Select Committee on Science and Technology Written Evidence

Memorandum by the Policy Research Institute on Ageing and Ethnicity


  1.  PRIAE is the leading body specialising in ageing and ethnicity in the UK and across Europe. Established as an independent charity in 1998, the Institute seeks to improve health, social care and housing, income, pensions and, employment and quality of life for current and future generations of black and minority ethnic (BME) elders at the national and European level.

  2.  The Institute works with BME elders and age organisations, with clinical and non-clinical professionals and researchers, across sectors to influence, inform, develop and strengthen the knowledge base, capacity and practice in ageing and ethnicity.

  3.  PRIAE welcomes the opportunity to respond to the House of Lords Select Committee on Science and Technology call for evidence on the scientific aspects of ageing. This submission is based on the Institute's health specific national and European programmes in dementia; hospital care; diabetes and heart disease (all funded by Department of Health) and the Minority Elderly Care (MEC) Report—empirical research undertaken as part of the EC Fifth Framework Research Programme. This research is highlighted for it is the largest research project in the area of ageing and ethnicity in the UK and across Europe, and a first for the European Commission in its 24 years of research framework funding. Relevant key findings from the Institute's research project are set out below. Due to its nature, related issues concerning BME elders and research enterprise and relevance are appropriately highlighted.

  4.  We set out first our key issues in research borne out of specific major developments highlighted above. This is then extended to cover the implications of our work and concerns for the future.


  1.  The BME elder population once considered "too small to worry about by policymakers and planners" is now set to double, triple or quadruple in this and the next two decades.[4] This is in the context of historical underdevelopment of age and ethnicity, giving rise to the need for rapid progress, and is the primary reason for PRIAE's establishment.[5] It is in this regard that PRIAE has developed a range of health research and development programmes to remedy substantial gaps in our understanding of specific health conditions and influence changes in policy, research and practice.

  2.  We appreciate that the scope of this enquiry relates to scientific aspects of ageing rather than care and service provision. Our response is thus limited to this purpose though it is worth stating that pressures to make service provision appropriate and adequate is stimulating the need for improved scientific base in ageing and ethnicity: for example we know that through service usage, BME elders show a higher level of "earlier ageing". This is usually attributed to socio-economic considerations as well as approximating personal definition of old age to life expectancy of the country from which BME elders originate, usually lower than in the West. We know less about consequences of occupational concentrations in areas such as foundries, manufacturing, transport which the current generation of BME elders were employed in. Nor do we have sufficient understanding about the "migration" effect in the UK of BME elder women and men on their physical and mental health. This in turn has reduced the focus on behaviour patterns of BME elders, which may delay the onset of long-term and/or help manage better the conditions that they experience. The scientific knowledge base is poor in this regard as shown by PRIAE's own membership of Joseph Rowntree Foundation's Enquiry into Long Term Care.

  3.  The MEC research project The MEC research is designed and managed by PRIAE, begun in year 2001 and concluded in August 2004, with a launch of its findings to be held at the European Parliament on 9 December 2004. The MEC research project was undertaken concurrently in ten European countries: Bosnia-Herzegovina, Croatia, Finland, France, Germany, Hungary, the Netherlands, Spain and Switzerland and the UK. The project addresses the position of 26 different ethnic groups throughout Europe and includes both qualitative and quantitative research and aims to improve service provision in the field of health care and social care for BME elders. The research adopted a multi-disciplinary approach—with some 30 researchers across Europe from sociology, anthropology, social psychology, economics, gerontology, demography and management studies backgrounds.

  4.  The MEC Project uses a three-foci approach covering BME elders; health and social care professionals, managers and planners; and BME voluntary organisations. The research was conducted in West Yorkshire, London and Scotland with target Afro Caribbean, South Asian and Chinese/Vietnamese between 2003-04. All the interviews in the UK were conducted face to face and in the chosen language of the interviewee. Research Instrument was developed through critical incidents, focus groups and then adaptation of both clinical (Easy Care for example) and research instruments on health, together with SERVEQOL—a quality management tool for service specification. This necessitated the translation of research instruments into 7 different languages and the recruitment of fieldworkers with appropriate language skills. Few previous research projects on BME elders have been able to focus on all BME groups in the UK due to limitations in language.

  5.  The topics covered in the BME elders' survey Work Package 2 (WP2) include a wide range of demographic data, the socio-economic background of the participants; their legal status and migration history; their medical condition as well as various emotional/psychological attributes; their experiences with regard to racial harassment; their use and satisfaction with health and social care services; and their expectations and perceptions of health and social care services. The WP3 survey covers how mainstream providers design services for BME elders, the provision and use of health and social care services and service quality expectations, perceptions and the gap between these. The survey provides an extensive data set from health and social care professionals and managers/planners and addresses whether BME elders have special health and social care needs and access problems and if so what the reasons for these are; measures used to encourage take-up of services by BME elders; resource issues and demand for services, collaboration in the design of services, service usage and target groups; and reasons for unmet service needs. In WP4 face to face interviews were conducted with 50 BME voluntary organisations in London, West Yorkshire and Scotland. The survey covers organisational characteristics; target BME groups and the needs of the elders; service provision; human and financial resources of the organisations; collaboration with others; attitudes towards mainstream provision and service quality expectations and perceptions. In some areas comparison of the results can be made across all three surveys.

  6.  The findings relevant to this Enquiry relate to health conditions which show that BME elders from seven ethnic groups face a range of health problems, for example:

    —  Afro-Caribbeans had a higher incidence of high blood pressure; compared to South Asians who had a higher incidence than the Chinese/Vietnamese.

    —  Afro-Caribbeans and South Asians had a higher incidence of diabetes than the Chinese/Vietnamese.

    —  Heart disease and lung/breathing conditions were highest amongst the South Asians.

    —  Osteoporosis and memory problems were highest amongst the Chinese/Vietnamese.

  7.  Full findings of the research will be released on 9 December 2004 at the launch at the European Parliament co-hosted by Claude Moraes MEP and Stephen Hughes MEP.

  8.  The purpose of MEC research was:

    —  To advance research in the area rather than be limited with small-scale studies which hitherto has been the experience to date in this area.

    —  To inform policy and planning and help direct appropriate investment in care and further research.

    —  To provide BME elders and organisations with sound knowledge base and tools, which they can use to influence nature of future work undertaken in the area, improving quality and funding.

    —  To use the research to produce specific actions from both clinical and non-clinical practice.

    —  To appreciate that ethnicity and age as important cross-sections can help majority older people with low incomes also (eg through research instruments developed and consequent practice which may arise from the findings).

    —  It is recognised in the health arena that BMEs have different health problems than the white British population. For example the differences with regard to diabetes are well known. Current research is attempting to identify the causal mechanisms leading to these differences. We believe the key issues are for the medical professional to understand the underlying causes of the differences in the incidence of certain medical conditions and then to address what can be done about it. There is a need to understand to what extent the differences between ethnic groups are unavoidable and what can be changed and improved over time. There may also be a strong case for more health education among certain BMEs.

  9.  The benefits of MEC research to the policymakers, planners, BME elders, organisations and research community is immense: we have quantitative data on health conditions and usage of services previously unavailable. The data is analysed with respect to age, gender and ethnicity allowing us to make specific deductions about prevalence of illnesses between these groups, and consequent responses leading to care considerations. This research was designed to inform policymakers on the direction of care based on the health experience of BME elders, and providers' response. From a research point of view, MEC research created 12 full time equivalent research posts for three years in ten countries. Fieldworkers were additionally employed. A majority of researchers had no experience of undertaking major research in ethnicity and age; where they had research experience in age, this was limited to qualitative work. In this way human and social capital has been produced; research instruments produced by PRIAE with partner comments, were applied in all countries and withstand rigorous statistical techniques. PRIAE conceptualised this research, designed it and led it at all stages with specific developments. This will be a first for a BME led body to engage in such a major research enterprise in age and ethnicity concerning health. The Enquiry asks for research capability: we have shown here that we have delivered a major and complex piece of research attracting personnel who could understand the proposal (earned the highest research rating in the theme of ageing) and implement it with use of appropriate techniques. At the end of this research phase, our main concern is how to sustain the personnel skilled up in the area and to maintain the engagement with our majority peers from gerontology to recognise the work. How funders see our work is essential to maintain the resource base for such research and supporting capacity within PRIAE.

  10.  CNEOPSA (Care Needs for Ethnic Older Persons with Alzheimers)—this research and development project from PRIAE established that dementia and ethnicity is on the agenda (Professor Marshall at the launch, 1998) and the research was described as "impressive and authoritative" by Health ministers (Rt Hon Paul Boateng MP 1998; Rt Hon John Hutton 1999).

  11.  PRIAE commissioned Dr Shah, a psycho-geriatrician and researcher and member of PRIAE's CNEOPSA working group recently, to outline assessment and diagnostic issues. We use an extract from this work (to be published by PRIAE)

  Dementia is difficult to diagnose in BME elders (George & Young, 1991; Patel & Mirza, 2000a) because of issues listed in Table 5. A further issue is the paucity of suitable screening and diagnostic instruments for dementia in this group (Shah, 1998). Cognitive tests developed and standardised in one ethnic group may not be appropriate for another ethnic group because they are influenced by culture, education, language, literacy skills, numeracy skills, sensory impairments, unfamiliarity with test situations and anxiety (Shah et al., 2004). Instruments measuring cognitive impairment developed for the English speaking indigenous population have been developed in a number of ethnic minority languages using a detailed translation and back-translation process and formal evaluation of psychometric properties (Shah et al., 2004). The Mini-Mental State Examination (MMSE) (Folstein et al., 1975) has been developed in several languages as listed in Table 6. The Hindi, Urdu, Punjabi, Bengali, Gujarati and Chinese versions are of particular relevance in the UK. The abbreviated Mental Test Score (Quereshi & Hodkinson, 1974) has been developed in several south Asian languages for use among Gujaratis and Pakistanis and in English for use among African Caribbeans in the UK (Rait et al., 1997, 2000a, 2000b). The MMSE, selected items from the CERAD neuropsychological test battery (Morris et al., 1989), the CAMCOG component of the CAMDEX interview (Roth et al., 1986) and clock drawing have been evaluated in elderly African Caribbean people (Richards & Brayne, 1996; Richards et al., 2000; Stewart et al., 2001). Most instruments developed for BME elders are either cognitive screening instruments or those measuring severity of cognitive impairment; diagnostic instruments have not been formally evaluated for use with BME elders (our emphasis).

  12.  The implication of PRIAE's work in dementia is that while we have lifted the area where it is regarded as important and included in National Service Framework for Older People, appropriate instruments, prevalence rates, clinical and non-clinical understanding of how dementia (mental health generally) is expressed in behaviour, is yet to be developed.

  13.  "What works for us" R &D into CHD and Diabetes concerning BME elders—PRIAE project funded by R&D at DH. We include here an extract from our soon to be published work, prepared by Dr H.Waters in this project (led by Dr L.Fredli, S.Griffiths and M.Gabriel). Very little material has been found that connects the problems of elderhood per se with either of the two conditions reviewed here, though there are a number of studies that discuss the incidence of these two conditions among the communities. A large amount of research is being undertaken on these two conditions and ethnicity. None specifically examines the intersection of age, ethnicity and illness which is the focus here. Therefore, analysis of practice and health care interventions in our field has to be extrapolated from a number of sources, and not necessarily confined to those that are strictly academic.

  14.  It is worth pointing out that the higher incidence of CHD among South Asians was largely placed on the agenda by South Asians themselves. As in other areas of BME life, it was communities themselves which first began demanding that their specific problems be addressed. As early as 1985, the Confederation of Indian Organisations approached the Coronary Prevention Group concerning its anxiety over the high rates of CHD among Asians in Britain. The resulting report, Coronary Heart Disease and Asians in Britain raised many of the issues that are still being unravelled, but appears to be rarely cited.[6]

  15.  A number of studies have attempted to discover the clinical reasons for such a high incidence, and factors such as diet, lifestyle, metabolism and genetic predisposition have all been adduced.[7] Much large-scale clinical research remains to be done. For example, the incidence of hypertension—a risk factor implicated in CHD, itself a risk factor of diabetes—is higher among middle-aged south Asians (around 30 per cent) and African Caribbeans (around 25-35 per cent) than among the overall population (10 to 20 per cent).[8] Yet the incidence of CHD is lower among African Caribbeans than the national average, while the incidence of stroke is higher.[9] One small scale survey, starting from the premise that differences in rates for the main cardiovascular risk factors are not substantial enough to account for the major differences in the incidence of CHD, surmised that worse "socio-economic circumstances (especially those associated with stress, such as that related to employment, income and housing)" among Asians may also be a factor.[10] The London Health Observatory has drawn attention to the "interaction between [health] risks" and "low income, unemployment, poor quality housing and low educational attainment" as "especially important in terms of differences in health between ethnic groups", with BME groups tending to have lower average incomes and higher unemployment.[11] Bardsley et al also call for more resources to be put into "Exploration of how differences in mortality by country of birth relate to socio-economic variables such as social class".[12] As we have already seen, BME elders, as pensioners, are among the poorest of an already poor social group—so the link between their health status and socio-economic status is not hard to discern, though it may be awkward to quantify and isolate in a rigorously academic way.

  16.  Similarly, it is difficult rigorously to quantify or isolate the factors underlying differential access for BME individuals to specialist services. Hence, material attempting to address this issue tends to fall outside the remit of the more purely academic literature reviews. Here, the expertise of PRIAE is important, in that, through its contact with BME elders at the receiving end of services, it can uncover the factors that may hinder them from getting appropriate care. More research has been done in the mental health field, relating to ethnicity, diagnosis and treatment, and discrepancies arising from discriminatory approaches, but little has been done in relation to other conditions. According to the London Health Observatory:

    —  out-patient attendance rates are lower for some ethnic minority groups

    —  . . . some evidence of inequity in specialist cardiac investigation services, especially for South Asian groups . . .

  All these are factors will particularly impinge on BME elders, but, apart from PRIAE's work, their experience of medical and care services has not been examined.


    (i)  We have shown above that major research and development work that can enhance good health and delay onset of long term conditions for BME elders is in its infancy. There are major gaps, and where work is being done, including by PRIAE, insufficient recognition is being given to it. There is an appearance of much work being done, but this needs to be seen from the context of very low base line developments from which it has emerged.

    (ii)  PRIAE's own capacity to promote good research and undertake areas that it regards as important is curtailed by (a) how ageing and ethnicity is conceived by funders and researchers (b) by funding as a self-financing Institute.

    (iii)  Any research investment strategy, and we hope that the Committee's deliberations shall lead to this, is to be welcomed if it can increase the focus on ageing and ethnicity and consequent research and developments that can follow.

    (iv)  In late 2004 it is correct to summarise research in ageing and ethnicity as: Characteristic of BME elder research, development and practice is that it is patchy, piecemeal and ad hoc—where research in one area undertaken is seen as addressing "anything and everything you wanted to know about BME elders and condition x". In this sense, BME elder research and developments is reduced to a very narrow conception of what is appropriate in ageing and ethnicity (Patel 1999), thereby denying possibility of wide spread understanding the process of ageing (both biologically and socially) and its impact on BME elders and communities. It would be true to say that technological developments or clinical trials for specific areas concerning older people are not likely to include BME elders in the sample frame. If they do it is likely to be too small, rendering the justification made by PRIAE that unless we have dedicated research in ageing and ethnicity, the field will remain undeveloped with differential care as a consequence. That cannot be good when agendas' about social cohesion, inclusion, health equality and equity are promoted as policy measures.


  1  Patel, N. (ed) (2003) Minority Elder Care in Europe—ten country profiles, MEC Research for the EC 5th Framework Research Programme, PRIAE.

  2  PRIAE report to the Royal Commission:

Patel, N. (1999) Perspectives on Black and Minority Ethnic Elders in the UK- report commissioned by the Royal Commission on Long Term Care for the Elderly, research volume 1, HMSO.

  3  Dementia Matters: Ethnic Concerns (PRIAE-CNEOPSA Project), (1999).

October 2004

4   Census 2001; References 1. Back

5   References 2. Back

6   References 2. Back

7   Coronary Prevention Group, Coronary Heart Disease and Asians in Britain: a report prepared . . . for the Confederation of Indian Organisations (London, CIO, 1986). Back

8   See, eg, T. Knight, Z. Smith, J. A. Lockton, P. Sahota, A. Bedford, M. Toop, E. Kernohan and M.R. Baker, "Ethnic differences in risk markers for heart disease in Bradford and implications for preventive strategies", Journal of Epidemiology and Community Health (Vol. 47, 1993), pp. 89-95; Nada Lemic-Stojcevic, Ruth Dundas, Stephen Jenkins, Anthony Rudd and Charles Wolfe, "Preventable risk factors for coronary heart disease in stroke amongst ethnic groups in London", Ethnicity and Health (Vol. 6, no. 2, 2001), pp. 87-94. Back

9   V. Soni Raleigh, "Diabetes and hypertension in Britain's ethnic minorities: implications for the future of renal services", British Medical Journal (Vol. 314, no 7075, 1997, pp. 209-13, cited in Mohammed Memon and Farha Abbas, "Reducing health risks in ethnic communities" Nursing Times (Vol. 95, no. 27, 1999). pp. 49-51. Back

10   LHO, "Black and minority ethnic populations", op cit, p 3; White, Carlin, Rankin and Adamson, op. citBack

11   G Y H Lip, C Luscombe, M McCarry, I Malik and G Beevers, "Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention", Ethnicity and Health (Vol. 1, no. 1, 1996), pp. 47-53, citing R. Williams, R Bhopal, and K. Hunt, "Coronary risk factors in a British Punjabi population: comparative profile of non-biochemical factors", International Journal of Epidemiology (Vol. 23, 1994), pp 28-37. Back

12   Bardsley, Hamm, Lowdell, Morgan and Storkey, op cit, p 11. Back

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2005