Equal England is a network of over 800 members, all of whom have a common interest in addressing health and social inequalities. In 2017-18, Equal England researchers delivered a research project: Integrating attention to ethnicity and migration within applied public health and health inequalities research. Ethnicity and migration play an important role within public health, yet this is frequently overlooked. The goal of this project was to begin to address this marginalisation within applied public health and health inequalities research in England. The aim was to consider ethnicity and migration status as key dimensions of social identity in modern Britain that have important implications for health and have so far been under-explored within public health research and practice.
Our research and why it is useful
The research team went through a process of reviewing key Local Authority strategic documents; they did stakeholder consultations; they reviewed national level policy documents on migrant and minority ethnic health; they looked at sources of data sources and how they could be improved. They also consulted other researchers who were not working on the project, seeking their input. The work involved significant engagement with local and national public health practitioners, as well as third sector organisations and members of the public.
Their research confirmed that attention to ethnicity and migration within health inequalities work in research, policy and practice remains very variable. The team concluded that there are significant capacity development needs in terms of generating data and performing analysis, as well as meaningful engagement with minoritised groups. However, there are examples of promising practice in needs assessment, research and practice, and these could usefully be shared. Effort is now needed to turn this patchy picture into opportunities to benchmark and share learning to prompt better practice more widely.
This work found that:
- There is a recent increased interest in England in the health and wellbeing of new migrant groups, but it is unclear that this newer focus on migrants is helpful to the broader agenda of diversity, inclusion and equality. Efforts are needed to ensure that work in these areas is better integrated.
- In terms of funded public health research, very little research is currently focused on ethnicity or migration as key social determinants of health. There is a need for action to ensure that the public health research evidence generated better meets the needs of our diverse population. Efforts are also needed to diversify the public health research workforce.
- National leadership remains limited, but there is a desire for a national network and the potential for good practice at local level to be shared via national agencies.
Real world impact
- Engagement – A lot of engagement, networking and relationships have developed as a result of this work. This in turn has raised awareness on this issue. A significant number of events and activities aimed at people who work in policy, people who practice public health and public engagement have taken place and include:
- Presentations – presentations on ‘How can we ensure good health in diverse communities?’ and ‘Embedding attention to ethnicity and migration within public health’ have been given to academics, local government and public health practitioners.
- Workshops – An expert event involving academics and public health policy and practitioners was held. This involved 12 expert talks and workshop sessions through which the group produced a set of guidelines and priorities for public health research attending to ethnicity and migration.
- Practice-sharing – A practice-sharing event took place which focused on ‘Embedding attention to ethnicity and migration within public health’. This included contributions from public health practitioners and the national organisation, the Race Equality Foundation, being presented alongside the research findings. Presentations from public contributors were also included. Interpretation facilities enabled contributions from those less confident to use English. Members of the public participated in table-top discussions with practitioners.
- Networks – A network of 120 interested individuals was established and were updated using a project newsletter and email updated. At the end of the project, members of this network were encouraged to subsequently join the Equal England network. SPHR continues its work on inequalities in collaboration with this network.
- Publications – Our analysis demonstrated that UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people. This work on transforming the health system for the UK’s multiethnic population was published in a special issue of the British Medical Journal (BMJ) which highlighted racism in medicine.
- Research materials and tools – The following research materials and tools were developed:
Impact continues to develop from this work and includes:
- Contribution to national policy developments – The project included significant engagement with local and national public health practitioners. Subsequently, lead researcher, Sarah Salway, was invited to be a member of the editorial team that shaped a special issue of the BMJ focused on Racism in Medicine. A paper based on the project was included within this special issue (February 2020). The paper highlighted the persistent lack of attention to ethnicity and racism within UK health research and policy and called for increased investment in the generation and application of evidence. The BMJ issue received high profile attention via a showcasing event chaired by Sir Simon Stevens (then Chief of NHS England). Our research contributed to this highly influential initiative that secured Stephens’ support for national investment in this neglected area of health inequalities research. This subsequently led to the establishment of the new national NHS Race and Health Observatory in 2020. Professor Salway is an invited member of the Maternal Health Stakeholder Group, and the observatory’s multi-million-pound programme of work is currently being developed, with mental health, maternal health and COVID-19 among identified priority areas.
- Contribution to national third sector work – Working with Race Equality Foundation during the project has led to opportunities to contribute to their national level work. Professor Salway is currently a member of the REF Health Equity Collaborative Project funded by the Health Foundation which is bringing NHS England and Public Health England, academics, practitioners, and people with lived experience together to develop solutions of how race and health inequalities should be addressed within the COVID-19 recovery plan across seven areas. Professor Salway is a member of the collaborative group focused on children & families.
- SPHR research programme – SPHR research has been influenced by this research, with SPHR work on inequalities building on the project’s findings by taking an explicit intersectionality focus – moving beyond the narrow socio-economic focus to give attention to ethnicity (racism) and other axes of disadvantage. Links to policy, practice and public established during the project have provided a strong foundation for this work.
- Capacity development – This work has also allowed our researchers to develop their skills. Study visits to South Africa and South Korea have taken place as a result of this work where our researchers were able to develop their skills and knowledge. Three PhD projects have also developed as a result of the project – 2 funded by SPHR and one funded by the Economic and Social Research Council in collaboration with Race Equality Foundation.