By Barnie Choudhury
GETTING the trust and confidence of south Asians are vital to winning the battle against diseases which are more widespread in their communities.
That is the warning from Dr Chaand Nagpaul, the chair of the doctors’ union, the British Medical Association.
Speaking exclusively to Eastern Eye, Nagpaul said public health messages needed to be “delivered in a way that is understood” by black Asian minority ethnic (BAME) communities.
“It’s how it is communicated, how effectively it is communicated, and whether it’s communicated in a way in which the BAME community feels confidence and trust,” he said. “We know, for example, we have lower rates of women from a BAME background who have breast screening, and we know that a lack of breast screening can result in undetected cancer. We need to do much more about not just raising awareness, but making the women feel confident that they can actually be treated with dignity, respect, and have any fears allayed.”
Asked about the challenges facing south Asian communities, another GP, Dr Samara Afzal pointed to diabetes, high blood pressure and heart disease being three killers. Dr Afzal is a doctor at the Limes Medical Centre in Stourbridge and the Urgent Care Centre at Russell’s Hall Hospital. She works in an inner-city surgery with a lot of deprived patients, many of whom are south Asians.
Dr Afzal said, “South Asians are prone to something called metabolic syndrome. That’s where you’re predisposed genetically to things like insulin resistance, which then leads to diabetes, high cholesterol levels, which then lead to strokes and heart disease, high blood pressure.
A poor choice in diet is one of the reasons for these illnesses.
“It doesn’t help the fact that our south Asian diet consists of a lot of fried foods, a lot of ghee (clarified butter), and that increases your risk for obesity, as well as your risk of diabetes,” she explained. “I’m increasingly seeing younger people getting type 2 diabetes. Previously, 20 years ago, it was almost unheard of to get type 2 diabetes in your twenties. But now we see it frequently. I’ve got three or four patients in their late twenties who’ve got type 2 diabetes.”
Diabetes.co.uk states: “South Asian people make up just four per cent of the total UK population, but account for an estimated eight per cent of all diagnosed cases of diabetes.”
Public Health England also found that 21 per cent of those who died from Covid-19 mentioned diabetes as a comorbidity. For south Asian groups, this proportion was 43 per cent.
The pandemic, according to Dr Nagpaul, brought into sharp focus the need to help south Asian communities by getting the messaging right.
“This is a very timely moment when that commitment needs to be delivered with some real actions, so that our BAME communities are properly looked after. What do you think we’re missing? Is it the fact that we aren’t advertising in the right places, that we’re not actually reaching those people for whom it is important that they look after their health, because they’re more disproportionately likely to be affected?”
Dr Nagpaul believes that the solution lies in addressing the structural inequalities which exist for BAME people, involving the different communities and their leaders.
“Culturally sensitive messaging is really important, and it needs to go beyond the tick box of just translating a message in a different language. It needs to be much deeper and be presented in a way that understands the perspective of our different communities.”
That culturally targeted messaging is echoed by Dr Afzal.
“In some communities, there isn’t the culture, for example, to exercise. They don’t make it part of their lifestyle to go to the gym. My south Asian patients, a lot of them are housewives.
“They are not expected to do anything else, and I do find that a lot of them actually are depressed. It must be really hard to just be at home all day cooking, cleaning and looking after the children. I know if I were to do that all day, I would go mad. I find being at home as a full-time housewife is actually much harder than going out to work as a doctor.”
What is needed, said Dr Nagpaul, is a complete examination of how society can make it easier for women to engage in exercise. “Those can be tackled through making real changes in terms of how you make people much more at ease.
“For example, we know that many women from the Asian communities don’t go swimming because of dress code, etc. Well, there are some swimming pools that have adopted a women’s only day and are much more accepting of greater covering of the body. There are different cultural elements, and making people healthier and allowing them to actually maximise their health will be a benefit to all of us; it’s a benefit to the health service.”
Experts have predicted that in six months the next pandemic will be mental health problems, during which black and Asian communities will be disproportionately affected.
Dr Afzal believes patients would benefit if the NHS invested in exercise projects. Last year, she took part in an eight-week pilot cricket programme for mums and daughters organised by the National Asian Cricket Council.
She said it was a “game-changer” in increasing physical and mental well-being.
“Sport has a big effect on mental health, and one of the reasons I’m as confident as a doctor, able to talk to different people, is because of sports,” said Dr Afzal.
“It teaches you teamwork. You have to speak; everybody has to give their opinion.
“With this project, I saw that a lot of these patients were suffering from depression and anxiety, but I saw them in a completely different setting, so it does make a big difference to stop them getting all these health problems.”