news with the additional twist of being either English or non-English language.

Categories and examples include:

National broadcast and print media:

ï English language focused on Asian populations - eg, redhotcurry.com, Eastern Eye, Asiana
ï Asian language eg, Gujarat Samachar
ï English language - broad audience

Regional broadcast and print media

ï English language focused on Asian populations eg, Sunrise Radio, Asian Leader
ï Asian language eg, Sabras Sound Radio, Garavi Gujarat
ï English language - broad audience Radio is the key media outlet accessed by ethnic minorities as it overcomes potential literacy barriers and has enormous cumulative reach if undertaken as part of a co-ordinated media relations programme.

Listener figures from RAJAR, the UK radio industry audience measurement body, show that ethnic minority audiences prefer tuning into local commercial stations and that BBC local radio services do not perform as well as BBC national radio stations. One of these is the BBC Asian Network, launched in October 2002, a high profile digital radio station with a mix of talk and music that targets second and third generation Asians.

In terms of the regional approach to media, targeting is key. It is important to consider where different groups of ethnic minorities live, the religion practised and languages spoken. Research should be undertaken as early as possible in the media strategy development process to ensure accuracy and success. As a starting point it is important to note that most ethnic minorities live in specific areas with three fifths of the UK minority ethnic population living in cities.

Four in 10 of all ethnic minorities live in London. Scotland, Wales, South-West and the North-East England have populations of less than 2 per cent.

Patient education materials

As part of a healthcare communications programme, patient information and educational resources are often developed. Professor Anthony Barnett, Birmingham Heartlands Hospital, states: the overriding priority when developing patient information materials for ethnic minorities, whether in English or a native language, is to be culturally sensitive. Always put the patient at the centre of the communications.

To be culturally competent, it is important to have understood the interface between faith and health and a good practical step when developing materials is to consult with doctors and nurses who work closely with ethnic minorities. It can also be useful to work with healthcare professionals who practise a specific faith as they will have an even deeper understanding and empathy.

The standard rules apply to the development of patient materials - use clear and concise language and avoid unnecessary technical terminology. In terms of translation of materials you can work with a native speaker or use a good quality translation service. Whatever route you choose, before you go to print it is important to have had the wording checked by a different individual who speaks the language. Otherwise, your well crafted copy could end up full of medical jargon.

Conclusion

Despite an increasingly positive profile, members of most ethnic minorities are still at a systematic disadvantage compared to the white population and negatively impacted in terms of actual health, knowledge about health, and access to health services. Our industry's contribution to health promotion must be sensitive to the specific needs of different ethnic minority groups, so that our activities benefit our diverse and exciting multi-cultural population.

The Authors
Neil Crump director and Bansree Takodra senior account executive, Athena Medical PR

2nd September 2008

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