How Healthcare professionals can tackle Health Inequalties?

1. How Healthcare professionals can tackle Health Inequalties? Alia Gilani Health Inequalities Pharmacist

2. Plan Of Action: • Part 1: Case Study • Part 2: Health Inequalities • Part 3: Ethnic Inequalities and Culture • Part 4: Group work • Part 5: Why should we care? • Revisit Part 1 • Part 6: Glasgow Model: Engaging with your Hard to Reach Community

3. Part 1: Case Study

6. Background: • Mr H Age: 72 years • Lives on his own Council flat in Govan which is in a poor condition • Patients mobility is limited • Poor attendance to h/care services • Cannot read/speak English • Lives several miles away from registered practice but does not wish to change practices due to bi-lingual G.P. Has difficulty getting to the surgery and his form of transport is a bus and some walking. • Disappears to Pakistan for several months in the year to see his much younger wife. • Is non compliant with his meds in Pakistan. Subsequently on his return gets admitted to hospital with poor glycaemic control

7. Key Issues • Referred to MELTS in January 2011 • HbA1c 16.4% (June 2010) • Frequent falls even when travelling to G.P • Refused access to the Home Care assistant when service was offered • No family support available only local newsagent • Is currently admitted to sec care with high B.M’s

8. Discuss what your approach would be to tackle the inequalities with Mr H?

9. Part 2: Health Inequalities

10. Definition: “Health Inequalities are differences in health status or in the distribution of health determinants between different population groups” World Health Organisation

11. Health Inequities are: “avoidable inequalities that are unfair or unjust” BMJ 2001;322:591-594

12. Strategic Drivers: • Black Report (1980) • Acheson Report (1998) • Marmot Review (England 2010) • Equally Well (Scotland 2008)

13. Life expectancy – a global view Source: WHO Health Report

14. Source: Office for National Statistics

15. Social Determinants of Health: Rainbow Model of Health. Dahlgren and Whitehead(1991)

16. Part 3: Ethnic Inequalities and Culture

17. Culture and health: • Behaviours • Beliefs • Organisation of family & kinship • Language and communication

18. Cultural Competence Cross cultural communication is ……far less knowledge than a set of skills and attitude

19. “Understanding patients beliefs about their disease and treatment affects health behaviours and provides opportunities for improvements in health outcomes” Mann DM et al. J Behav Med 2009; 32: 278-284

20. Not Understanding Your Patient….. Language is more than words! Paralinguistic features What is “normal” communication? Confidentiality & Interpreters Why not learn English?

21. Poor communication with your patient can lead to: Distrust Misunderstanding Dislike Label patients Odd or Unpredictable Affect Care Given

22. Ethnic Group…. “ A group of people who share characteristics such as language, history, religion, nationality, geographical and ancestral origins and place” Dept of Health

23. Ethnic Inequalities first Noted….. The condition of the working class in England – Friedrich Engels 1845

24. Migration to the UK of Ethnic Groups: • 1950’s: Caribbean & India • 1960’s: Pakistan • 1970’s: Bangladesh • 1980’s: Hong Kong • 1990’s: Hong Kong • Last decade: refugees

25. Bhopal R. Journal of Public Health 2009;31:315 Socio-economic status Migratory Factors Factors contributing to Ethnic Inequalities Genetic Factors Culture & Lifestyle Access to healthcare services

26. Part 4: Group Work • Discuss your viewpoint as to what is a HCP’s role and responsibility in tackling health/ethnic inequalities? • Discuss effective strategies to tackling Health Inequalities? • Identify groups with health/ethnic inequalities in Glasgow

27. Ethnic Groups who have Inequalities South Asian’s Roma Travellers Asylum Seekers African Carribeans

28. Part 5: Why should we care?

29. “Health Inequalities are remediable” (AchesonReport) “The primary determinants of disease are economic and social, and therefore, that its remedies must also be economic and social” (Geoffrey Rose) “1.3-2.5 million years lost for those dying prematurely in England” (Marmot Review)

30. Tackling H.I will….. • Economic benefit • Social Justice • Extend beyond H.I……

31. “Poverty being the worlds biggest killer and greatest cause of ill health and suffering across the globe” -WHO 1995

32. Link between poverty and health: • Poor health Poverty • Poverty Poor health • Improved health Way out of poverty

33. Where do HCP’s fit in?

34. HCP Role in Social Determinants of Health: MICRO LEVEL Health Care MESO LEVEL Provider MACRO LEVEL Healthcare Provider

35. How do we address Inequalities? • Social Gradient • National Policy Local delivery • Social determinants • Anticipatory care • Patient empowerment • Start early • Improve access • More Research e.g. impact of SE inequalities in ethnic inequalities • Recording of ethnicity • Racism • Workforce focus on social determinants

36. Part 1 Revisited: Case Study – Mr H

37. Addressing key issues with Mr H: • Using the newsagent as a key ally • Improvement in B.M’s and weight • Increased engagement at secondary care • Undergoing a social care review for new housing/benefits • Received a mobile wheeler!

38. “It is more important to what sort of patient has a disease than what sort of disease a patient has” - William Osler 1904

39. Inverse Care Law: “the availability of good medical care tends to vary inversely with the need for it in the population serve” -Julian Tudor Hart 1971 Lancet

40. Part 6: Glasgow Model – Engaging with your Hard to Reach Community

41. Service DevelopmentOld service Not meeting the needs of South Asians

42. Solution…… Changing the Model of Care

43. Stage 1: Changing the NHS invitation process Targeting practices with South Asian diabetic patients by telephoning them in their spoken language of Urdu.

44. Stage 2:Enabling access through community venues

45. Glasgow Central Mosque

46. Stage 3: Using Community Pharmacies • Community pharmacies accessed by 99% of the population • Targeted a pharmacy located in an area with the highest south asian population in Glasgow • Process • Messaging service

47. Stage 4: Set up of a new access point • MELTS (minority ethnic long term medicines service) • Referral criteria • Who can refer

48. Pharmacy Minority Ethnic Long Term Medicines Service Referral Criteria: 1. Polypharmacy for Long Term Condition(s) and 2. Minority Ethnic Individuals e.g. South Asian, Chinese and/or 3. First language not English And has the capacity to benefit from a 1:1 medication review with a bi-lingual pharmacist (Alia Gilani). Name of Person Referring:_________________________________ Contact details:_________________________________ ___________________________________________________________ ______________________________________________________________________________________________________________________ Patient’s Name:____________________________________________ If possible, please ask the individual consenting to the review to sign below. If this is not possible please complete the details and we will seek consent by contacting the patient ourselves. Patient’s signature:_________________________________________ Patient’s address:_______________________________________________ _______________________________________________ Date of Birth: ________________ GP:______________________ Date: _______________________ Please fax/post to: Minority Ethnic Long Term Medicines Service, Queens Park House, Victoria Infirmary, G42 9T Phone: 201 5752

50. Onward Referral Language and Computing Social Work CPN andMental Health Team Secondary Care Patient at medication review clinic Care of Older Peoples Team Falls Team Dexa Scan Retinal Screen Spirometry Podiatry Physio and Exercise Classes