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Childhood obesity and cancer part of NHS expert evidence review

Childhood obesity, cancer, mental ill health and response to drugs therapy all present major challenges to the NHS for ethnic minority populations. These topics are being given priority in this year’s NHS Evidence update for ethnicity and health.

The NHS Evidence Collection (Ethnicity and Health) update will be taking place online from 19th to 23rd October (www.library.nhs.uk/ethnicity). The Collection, based at the University of Warwick and run in collaboration with De Montfort University, was formerly known as the Specialist Library for Ethnicity and Health.

In the first report, Dr Deborah Bird and Dr Monica Lakhanpaul from Leicester University give their overview of childhood obesity. They point out that UK obesity rates are significantly higher for South Asian children compared to white British children. However, a 2009 review of all the published evidence on interventions for treating obesity in children could not find any research which recorded ethnicity or considered its impact on successful intervention. Currently South Asian adults in the UK are six times more likely to suffer from conditions associated with obesity such as diabetes. Childhood obesity in South Asian population therefore represents a future time bomb for the NHS which needs to be addressed.

In another commentary, Paula Lloyd, Associate Director of the National Cancer Action Team points out that 30 years after collection of ethnic monitoring data was initiated by the NHS, the first analysis of cancer by ethnicity has been undertaken in England.  She comments that the report published this year, “has for the first time confirmed increased rates in specific ethnic minority groups”.  She also recommends immediate action since “this first national picture of how cancer affects minority ethnic populations raises a number of important issues for commissioners around the notion of awareness and detection and screening programmes”.

Differences in drug response between ethnic groups have long been acknowledged although little action has been taken by the NHS to date.  Professor Larry Goodyer from Leicester School of Pharmacy and Tom Burnham from Guy’s Hospital, London point out that differences can affect the incidence of adverse effects or failure of therapy. In 2009, the Collection identified over 155 different drugs or classes of drug which are of immediate interest. However examination also showed “only 16 drug labels in the UK commented on the response to drugs in Asians”. In the USA the Food and Drug Administration (FDA) has now licensed specific drug combinations for use in African American patients with heart failure, but this lead has not been followed in the UK. Risks associated with differences in drug response between ethnic groups still need to be acknowledged and then addressed by the NHS.

In an update on mental health policy, Professor Kam Bhui from the Centre for Psychiatry, Wolfson Institute of Preventative Medicine, London comments that as the Delivering Race Equality programme in England comes to an end and is absorbed into a broader equalities programme, there is as yet no agreement on a separate race equality strand or policy for mental health. At the same time “there is evidence that integrated equalities and mental health policies, where these exist, have not successfully addressed ethnic inequalities”. With the National Service Framework for Mental Health coming to an end and New Horizons adopting a dramatically different approach with an emphasis on preventive actions, Prof Bhui argues that there is a danger that known inequalities will increase.  The challenge is how best to “make use of the developing evidence base on ethnicity and mental health in order to guard against (and even reverse) any possible trends towards increased inequalities, in the light of the new public mental health agenda”.

Professor Ala Szczepura (Warwick Medical School) and Professor Mark Johnson (De Montfort University, Leicester) who are leads for the Collection have designed the 2009 annual evidence update to throw a spotlight on these areas of concern.

Professor Szczepura said: “As we collect and filter the evidence it has become increasingly clear that there is a need for more research combined with action by commissioners and service providers in the NHS to address emerging inequalities built into the health system”.

Notes
The NHS Evidence - ethnicity & health collection is a key way in which the NHS shows its commitment to improving the quality of healthcare to its black and minority ethnic patients.  It was created by the collaborative Centre for Evidence in Ethnicity Health & Diversity (CEEHD) at the University of Warwick and De Montfort University Leicester.

The Collection was launched in October 2006, at the House of Commons Westminster, by the Secretary of State for Health.  In 2009, the Collection became part of a new initiative NHS Evidence under the direction of the National Institute for Health & Clinical Excellence (NICE).

The team now intends to extend its work across Europe.  Professor Manuel Carballo, of the Geneva-based International Centre for Migration and Health is highly supportive “About time too.  We are fully supportive of these plans, which will also assist our objective of creating an international curriculum for culturally competent healthcare practitioners across Europe”.

For further information contact Professor Ala Szczepura, 02476 523985, ala.szczepura@warwick.ac.uk, alternatively contact Kelly Parkes-Harrison, Communications Officer, University of Warwick, 02476 150483, 07824 540863, k.e.parkes@warwick.ac.uk.