Addressing race inequality in Scotland: the way forward

A report from the Scottish Government's independent adviser on race equality in Scotland.

E. Health

44. The actions to tackle health inequalities are drawn from the Scottish Health and Ethnicity Linkage Study ( SHELS) of '4.65 million people exploring ethnic variations in disease in Scotland'.

45. The findings of the recent SHELS study show that the health of minority ethnic communities is in some respects better than that of the majority white Scottish population. However, it also points to significant health inequalities that are evident in the high rates of coronary artery disease and diabetes in South Asians, the low uptake of breast and bowel cancer screening, the disparate patterns of psychiatric hospitalisation by ethnic group in Scotland and the late diagnosis of HIV.

46. The aim of the actions set out below is by the end of 4 years, to significantly reduce the health disparities identified by SHELS. My recommendations for the actions/deliverables to be addressed cover the following:

  • Data Collection
  • Breast Screening
  • Cardiovascular Diseases
  • Mental Health
  • HIV

Data Collection

47. The incomplete recording of ethnicity in routine health data remains an issue. The recording of ethnicity in health service data needs to be comprehensive to effectively promote and protect the health and well-being of minority ethnic communities in Scotland. Without a clear baseline it would be impossible to measure any change in relation to ethnicity and health. The creation of a system that ensures consistent ethnic coding within Scotland's health information systems has to be a key priority for the Scottish Government.

Action 52: The Scottish Government should, as part of its data strategy, create a system that ensures consistent ethnic coding within Scotland's health information systems.


48. SHELS data demonstrate that 23 years after the introduction of the UK's national breast screening programme, the uptake at first invite is substantially lower for almost every BME group in Scotland particularly for Pakistani and African women. This matters because research shows that women who attend breast screening at first invitation are more likely to attend for subsequent screens. The consequent ethnic inequity in the extent of preventable cancer mortality may be marked, especially for Pakistani and African women.

Action 53: The Scottish Government, in partnership with the Scottish Screening Committee should:

  • Commission research to fully understand the reasons for the low service use by minority ethnic groups, in particular how informed they are about breast screening in order to make an informed choice, and simultaneously
  • Trial interventions/modifications that have been successful elsewhere [6] using community link workers, with the aim of achieving ethnic parity in the uptake of breast screening services.

Cardiovascular diseases

49. SHELS research shows that the South Asian ethnic groups in Scotland, comprising mostly people of Pakistani and Indian origins, have substantially higher rates of CVDDM (3-4 times higher for diabetes) compared to the White Scottish population. By 2020 the Scottish Government should aim to substantially reduce the incidence of cardiovascular disease and diabetes mellitus in BME communities.

Action 54: The Scottish Government should fund the implementation of a low cost community intervention project that has already been developed by a Taskforce coordinated by SHELS, with the aim of bringing about lifestyle changes that would a) prevent and b) improve management, of these diseases.

  • The programme should include the development of a certificated course to train people as community champions/ambassadors on diabetes and CVD prevention. The community champions/ambassadors could be one strand of the 250 community link workers recruited to support the most deprived communities who need additional support on health;
  • The production of paper and web based health related resources; and
  • Proposals for an evaluation of the effectiveness of the project.

Mental Health

50. The SHELS study concluded that disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care. In line with the commitment to provide £150 million over 5 years for mental health services, the Scottish Government should take the following action:

Action 55: The Scottish Government should commission research to identify the barriers, and a plan put in place to address, the unmet need and persistent ethnic inequalities in mental health care.

HIV Prevention

51. From data analysed for 2001-2013, SHELS found that African men were over twofold higher risk of 'late' HIV diagnosis than white Scottish men. The implication is therefore of more advanced HIV disease in African men and reduced opportunity for treatment which affects the survival rate of African men who are HIV positive.

Action 56: To reduce the number of African men in Scotland with a late HIV diagnosis, the Scottish Government should require Health Care Providers and policy makers to explore with the African community in Scotland, the most effective ways of targeting the African population (particularly men) for improved testing and diagnosis to ensure early access to treatment and care.


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