Original ResearchDelivering services to the Bangladeshi community: the views of healthcare professionals in East London
Introduction
The population of North East London is among the most cosmopolitan in Europe, with large and diverse ethnic minorities. One-third of the population of the borough of Tower Hamlets is of Bangladeshi origin, and in those under 24 years of age, this proportion rises to over 40%.1 This community originates from the Sylheti district of North East Bangladesh, mainly from peasant farming families, and has settled in Tower Hamlets since the Second World War. Tower Hamlets is the sixth most deprived borough in England.2 Unsurprisingly, health is poor.3 Morbidity levels are the highest in London for both sexes. Thus, the challenges to local health services are considerable.
Although the first paragraph referred to ‘the community’, this usage is problematic. The word ‘community’ is used to mean many different things: everybody4; lots and lots of people5; people who inhabit the same district6; people who have common interests7; or people who act together to pursue their interests.8 Other shades of meaning (and very many more references) could be cited to amplify the point.
Whatever the shade of meaning, the word tends to assume a similarity between members, making no recognition of differences and of competing interests within ‘communities’.9, 10 In the case of ethnic minority communities, such unwarranted assumptions about cultural homogeneity are common.11, 12, 13
Nevertheless, ‘community’ approaches to health service planning and provision are a policy imperative.14, 15 This is clearly a well-intentioned aim, although the difficulties of involving communities are considerable.16, 17, 18 There is abundant evidence that ethnic minority communities do have characteristic and persistent health problems,19, 20 and a focus on community approaches should help to prioritize such problems. A community focus reflects a public health approach to the provision of services, rather than an individual patient approach, and should therefore be broadly welcomed despite its associated problems.
Healthcare staff are in a paradoxical position in attempting a population-based approach. It is desirable that they appreciate the common needs and interests of ethnic groups, but not that they should characterize members of each of these groups as essentially identical. This paper considers this dilemma using data from a small study of how staff working in Tower Hamlets Primary Care Trust (PCT) see the challenges of providing services to the community. The focus of the research was on services for children; however, the contributors spoke overwhelmingly about the community in general, and about parents rather than children.
Section snippets
Methods
A focus group methodology was used. Six groups of local health professionals were convened between June 2004 and March 2005. Focus groups were usually conducted at the end of or in place of their weekly or monthly team meetings, as this proved to be the only practical way to convene groups. This was negotiated well in advance so that team members were able to take an informed decision to take part. The groups were:
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speech and language therapists working with children (SLTs);
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the child development
Results
Table 1 shows the composition of the focus groups.
The following themes were identified in the analysis:
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perceptions of a separate, homogeneous community;
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how the community uses services; and
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service failures.
Discussion
When introducing himself to focus group members, MR, who conducted the groups, identified himself as a GP but did not mention his ethnicity (mixed White/Caribbean, born and brought up in France, a fluent English speaker), although it will have been evident to participants that he was not White British. It is impossible to determine the effects of professional status and ethnicity on what members chose to contribute to the groups, if any, but the findings suggest that most group members felt
Conclusions
If public health is everyone's business,39, 40 health professionals’ understanding of community problems should be grounded in public health perspectives and data. In the case of the study contributors, the lack of such a grounding suggests an institutional unawareness of and unresponsiveness to minority needs, which are aspects of institutional racism.41
This is not to say that Tower Hamlets PCT is simply unresponsive to the needs of this community. For example, a religious and cultural male
Acknowledgements
The authors are grateful to all who took part in the focus groups, and those who helped to arrange them. The paper has been improved in the light of a peer reviewer's comments.
Ethical approval
East London and the City Local Research Ethics Committee. Reference RS/MY/P1/04/Q0603/21.
Funding
Tower Hamlets Primary Care Trust and Barts and the London NHS Trust.
Competing interests
None.
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