How Healthcare professionals can tackle Health Inequalties?

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How Healthcare professionals can tackle Health
Inequalties?

• Alia Gilani
• Health Inequalities Pharmacist

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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

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Part 1 Case Study
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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

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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.Ms

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Discuss what your approach would be to tackle the
inequalities with Mr H?
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Part 2 Health Inequalities
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Definition

• Health Inequalities are differences in health
  status or in the distribution of health
  determinants between different population
  groups
• World Health Organisation

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• Health Inequities are
• avoidable inequalities that are unfair or
  unjust
• BMJ 2001322591-594

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Strategic Drivers

• Black Report (1980)
• Acheson Report (1998)
• Marmot Review (England 2010)
• Equally Well (Scotland 2008)

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Life expectancy a global view
Source WHO Health Report
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Source Office for National Statistics
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• Social Determinants of Health Rainbow Model of
  Health. Dahlgren and Whitehead(1991)

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Part 3 Ethnic Inequalities and Culture
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Culture and health

• Behaviours
• Beliefs
• Organisation of family kinship
• Language and communication

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Cultural Competence

• Cross cultural communication is far less
  knowledge than a set of skills and attitude

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• 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

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Not Understanding Your Patient..

• Language is more than words!
• Paralinguistic features
• What is normal communication?
• Confidentiality Interpreters
• Why not learn English?

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

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Ethnic Group.

• A group of people who share characteristics
  such as language, history, religion, nationality,
  geographical and ancestral origins and place
• Dept of Health

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Ethnic Inequalities first Noted..

• The condition of the working class in England
  Friedrich Engels 1845

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Migration to the UK of Ethnic Groups

• 1950s Caribbean India
• 1960s Pakistan
• 1970s Bangladesh
• 1980s Hong Kong
• 1990s Hong Kong
• Last decade refugees

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Bhopal R. Journal of Public Health 200931315
Socio-economic status
Migratory Factors
Factors contributing to Ethnic Inequalities
Genetic Factors
Culture Lifestyle
Access to healthcare services
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Part 4 Group Work

• Discuss your viewpoint as to what is a HCPs role
  and responsibility in tackling health/ethnic
  inequalities?
• Discuss effective strategies to tackling Health
  Inequalities?
• Identify groups with health/ethnic inequalities
  in Glasgow

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Ethnic Groups who have Inequalities
South Asians
Roma Travellers
African Carribeans
Asylum Seekers
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Part 5 Why should we care?
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• 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)

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Tackling H.I will..

• Economic benefit
• Social Justice
• Extend beyond H.I

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Poverty being the worlds biggest killer and
greatest cause of ill health and suffering across
the globe

• -WHO 1995

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Link between poverty and health

• Poor health Poverty
• Poverty Poor health
• Improved health Way out of
• poverty
  

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Where do HCPs fit in?
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HCP Role in Social Determinants of Health

• MICRO LEVEL
• Health Care MESO LEVEL
• Provider
• MACRO LEVEL

Healthcare Provider
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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

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Part 1 Revisited Case Study Mr H
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Addressing key issues with Mr H

• Using the newsagent as a key ally
• Improvement in B.Ms and weight
• Increased engagement at secondary care
• Undergoing a social care review for new
  housing/benefits
• Received a mobile wheeler!

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It is more important to what sort of patient
has a disease than what sort of disease a
patient has

• - William Osler 1904

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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

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Part 6 Glasgow Model Engaging with your Hard
to Reach Community
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Service DevelopmentOld service

• Not meeting the needs of South Asians

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Solution
Changing the Model of Care
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Stage 1 Changing the NHS invitation process

• Targeting practices with South Asian diabetic
  patients by telephoning them in
• their spoken language of Urdu.

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Stage 2 Enabling access through community venues
Patient in community
Outreach clinics
Hindu Elderly centre
Mosque
Voluntary centre
Sikh elderly centre
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Glasgow Central Mosque
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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

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Stage 4 Set up of a new access point

• MELTS (minority ethnic long term medicines
  service)
• Referral criteria
• Who can refer

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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 11 medication
review with a bi-lingual pharmacist (Alia
Gilani). Name of Person Referring_______________
__________________ Contact details_______________
__________________ _______________________________
____________________________ _____________________
__________________________________________________
_______________________________________________ Pa
tients 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.
Patients signature__________________
_______________________ Patients
address__________________________________________
_____ ___________________________________________
____ Date of Birth ________________ GP_________
_____________ Date _______________________ Please
fax/post to Minority Ethnic Long Term
Medicines Service, Queens Park House, Victoria
Infirmary, G42 9T Phone [phone]
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Patient

Medication Review with outreach pharmacist
Onward referral into the health and social care team
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Onward Referral
Language and Computing
Social Work
CPN and Mental 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
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Dixon Hall Community Elderly Centre
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Final Thoughts..