Birmingham Pakistani exclusion from (health) structures


In 2013 I published the book Dear Birmingham which drew attention to the exclusion of Pakistanis from opportunities and centres of power across Birmingham. Since then, further research has been conducted which has shown continued exclusion of the community. The focus here is on Birmingham City Council and the health services in the city.


According to the Census 2021, 17% of the Birmingham’s population are Pakistani. Two-thirds pf this community are from Azad Kashmir, the remainder are Pashtun, Punjabis and other ‘Pakistanis’.

Drawing on Birmingham City Council 2011 data, 24% of the school children were Pakistani. This percentage will have increased since then. According to local health data, Pakistanis had the largest number of pregnancies which provides a clear indicator of population. 

Birmingham Pregnancies

  • Pakistani                      517
  • British (White?)         515
  • Black African              91
  • White other                91
  • Asian other                  77
  • Indian                          73
  • Bangladeshi               69
  • Middle Eastern          37

Pakistani health

British Pakistanis are generally a disadvantaged community.

According to the Birmingham Pakistani Health Profile,

  • life expectancy of Pakistani women 84.8
  • life expectancy of Pakistani men is 82.3
  • Pakistanis consistently had the highest rate of infant mortality of all Asian subcategories.
  • Pakistani women are the least active of all ethnicities, men not much better.
  • Pakistani men, almost three times as likely as the general population to have type 2 diabetes
  • Pakistani women five times more likely to be diabetic when compared with the women in the general population
  • Pakistani children, ages 10-11, have higher prevalence of obesity; also children 4-5 years of age with the same problem
  • 49.9% of Pakistani mothers were in consanguineous relationships.

Birmingham City Council Employment

According to the Birmingham Stephen Lawrence Commission Report (2001) the Council had previously set and achieved a 20% target for employing ethnic minorities. The Council then decided to set differentiated targets, in proportion to the population. For their Pakistani workforce the Annual Improvement Target (2001/2002) was 6.9%. I have monitored the progress of this target over the years through Freedom of Information, as follows:

Birmingham City Council Pakistani workforce over the years

2000                2%

2012                3.85%

2018                4.8%

2020                5.19%

2023                6.99% (the 2001/2002 target). This is against the Pakistani presence in the population of 17%.

Pakistanis in the health system

Through Freedom of Information, I have collected the following picture of Pakistanis as registered patients, in the health workforce and on health boards.

Birmingham Women’s and Children’s NHS Foundation Trust

  • Pakistani patients                    20.71%
  • Pakistanis on boards               5.43%

Birmingham Community Healthcare NHS Foundation Trust.

  • Pakistani patients                    14.22%
  • Pakistanis in the workforce  6.41%
  • Pakistanis on the board          8%
  • Positive Action

The Trust has no strategy targeted at any singular ethnicity in its workforce, including the Board. But the Trust is committed to a representative workforce with inclusive leadership. To support this, we have various work streams to increase the representation of BME staff at Band 8a above. This includes Band 8a assurance framework, positive action for underrepresented groups, and equality statement on Trust job adverts. In addition, the Possibilities Beyond Limits programme is in place to support BME colleagues to progress. This work is focused on BME staff and not one sole ethnic group. We provide inclusive leadership training to all senior managers on Band 6 and above, in addition to cultural competence training.

Sandwell and West Birmingham Hospitals NHS Trust

Pakistanis in the workforce                5.2% 

Pakistanis on the board                        7% 

Birmingham and Solihull Mental Health NHS Foundation Trust

Pakistani patients                    7.6%

Pakistanis in the workforce    5.49%

Pakistanis on the board                       There are NIL Pakistani board members.

Please note that there are 2 board members without an ethnic origin recorded on the Trust ESR system (workforce system) and therefore we are unable to confirm if they of Pakistani ethnic origin.

NHS Birmingham and Solihull Integrated Care Board.

  • Pakistanis in the workforce                6.3%
  • Pakistanis on the board                      0%
  • Positive Action is covered in our Equality Strategy (slide 26), and EDI Policy.

The ICB do not specifically target action at individual ethnic origin categories, such as Asian Pakistani but take a wider view where there is under-representation of minority ethnic groups at a particular pay band.

The ICB is working towards the NHS requirements, set out in the Workforce Race Equality Standard Model Employer paper, published in January 2019, this sets out an ambition to increase black and minority ethnic representation at all levels of workforce by 2028.

Our positive action work covers all levels of the organisation.

Key Question

What difference does it make when a community such as the Pakistanis is underrepresented in the workforce and in the decision-making structures? How does it impact on the services that are provided or the appropriateness of such services? What message is being sent to the Pakistani community? (you are not welcome here; you have nothing to contribute; we will decide for you!).

Suggested recommendations

Suggested recommendations

  1. 17% target Pakistanis in the workforce – pipeline strategy
  2. 17% target Pakistanis on the Boards and all decision-making structures
  3. Decision making structures to include multilingual strategies such as interpreters (in Mirpuri/Pahari, Pashto), especially for women.
  4. A Pakistani health practitioners’ group (sub-groups such as Kashmiri, Pashtun) to feed intelligence and expertise into the system.
  5. Pakistani sub-groups on health (e.g. Kashmiri, Pashtun) in order to understand the needs and provide a culturally competent health service.
  6. A BLACHIR type approach to Pakistani community, in partnership with authorities such as Bradford whose ‘Born in Bradford’ study offers a model for work on consanguinity which was flagged up as a Birmingham problem.
  7. A health profile to be produced for the largest of the Pakistani communities, the Kashmiri community.

Birmingham City Council should take urgent action to rectify the unacceptable imbalance between the Pakistani population and Pakistani origin employees in the Council.

Professor Muhammad Anwar, Birmingham Pakistan Forum report 20-21 April 1996.