Tower of strength

Fifty-eight per cent of the population in Tower Hamlets in London’s East End belongs to an ethnic group other than white British. One-third is Bangladeshi. Although banking and the financial service sector accounts for 40 per cent of employment in the borough, it remains one of the most deprived areas in the UK.

The combination of international cultures and domestic deprivation led to poor health and social care for many established communities.

In 1981 a group of local female community and health workers recognised a need among ethnic minorities, particularly Bengali women, to improve the take-up of maternity services and to reduce perinatal mortality and morbidity rates.

The championing of maternity services gave birth to the Women’s Health and Family Services – a multi-ethnic health advocacy, support and advice organisation. “We did that work for eight years,” says project co-ordinator Jo Weller, “by which time the advocates became mainstream and were employed by the hospitals and community health.”

The service has since diversified and taken up other health projects such as infant breastfeeding, diabetes and hearing impairment, and more social-oriented activities such as the Somali women’s lunch club.

But take-up of these services is poor. Weller explains: “There’s difficulties in accessing services because of language barriers; a lack of understanding of the set-up; not knowing how to register with a GP. And there are cultural differences, such as keeping matters in the family and not asking for help. Services aren’t set up to accommodate such clients.”

Department of Health figures bear out the health risks. For example, people in ethnic minorities in Tower Hamlets are 40 per cent more likely to die of chronic diseases such as coronary heart disease, hypertension and cancer. Mental health is also a concern, as is the high suicide rate among young Somali men.

Indeed, that the Somali community is three times more likely to be diabetic resulted in the setting-up of the diabetes project with a £94,000 development grant from the King’s Fund. A Somali-speaking project worker, the first of its kind, provided education about the condition.

“This involves outreach work with the diabetes clinic at Mile End Hospital and GP practices, and holding sessions in Somali community centres,” says Weller. “The worker looks at healthy eating, exercise, self-management and issues such as treatment during Ramadan and fasting.”

As with all their projects, the hope is to see the work mainstreamed and taken over full-time by statutory services. Weller says: “In the voluntary sector we’re always trying to identify and then fill the gaps.”

Seven languages are spoken by staff at the service which has 12 streams of funding, enabling a four-pronged approach: health advocacy, including campaigning and representing women’s issues; advice and support through interpreting; health promotion and education, including counselling and keep fit; and special projects, such as the Hearing Project for Bangladeshi children with hearing impairment.

“The Hearing Project came about after discussing case work with advocates,” says co-ordinator Joyce Grandison. “Hearing problems for this group are three times the national average and diagnostic pick-up was 24 months later than others and has affected development. But, even if diagnosed late, many wouldn’t attend the clinic because of the stigma within the community about hearing loss.”

Parents felt that if their children were deaf and could not be cured there seemed little point in attending any clinic. “It was about educating the community on the importance of visiting clinics and keeping appointments and so on,” says Grandison.

It has been another success for the service. Within 18 months the non-attendance rate at clinics reduced from 35 per cent to 5 per cent. And, according to Grandison, the usual trade-off is also set to happen. “The primary care trust is planning to mainstream the project,” she says.

Lessons learned

  • Health advocates working in their own communities are well placed to identify significant health and social care needs through their case work.
  • National and local research and reports also indicate where problems may lie, enabling the Women’s Health and Family Services to assess the needs of the local community.
  • While the original focus of better access to maternity services for women from ethnic minorities is a persistent need, the service has prospered by identifying wider needs of the communities it serves. It has recognised the need for health and social work with older ethnic minority women’s groups, access to mental health services for Somali men and access to services for chronic diseases for all ethnic minority communities.


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