Case studies from partners across the region tackling health inequalities

As major institutions within the region, universities have a role to play in tackling the region’s health inequalities, for example, by collaborating with public bodies, private and voluntary sector organisations on health improvement initiatives or improving their social value to support their local community’s health and wellbeing through workforce development. Aston University is used here as a case study to bring to life some of this work in the region.

Aston University has been committed to improving the representation, progression and success of minority ethnic staff and students within higher education. By joining the Race Equality Charter, the University has been working through its framework to systematically identify and self-reflect on institutional and cultural barriers standing in the way of Black, Asian and minority ethnic staff and students. In response, the University has been developing initiatives and solutions for action. They are working towards obtaining their Bronze Race Equality Charter award.

The University has been exploring their role in widening access to health and care for the community that they sit within. They would like to develop a Health Hub at Aston that would be open to the local community and have been prioritising engaging with communities in the planning stage. They have been undertaking listening events to share local views and experiences of access to health and care in order to develop the Health Hub so that is serves the local community.

Aston University has been working in partnership with Aston Villa Foundation (and supported by Essilor) to go into local schools to deliver workshops about eye health, conduct eye screening and eye tests for those that need it in low-income communities. They collaborated with local organisation to listen to communities to understand barriers faced in relation to eye health and factored these into the Villa Vision programme. As of January 2022, they have been able to engage with around 4500 individuals in various capacities to help raise awareness around the importance of eye health. Within schools, this includes:

• Over 2200 children receiving the Villa Vision workshop across 30 schools
• Almost 1800 children having a vision and colour vision screening check in local primary schools
• Approximately 280 children (around 16%) being flagged for further investigation.
• Around 100 fully comprehensive eye tests being conducted at schools using the Villa Vision eyecare van
• Nearly 120 pairs of glasses being provided to children requiring them, helping to support both their educational and social development

Aston University and Aston Villa Foundation have also been working with children and parents on childhood eating habits to encourage healthy eating habits and enable healthy choices. The University has been exploring the role of food and health through its research, for example social media ‘likes’ are found to positively influence healthy food choices and children who watch smiling adults eat vegetables consume more than double the amount themselves. To explore and promote how a healthy food economy might operate in an area faced with multiple levels of inequalities, the University undertook research in partnership with Birmingham City Council on family food purchasing in East Birmingham[1]. The research identified opportunity barriers to healthy food purchasing but also the opportunities provided by healthy eating. The recommendations suggest that future interventions are not limited to educational and financial support but also focus upon motivational aspects of healthy food purchasing such as enjoyment, indulgence, and social bonding.

There is an established shared purpose for policing and health improvement[2], for example, by promoting proactive prevention, working with partner organisations to problem-solve, create cohesive communities, improve data-sharing, and promote evidence-based practice. Action led by the West Midlands Police and Crime Commissioner (PCC) shares this approach through their work on tackling health inequalities.

The WMPCC is prioritising building trust and strong relationships through working to look more like the people they serve with a target of recruiting 1,000 minority ethnic officers by 2025. Various initiatives have been taking place to increase the diversity of the Force and are already starting to see an increase in representation. Initiatives include data driven decision making, targeted advertising, intensive qualification support and maximising internal support. They have held successful recruitment events within specific locations to target underrepresented groups such as Perry Barr.  

Supporting young people is critical to preventing and reducing crime through diverting young people away from crime and into employment[3],[4]. As part of this work, the PCC continues to increase the number of police cadets to support young people and reduce inequalities they experience in tackling the wider determinants of health. The scheme fosters self-confidence and community engagement with policing. It gives children and young people valuable skills and experience, and some will be police officers of the future. The PCC has committed to increase the size of the West Midlands Police Cadets programme with an expectation the number of cadets will increase to 750- with measures for success in place.

Through collaborative working, the PCC are working towards early intervention and prevention to tackle the challenges faced by individuals and communities. This includes focusing on reducing harm caused by drugs, gangs and violence. For example, violence prevention through youth work, drugs strategy and prioritising those at risk through rolling out units in our most diverse and challenging areas, focusing on young people who need the most support.

Local infrastructure and equalities organisations within the health and wellbeing system enable the voluntary, community and social enterprise (VCSE) sector alongside public bodies to take action on health inequalities. The Wolverhampton Ethnic Minority Council case study brings this to life through their collaboration within the regional system supporting ethnic minority and equality groups.

The Ethnic Minority Council undertook a raft of work to support the Covid-19 Community Champions work. Community champions are community members who promote health and wellbeing or improve conditions in their local community[5]. They utilise their networks and experience to address barriers to engagement and improve connections between services and disadvantaged communities. Community champions approaches provide rich learning for reducing health inequalities, they have been vital to supporting the local Covid-19 response.

The Ethnic Minority Council (EMC) facilitated engagement across community and equality groups focusing upon the take up of the Covid-19 vaccination, through which enhancing relations and partnership working between communities and public bodies.  They worked to enable those who may usually be unable to take part due to barriers or needs including those with disabilities, ethnic minority and LGBT+ groups. Action included facilitating one-to-one consultation with Community Champions, Media and Marketing support, Wellness Activities, Q&A sessions, PPE Gifting, Community outreach videos, Community photo messages, and strategic social media campaigns.

Their Covid Champions activity provides helpful learning to understand different engagement techniques as they adapted their engagement approach to meet different needs. For example, specialist support sessions for Covid Awareness such as LGBT+, Punjabi and Urdu-speaking Ramadan. Q&A sessions included local specialist doctors and EMC Ambassador to discuss the Covid vaccine and myth busting with translated presentation slides. Another example was the use of wellness activity to provide Covid updates, Q&A, signposting and PPE. This meant holding events outdoors in community locations such as Silk Flower Arranging with the Sahali Group, Caribbean Tea Moments, Older Men’s Hang-out & Covid Update, Children & Young People’s Covid, Summer Samosas & Chai with Happy House. The focus on wellness over cultural food or activity encouraged discussions around the negative impact of Covid on mental wellbeing such as isolation which is damaging to both physical and mental health. The events were used to record community Covid messaging for social media with targeted distribution. This activity captures good practice for increasing the outreach and engagement of services to raise awareness and promote public health guidance and people-powered health and wellbeing within diverse range of resident groups within the West Midlands. EMC promoted community cohesion and a strong community spirit to help address health inequalities.

Through supportive and collaborative work, the Ethnic Minority Council works across equality grassroots groups and statutory bodies to promote the reduction of health inequalities and improvement of health and wellbeing. 

Across the Voluntary, Community and Faith sector, grassroots organisations provide specialist support for ethnic minority and vulnerable groups to tackle specific health and wellbeing issues which impact upon health inequalities. This case study looking at the work of Midlands-based Cysters charity helps to bring this vital part of the health and wellbeing system to life.

Cysters supports marginalised individuals and their communities with reproductive and mental health issues. Through their activity, they challenge the perception and narrative of marginalised people and their experience of illness which impacts upon the wider determinants of health such as education and identity. For example, Cysters partnered with the University of Birmingham in the Polycystic Ovaries Syndrome (PCOS) Leadership Programme and Study to improve experience of illness for women with PCOS. The research-based programme involves 1,000 women with a large proportion from an ethnic minority background to which Cysters provides support. Their grassroots activity contributes to the health and wellbeing of marginalised individuals and communities through addressing their experience and building control and resilience and, management of long-term illness[6].

They are committed to changing the narrative around accessing healthcare and offer peer-to-peer support and provide forums to discuss what may be useful when pursuing a diagnosis or asking for a referral. Cysters challenge the “hard to reach” narrative associated with people of colour and instead carve out a safe supportive space to engage with healthcare and services. They involve and empower marginalised individuals and communities to promote health and reduce the health inequalities they experience.

The charity works to tackle barriers around access to health and care services towards an inclusive healthcare system. To enable this, the charity has been developing bespoke training and workshops focused on the need for intersectionality for inclusive healthcare. [explain intersection]. They have been supporting healthcare research projects with the recruitment of diverse participants, bespoke inclusivity training programmes and shaping research to include lived experience. Cysters has been tackling the widening inequality of period poverty throughout the pandemic where 3 in 10 girls has struggled to afford or access sanitary wear during lockdown[7]. As an example, provided over 6000 menstrual products in one weekend and are supplying products to food banks, local support groups and the NHS. Cysters activity provides helpful examples for bottom-up grassroots activity to tackle health inequalities across the region.

Community organisations are able to provide support at a community level to address factors that protect and create health and wellbeing. This case study looking at the West Bromwich African Caribbean Resource Centre helps to illustrate the role of community organisations with a focus on hearing voices of local communities.

The Centre undertook community-based research on the thoughts, feelings and impact of Covid-19 and the lockdown on Black African diaspora communities in Sandwell, West Birmingham and the wider West Midlands[8]. This type of research starts with the premise of listening and providing the time and means for participants to express themselves. This research is not only interested in the answers but the reasons behind the answers. The research independence challenges community research that is often “done to” Black African diaspora communities and places control with the community group to do its own research. The process is helpful learning for other community organisations to conduct their own research.

The research focused on the experience of Black African, African Caribbean, West Indian, Black British and dual heritage and other groups who have Black African lineage. Their work rejects and challenges the abbreviation for Black Asian Minority Ethnic (BAME) term. This is because it lessens individual experiences by amalgamating experiences together due to smaller numbers and less comparable social economic and political power. The research was prompted by emerging statistics throughout the pandemic that demonstrated racial disparities in those being hospitalised with Covid-19 and those dying from Covid-19 [insert reference]. As well as reported vaccine hesitancy amongst Black population. The research explored a better understanding of vaccine hesitancy and other matters relating to Covid-19 pandemic and lockdown.

Its findings challenge the portrayal of Black people being anti-vaxxers and identified successful vaccine promotion through Black doctors and health professionals providing information and answering queries. The findings also challenge the explanation of overcrowded housing for high infection rates within ‘BAME’ groups which may not apply to Black African Diaspora groups. The research identified underlying mistrust of the wider socioeconomic political system, which can be linked to negative experiences of racism which is evidenced by racial inequality. The lack of infrastructure investment into Black African Diaspora community groups was considered to be a contributing factor. The reporting of racial disparities in Covid-19 deaths was considered at times to lack sensitivity and served to exacerbate pre-existing fear and distrust. The research indicates that this perpetuated barriers to engaging with public health messaging and preventative actions. The findings and series of recommendations have been acknowledged by the Black Country & West Birmingham NHS Integrated Care System.  They provide a helpful knowledge base for working to address health and wellbeing issues related to Covid-10 experienced by African Diaspora groups in the West Midlands.

NHS Integrated Care Systems and their Boards have a major role to play within the system to reduce inequalities between different groups and is reflected in their statutory duty to reduce health inequalities in access to and outcomes from health services[9]. NHS bodies have a core role to play in addressing health inequalities in the way that it provides services and supports an increased focus on prevention and early intervention[10]. Yet the role of the NHS goes beyond the direct provision of care to creating social value for local communities. For example, the NHS is a significant employer, purchaser and estate owner. The NHS can help shape a place through impacting local socio-economic conditions and tackle the underlying drivers of poor health. The NHS is able to recognise its role as an anchor institution and have an impact in areas of deprivation. In doing so, support the government’s commitment to levelling up. Two case studies from within the region are drawn upon to illustrate the role of the NHS in tackling health inequalities.  

The Dudley Group NHS Foundation Trust: Using workforce and service development to tackle health inequalities

The Dudley Group NHS Foundation Trust have been committed to supporting their workforce through their ethnic minority staff inclusion network which included a 12-month calendar of culturally appropriate health and wellbeing initiatives to support staff from a physical and mental wellbeing perspective. The network has been active with the members attending COVID vaccine walkabouts to promote uptake of the vaccination.  Members took part in a Covid-19 mental health winter webinar.  The network has invited external speakers to increase awareness of conditions that have a greater impact on people from the ethnic minority community and as a result highlight health inequalities.  They have looked at lupus and prostate cancer and plan to raise awareness about sickle cell and thalassaemia.

The Trust has been working collaboratively with partners to explore how they can ensure more employment opportunities for local people, in particular those who have found it hard to get employment in the past. This work has meant 27 young people have received placements as part of the Kickstart programme, with 3 of these qualifying and being employed as phlebotomists.   Two have secured posts as trainee Clinical Support Workers, with a further 3 starting apprenticeships with the Trust. The trust has signed up to the Care Covenant which is a national inclusion programme that supports care leavers aged 16-25 to live independently with opportunities and are in the process of recruiting to a cohort of care worker roles for care leavers. The Trust is in active discussions with partners about the proposed university centre in Dudley so that local people get the maximum benefit and the courses offered align with our current and future workforce needs.

Work is underway with colleagues in Dudley such as the local Council for Voluntary Service (CVS) to explore how to collectively make a difference to cancer outcomes, with a particular focus on parts of the Borough where outcomes are poorer. They organised a workshop in November 2021 for trust staff and local voluntary organisations to identify the barriers to accessing services. The trust is looking at what action can be taken quickly with a commitment to conduct deeper conversations in the future. This will include ensuring screening services provided by the Trust are delivered in a way which encourages uptake from more vulnerable people and how cancer services are culturally sensitive and more person centred.

University Hospitals Birmingham Trust: Using digital transformation to tackle health inequalities

University Hospitals Birmingham Trust has been using digital transformation to reduce health inequalities by bringing care closer to communities. This has meant enabling people to access health care and information in a more accessible and a timely way through the creation of community-based diagnostic hubs in local neighbourhoods. The Trust has been working with the WMCA on an evidence-based approach to locate the diagnostic hubs in areas most accessible by the people most underserved and most in need of care. The programme has deployed a local non-medical workforce to help bridge the gap between services and the communities they serve whilst providing employment opportunities and career progression for local people.

The new model of care brings efficiency and personalised care is currently in place for dermatology and ophthalmology pathways, with ear and nose pathways due to go live in Spring 2022. There is a total 40 pathways planned for the future. The model allows for testing to be carried out remotely by non-medical workforce and escalated to clinicians for in-person care when needed. Data and intelligence from the patch is used to inform how the model operates across different setting and services.  The model is currently focused on the Birmingham and Solihull NHS Integrated Care System patch with scope for wider scale across the region.

The Trust has also been using digital transformation towards early intervention in the community team supporting older people. For example, remote monitoring to support earlier return home for patients with respiratory conditions - initially for chronic obstructive pulmonary disease, now broadening to other conditions - following a stay in hospital. And, remote digital diagnostic equipment is being used between ambulance crews and hospital staff, to provide specialist care in people’s homes which will soon to expand to community nursing staff.

An outpatient communication platform has been implemented to allow patients to specify how they would like to receive communications from the Trust relating to their care. This allows for patients to define how they wish to engage – whether that be on paper, by phone, or digitally.