{"id":1758,"date":"2023-11-14T14:23:41","date_gmt":"2023-11-14T14:23:41","guid":{"rendered":"http:\/\/www.forwardpartnership.org.uk\/?p=1758"},"modified":"2024-01-26T10:46:32","modified_gmt":"2024-01-26T10:46:32","slug":"birmingham-pakistani-exclusion-from-health-structures","status":"publish","type":"post","link":"https:\/\/www.forwardpartnership.org.uk\/?p=1758","title":{"rendered":"Birmingham Pakistani exclusion from (health) structures"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\"><strong>Background<\/strong><\/h1>\n\n\n\n<p>In 2013 I published the book <a href=\"http:\/\/www.forwardpartnership.org.uk\/?p=1118\">Dear Birmingham<\/a> 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. <\/p>\n\n\n\n<p><strong>Pakistani-Birmingham<\/strong><\/p>\n\n\n\n<p>According to the Census 2021, 17% of the Birmingham\u2019s population are Pakistani. <a href=\"https:\/\/www.bera.ac.uk\/blog\/majority-of-british-pakistanis-are-actually-kashmiris-who-speak-pahari\">Two-thirds pf this community are from Azad Kashmir<\/a>, the remainder are Pashtun, Punjabis and other \u2018Pakistanis\u2019. <\/p>\n\n\n\n<p>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.&nbsp; <\/p>\n\n\n\n<p><strong>Birmingham Pregnancies <\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Pakistani &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 517<\/li><li>British (White?) &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;515<\/li><li>Black African &nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;91<\/li><li>White other &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 91<\/li><li>Asian other &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 77<\/li><li>Indian &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;     73<\/li><li>Bangladeshi &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;69<\/li><li>Middle Eastern &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;37<\/li><\/ul>\n\n\n\n<p><strong>Pakistani health<\/strong><\/p>\n\n\n\n<p><a href=\"http:\/\/www.forwardpartnership.org.uk\/?p=1665\">British Pakistanis are generally a disadvantaged community. <\/a> <\/p>\n\n\n\n<p>According to the <a href=\"https:\/\/www.birmingham.gov.uk\/downloads\/file\/27788\/pakistani_community_health_profile_report\">Birmingham Pakistani Health Profile<\/a>, <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>life expectancy of Pakistani women   84.8<\/li><li>life expectancy of Pakistani men is     82.3<\/li><li>Pakistanis consistently had the highest rate of infant mortality of all Asian subcategories. <\/li><li>Pakistani women are the least active of all ethnicities, men not much better. <\/li><li>Pakistani men, almost three times as likely as the general population to have type 2 diabetes<\/li><li>Pakistani women five times more likely to be diabetic when compared with the women in the general population<\/li><li>Pakistani children, ages 10-11, have higher prevalence of obesity; also children 4-5 years of age with the same problem<\/li><li>49.9% of Pakistani mothers were in consanguineous relationships. <\/li><\/ul>\n\n\n\n<p><strong>Birmingham City Council Employment<\/strong><\/p>\n\n\n\n<p>According to the Birmingham Stephen Lawrence Commission Report\n(2001) the Council had previously set and achieved a 20% target for employing\nethnic minorities. The Council then decided to set differentiated targets, in\nproportion to the population. For their Pakistani workforce the Annual\nImprovement Target (2001\/2002) was 6.9%. I have monitored the progress of this\ntarget over the years through Freedom of Information, as follows:<\/p>\n\n\n\n<p><strong>Birmingham City Council Pakistani workforce over the years<\/strong><\/p>\n\n\n\n<p>2000&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 2%<\/p>\n\n\n\n<p>2012&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 3.85%<\/p>\n\n\n\n<p>2018&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 4.8%<\/p>\n\n\n\n<p>2020&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 5.19%<\/p>\n\n\n\n<p>2023&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_57#describe_state_form_1\">6.99%<\/a> (the 2001\/2002 target). This is against the Pakistani presence in the population of 17%. <\/p>\n\n\n\n<p><strong>Pakistanis in the health system<\/strong><\/p>\n\n\n\n<p>Through Freedom of Information, I have collected the following\npicture of Pakistanis as registered patients, in the health workforce and on\nhealth boards. <\/p>\n\n\n\n<p><strong><a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_49#describe_state_form_1\">Birmingham Women&#8217;s and Children&#8217;s NHS Foundation Trust<\/a><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Pakistani\npatients&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 20.71%<\/li><li>Pakistanis on\nboards&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 5.43%<\/li><\/ul>\n\n\n\n<p><strong><a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_53#describe_state_form_1\">Birmingham Community Healthcare NHS Foundation Trust.<\/a><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Pakistani patients&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 14.22%<\/li><li>Pakistanis in the workforce&nbsp;&nbsp;6.41%<\/li><li>Pakistanis on the board&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 8%<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Positive Action<\/li><\/ul>\n\n\n\n<p><em>The Trust has no strategy targeted at\nany singular ethnicity in its workforce, including the Board. But the Trust is\ncommitted to a representative workforce with inclusive leadership. To support\nthis, we have various work streams to increase the representation of BME staff\nat Band 8a above. This includes Band 8a assurance framework, positive action\nfor underrepresented groups, and equality statement on Trust job adverts. In\naddition, the Possibilities Beyond Limits programme is in place to support BME\ncolleagues to progress. This work is focused on BME staff and not one sole\nethnic group. We provide inclusive leadership training to all senior managers\non Band 6 and above, in addition to cultural competence training.<\/em><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_56#describe_state_form_1\">Sandwell and West Birmingham Hospitals NHS Trust<\/a><\/strong><\/p>\n\n\n\n<p>Pakistanis in the workforce&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 5.2%&nbsp;<\/p>\n\n\n\n<p>Pakistanis on the board&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7%&nbsp;<\/p>\n\n\n\n<p><strong><a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_52?nocache=incoming-2225400#incoming-2225400\">Birmingham and Solihull Mental Health NHS Foundation Trust<\/a><\/strong><\/p>\n\n\n\n<p>Pakistani patients&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 7.6%<\/p>\n\n\n\n<p>Pakistanis in the workforce&nbsp;&nbsp;&nbsp; 5.49%<\/p>\n\n\n\n<p>Pakistanis\non the board&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; There\nare NIL Pakistani board members. <\/p>\n\n\n\n<p>Please note that there are 2 board members\nwithout an ethnic origin recorded on the Trust ESR system (workforce system)\nand therefore we are unable to confirm if they of Pakistani ethnic origin.<\/p>\n\n\n\n<p><strong><a href=\"https:\/\/www.whatdotheyknow.com\/request\/pakistani_representation_54?nocache=incoming-2247698#incoming-2247698\">NHS Birmingham and Solihull Integrated Care Board.<\/a><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Pakistanis in the workforce&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 6.3%<\/li><li>Pakistanis on the board&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 0%<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Positive Action is covered in our Equality Strategy\n(slide 26), and EDI Policy. <\/li><\/ul>\n\n\n\n<p>The ICB do not specifically target action at\nindividual ethnic origin categories, such as Asian Pakistani but take a wider\nview where there is under-representation of minority ethnic groups at a\nparticular pay band.<\/p>\n\n\n\n<p>The ICB is working towards the NHS requirements, set\nout in the Workforce Race Equality Standard Model Employer paper, published in\nJanuary 2019, this sets out an ambition to increase black and minority ethnic\nrepresentation at all levels of workforce by 2028.<\/p>\n\n\n\n<p>Our positive action work covers all levels of the organisation.<\/p>\n\n\n\n<p><strong>Key Question<\/strong><\/p>\n\n\n\n<p>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!).  <\/p>\n\n\n\n<p><strong>Suggested recommendations<\/strong><\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Suggested recommendations<\/h1>\n\n\n\n<ol class=\"wp-block-list\"><li>17% target Pakistanis in the workforce \u2013 pipeline strategy<\/li><li>17% target Pakistanis on the Boards and all decision-making structures<\/li><li>Decision making structures to include multilingual strategies such as interpreters (in Mirpuri\/Pahari, Pashto), especially for women. <\/li><li>A Pakistani health practitioners\u2019 group (sub-groups such as Kashmiri, Pashtun) to feed intelligence and expertise into the system.<\/li><li>Pakistani sub-groups on health (e.g. Kashmiri, Pashtun) in order to understand the needs and provide a culturally competent health service. <\/li><li>A <a href=\"https:\/\/www.birmingham.gov.uk\/info\/50266\/other_public_health_projects\/2309\/birmingham_and_lewisham_african_and_caribbean_health_inequalities_review_blachir\">BLACHIR<\/a> type approach to Pakistani community, in partnership with authorities such as Bradford whose \u2018Born in Bradford\u2019 study offers a model for work on consanguinity which was flagged up as a Birmingham problem. <\/li><li>A health profile to be produced for the largest of the Pakistani communities, the Kashmiri community. <\/li><\/ol>\n\n\n\n<p><em>Birmingham City Council should take\nurgent action to rectify the unacceptable imbalance between the Pakistani\npopulation and Pakistani origin employees in the Council.<\/em><\/p>\n\n\n\n<p>Professor Muhammad Anwar, Birmingham Pakistan Forum report 20-21 April 1996.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Background 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. &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/www.forwardpartnership.org.uk\/?p=1758\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Birmingham Pakistani exclusion from (health) structures&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2,1],"tags":[],"class_list":["post-1758","post","type-post","status-publish","format-standard","hentry","category-blog","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1758","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1758"}],"version-history":[{"count":6,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1758\/revisions"}],"predecessor-version":[{"id":1775,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1758\/revisions\/1775"}],"wp:attachment":[{"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1758"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1758"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.forwardpartnership.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1758"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}