Dr Mary Tilki is an expert in health and social policy and wrote a briefing for the Foundation on Dementia and cancer in the Irish community in Britain.
Despite legislation since the 1960s, there is still evidence that people from Black and Minority Ethnic (BAME) groups continue to experience health inequalities and dissatisfaction with health services (Salway et al 2016, Evandrou et al 2016). However when policy makers, professionals and members of the public think “ethnic minority” they rarely consider the Irish as a BAME community. Ethnicity in the UK tends to be seen in a restricted skin colour paradigm which renders the (largely) white Irish ethnic group invisible. Although appearing to have much in common with the majority population, the pattern of Irish health and experiences of migration and health care are more akin to those of BAME communities.
After several decades of evidence of considerable health disadvantage, comparable and in some cases worse than many other BAME communities, the poor health of the Irish in Britain is repeatedly ignored. Because of the way ethnicity data is collected, analysed or presented, there is a paucity of recent information about mortality and morbidity in the Irish community. Research studies and policy documents either ignore the Irish or focus on “visible” BAME with at best a mention that this community exists. Although the Department of Health (DH 2005), clearly recommended a separate ethnic monitoring category for the Irish, Irish data continues to be aggregated into the overall ‘White’ category making the community invisible. This seriously limits information available to measure disparities or to compare with the general population or other minority ethnic groups. The recent Public Health Outcomes Framework Health Equity Report : Focus on Ethnicity ( PHE 2017) excludes any discussion of the Irish, but presents tables showing this old and large population in the top three groups dying prematurely from all causes
Despite the lack of contemporary research, older research data and mortality statistics evidence poor health among the Irish in England often persisting into the third generation (Aspinall and Jacobson 2004). This is consistent with experiences of Irish community organisations. Perhaps the most significant concern is persistent and sometimes increasing cancer mortality among the Irish in England and Wales (Harding et al 2009, Tilki 2015a ). There is also excess and some increasing, mortality among Irish men and women from coronary heart disease, hypertension and stroke (Harding et al 2008). This is consistent with analyses of Proportional Admission Ratios 2003-2006, by the London Health Observatory, which demonstrate higher levels of admission for most cancers, and cardiovascular disease (and others) than would be expected from the Irish population in London (LHO 2013).
Analyses of Census 2011 undertaken by Irish in Britain, shows limiting long term illness (LLTI) and self-reported poor health among Irish people over 50 and over similar to or higher than Bangladeshi or Pakistani people (Ryan et al 2014). There is significant economic inactivity due to poor health among Irish people, particularly men from 50 onwards (Tilki et al 2009). Irish Travellers have the highest levels of LLTI in the population and report bad or very bad health at all ages more than any other group (Ryan et al 2014).
The older age profile of the Irish population compared to general population and other minority ethnic groups, is invariably associated with ill-health. In the absence of empirical evidence Truswell (2013) estimates about 10,000 Irish people in England with dementia. This resonates with reports from Irish community organisations supporting significant numbers with memory loss, most of which is undiagnosed or untreated (Tilki et al 2011). There is also evidence that the cultural needs of Irish people with dementia are not recognised (APPG 2013). Given the incidence of coronary heart disease, stroke and hypertension in the Irish community, the risk of vascular dementia may well be higher than the age profile suggests. The poor socio-economic circumstances of a significant proportion of the older population living in areas of deprivation, leads to social isolation and confounds their ability to access health and social care in an equitable or timely manner (Tilki et al 2009).
Although dated, the EMPIRIC study shows evidence of longstanding depression and anxiety (Sproston and Nazroo 2002). This fits with anecdotal experience from community organisations Count Me in Censuses from 2005 -2010 repeatedly demonstrated excessive admissions to mental health establishments of Irish people over 50 (CQC/NMHDU 2010), many of whom have physical disabilities. Suicide levels have not declined as in other populations (Maynard et al (2012). Mental ill-health and suicide are particular issues for Irish Travellers in addition to their low life expectancy and poor health profile (Parry et al 2007).
While acknowledging the limits of research, Irish in Britain are concerned that there is little effort to understand the Irish community. Mappings of JSNAs confirm that although many authorities acknowledge local Irish communities, few identify any health needs (Irish in Britain 2013). Neither do they contact Irish organisations for consultation, information or to utilise the assets that already exist. Therefore the health inequalities experienced by Irish people rarely feature in Health and Wellbeing Strategies.
Irish organisations emerged over four decades to address the discrimination experienced by the Irish community and the social and health inequalities which followed (Hickman and Walter 1974). Many have thrived and become professional because of funding from the Irish Government, reciprocating the remittances of Irish migrants in earlier times. Small grants enabled community organisations to provide advice, information and advocacy. Many went on to become professional and to accessing funding for housing, health and social services to which they were entitled as UK taxpayers. Irish community organisations benefitted from Irish grants during the economic boom but recession in Ireland meant serious cutbacks when austerity measures began to hit the UK. Changes in Irish migration dictate the need to support Irish people in other parts of the world and funding from the Emigrant Support Programme for the UK is more competitive.
Notwithstanding the difficulties faced by BAME community organisations in a competitive tendering environment (Tilki et al 2015 b) the Irish voluntary sector continues to offer exemplary, services. The umbrella organization, Irish in Britain has over 100 member organisations providing examples of best practice and harnessing the commitment and skills of armies of volunteers. Organisations vary considerably but given the demography, focus on providing information, advice, befriending, social activities or luncheon clubs for an older population. Most offer multiple services to address local need but this publication can only describe examples which address specific health issue for the Irish community.
Examples of good practice
It is impossible to detail all the work undertaken by Irish community organisations in Britain. Most offer multiple services, but the scope of this document only allows a limited view of the range of facilities provided.
Irish in Britain
As the national organisation, Irish in Britain represents the community in policy and political circles, often collaborating with other BAME groups. It leads on certain campaigns to address major health inequalities.
Green Hearts is a recent culturally sensitive, nationwide campaign to improve heart health, well–being and healthy life-years for the Irish community in Britain, collaborating with statutory bodies, mainstream charities and member organisations as appropriate http://www.irishinbritain.org/campaigns/green-hearts.
Cuimhne (pronounced “queevna”, the Irish word for memory), is a whole-community campaign for a culturally sensitive, strengths based approach to quality of life for Irish people with dementia and their family carers. http://www.irishinbritain.org/campaigns/cuimhne-irish-memory-loss-alliance . Cuimhne has generated an increased provision for people living with dementia. Organisations have all undertaken Cuimhne training and most now offer culturally sensitive services for isolated Irish people with or at risk of dementia.
Leeds Irish Health and Homes provides social groups, befriending and a service for people with dementia living at home and their carers http://www.lihh.org/support-services/aran-home-support-services-dementia-memory-loss-service
Irish Community Services Greenwich Bexley and Lewisham (ICS) provides carer support and three reminiscence groups across the boroughs. Its memory services include “Your Life Through Song” and “Life Story Books’ involving people living with dementia, families, neighbours and appropriately skilled volunteers. https://www.irishcommunityservices.org/irish-community-services-1.
Ashford Place is the home of the social movement, Community Action on Dementia Brent (CADBrent) http://cad-brent.org.uk/ The Dementia Peer Support Service is just one of the services offered, provided by people with dementia for people with dementia and is funded by Brent CCG.
Innisfree Housing Association in collaboration with CADBrent provide The Shedwhich aims to protect men from social isolation, cope with retirement and enhance health and wellbeing http://www.innisfree.org.uk/news-events/2017/08/1857/.
Sláinte le Chéile (Health Together) in Liverpool is just one example of how Irish organisations provide health promoting activities in liason with local NHS, Clinical Commissioning Groups or Pubic Health initiatives. https://www.liverpoolirishcentre.org/communtiy-partners
St Finbarr’s Sports and Social Club in Coventry provides walking football for men over 50 Supported by Coventry City FC, over 100 men participate weekly and report gains to their physical and mental health.
Irish Community Services Greenwich Bexley and Lewisham is unique in offering support for Irish people living with cancer, who are referred by themselves or by GPs, Macmillan Nurses or other professionals.
Immigrant Counselling and Psychotherapy (ICAP) provide culturally sensitive psychological therapies in London and Birmingham and in collaboration with other Irish organisations http://www.icap.org.uk/.
LeedsGATE and HertsGATE are both user-led organisations reaching out to Travellers
Lewisham Irish Centre , Irish Community Care (Merseyside) are among the Irish organisations providing outreach to Travellers http://www.lewishamirish.plus.com/
Irish Chaplaincy and Irish Community Care (Merseyside) http://www.irishchaplaincy.org.uk/ http://iccm.org.uk/ offer outreach to Irish prisoners and their families, many of whom are from Traveller backgounds.
While mainstream initiatives will address some sections of the community, many older and more vulnerable Irish people will not access them. There is an urgent need for culturally sensitive approaches which understand Irish people, their fears and experiences and which are trusted, tried and tested by the community. There is considerable scope to capitalise on the work of the Irish third sector for health improvement activities or for the delivery of culturally sensitive services.
APPG (2013) Dementia does not discriminate: The experiences of Black, Asian and minority ethnic communities
Aspinall P, Jacobson B. Ethnic disparities in health and health care: A focused Review of the evidence and selected examples of good practice. London: LHO, 2004.
CQC/NMHDU(2010) Count Me In 2010 – The national mental health and learning disability census. London. Care Quality Commission and National Mental Health Development Unit
CRE(2004) Gypsies and Travellers : A strategy for the CRE 2004-2007. London. Commission for Racial Equality
DH (2005) A practical guide to ethnic monitoring in the NHS and social care. London. Department of Health.
Harding S, Rosato M, Teyhan A (2009) Trends in cancer mortality among migrants in England and Wales European Journal of Cancer, 45 (12), 2168-2179
Ethnic inequalities in limiting health and self-reported health in later life revisited
Evandrou M, Falkingham J, Feng Z, Vlachantoni A (2016 )Ethnic inequalities in limiting health and self-reported health in later life revisitedJournal Epidemiology and Community Health 70 (7 ) :653-662
Harding S, Rosato M, Teyhan A (2008) Trends for coronary heath disease and stroke mortality among migrants in England and Wales : Slow declines for some groups. Heart. 94, 463-470
Hickman M., Walter B. (1997) Discrimination and the Irish community in Britain. London. Commission for Racial Equality.
Irish in Britain (2013) Degrees of ethnic inclusion revisited: Analysis of Irish inclusion in JSNAs. London. Irish in Britain. http://www.irishinbritain.org/cmsfiles/Publications/Reports/JSNA-Report-FINAL-pdf.pdf
LHO (2013) Hospital Proportional Admission Ratios (PAR) for selected diagnoses and causes for London Residents 2003-2006. www.lho.org.uk
Maynard M, Rosato M, Teyhan A, Harding S (2012) Trends in suicide among migrants in England and Walws 1979-2003), Ethnicity and Health, 17, 1-2, 135-140.
Parry G, van Cleemput P, Peters J, Walters S, Thomas K, Cooper C (2007) Health status of Gypsies and Travellers in England. Journal of Epidemiology and Community Health, 61, 198-204
Ryan L, D’Angelo A, Puniskis m, Kaye N, (2014) Analysis of 2011 Census data. Irish community Statistics, England and seleceted urban areas. Report for London. http://www.irishinbritain.org/cmsfiles/Downloads/Reports/Irish-Census-Analysis-Report—London.pdf
PHE ( 2017) Public Health Outcomes Framework: Health Equity Report Focus on ethnicity 2017 Public Health Engalnd https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/629563/PHOF_Health_Equity_Report.pdf)
Salway S , Mir G , Turner D , Ellison G , Carter L , Gerrish G ( 2016) Obstacles to “race equality” in the English National Health Service: Insights from the healthcare commissioning arena a School of Health and Related Social Science & Medicine 152 102e110
Scanlon K, Harding S, Hunt K, Pettricrew M, Rosato M, Williams R, (2006) Potential Barriers to prevention of cancers and to early cancer detection among Irish people living in Britain: A qualitative study. Ethnicity and Health 11, ( 3), 325 -341
Sproston K., Nazroo J. (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC). London. The Stationery Office.
Tilki, M., Ryan, L., D’Angelo, A., & Sales, R. (2009). The forgotten Irish : Report of a research project commissioned by Ireland Fund of Great Britain. London: Ireland Fund of Great Britain http://eprints.mdx.ac.uk/6350
Tilki M, Mulligan E, Pratt E, Halley E, Taylor E, (2011) Older Irish people with dementia in England. Advances in Mental Health. 9, (3), 221-232
Tilki M (2015a) Dementia and cancer in the Irish community in Britain. Race Equality Foundation Better Health Briefing 38. London. Race Equality Foundation
Tilki M, Thompson R, Robinson L, Bruce J, Chan E, Lewis O, Chinegwundoh F, Nelson H, (2015b) The BME Third Sector : Marginalised and Exploited. Voluntary Sector Review, 6, (1) : 93-102
Truswell, D (2013) Black and minority ethnic communities and dementia – where are we now?, Better Health Briefing Paper 20, Race Equality Foundation www.better-health.org.uk/briefings/black-and-minority-ethnic-communities-anddementia-where-are-we-now?