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Background: Immigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK., Methods: A linked 17-21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709) men and women, aged 25-74 years, recruited between 1993 and 1997. Poisson regression was used to estimate mortality rate ratios (MRRs) for all-cause mortality. Sensitivity analysis explored the possible effect of differences between ethnic groups in loss to follow-up. The impact of adjustment for established risk factors on MRRs was studied., Results: South Asians had lower all-cause age-adjusted and sex-adjusted mortality than Europeans (MRR 0.70; 95% CI 0.58 to 0.85). There was higher loss to follow-up in South Asians. Sensitivity analyses demonstrated that this did not account for the observed lower mortality. Adjustment for cardiometabolic, behavioural and socioeconomic characteristics attenuated but did not eliminate the mortality differences between South Asians and Europeans, although CIs now cross 1 (MRR 0.79; 95% CI 0.55 to 1.13)., Conclusions: South Asians had lower all-cause mortality compared with European origin individuals living in Newcastle upon Tyne that were not accounted for by incomplete mortality data. It is possible that such migrants to the UK have the resources and motivation to move in search of better opportunities and may be healthier and wealthier than those who remain in their country of origin. These findings challenge us to better understand and measure the factors contributing to their survival advantage., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Few countries record the data needed to estimate life expectancy by ethnic group. Such information is helpful in assessing the extent of health inequality., Method: Life tables were created using 3 years of deaths (May 2001-April 2004) linked to Scottish 2001 Census data for 4.62 million individuals with self-reported ethnicity. We created 8 ethnic groups based on the census definitions, each with at least 5000 individuals and 40 deaths. Life expectancy at birth was calculated using the revised Chiang method., Results: The life expectancy of White Scottish males at birth was 74.7 years (95% CI 74.6 to 74.8), similar to Mixed Background (73.0; 70.2 to 75.8) and White Irish (75.0; 74.0 to 75.9), but shorter than Indian (80.9; 78.4 to 83.4), Pakistani (79.3; 76.9 to 81.6), Chinese (79.0; 76.5 to 81.5), Other White British (78.9; 78.6 to 79.2) and Other White (77.2; 76.4 to 78.1). The life expectancy of White Scottish females was 79.4 years (79.3 to 79.5), similar to mixed background (79.3; 76.6 to 82.0), but shorter than Pakistani (84.6; 82.0 to 87.3), Chinese (83.4; 81.1 to 85.7), Indian (83.3; 80.7 to 85.9), Other White British (82.6; 82.3 to 82.9), other White (82.0; 81.3 to 82.8) and White Irish (81; 80.2 to 81.8)., Conclusions: Males and females in most of the larger ethnic minority groups in Scotland have longer life expectancies than the majority White Scottish population., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Previous studies have shown markedly lower birth weight among infants of South Asian origin compared with those of White European origin. Whether such differences mask greater adiposity in South Asian infants and whether they persist across generations in contemporary UK populations is unclear. Our aim was to compare birth weight, skinfold thickness and cord leptin between Pakistani and White British infants and to investigate the explanatory factors, including parental and grandparental birthplace., Methods: We examined the differences in birth weight and skinfold thickness between 4649 Pakistani and 4055 White British infants born at term in the same UK maternity unit and compared cord leptin in a subgroup of 775 Pakistani and 612 White British infants., Results: Pakistani infants were lighter (adjusted mean difference -234 g 95% CI -258 to -210) and were smaller in both subscapular and triceps skinfold measurements. The differences for subscapular and triceps skinfold thickness (mean z-score difference -0.27 95% CI -0.34 to -0.20 and -0.23 95% CI -0.30 to -0.16, respectively) were smaller than the difference in birth weight (mean z-score difference -0.52 95% CI -0.58 to -0.47) and attenuated to the null with adjustment for birth weight (0.03 95% CI -0.03 to 0.09 and -0.01 95% CI -0.08 to 0.05, respectively). Cord leptin concentration (indicator of fat mass) was similar in Pakistani and White British infants without adjustment for birth weight, but with adjustment became 30% higher (95% CI 17% to 44%) among Pakistani infants compared with White British infants. The magnitudes of difference did not differ by generation., Conclusions: Despite being markedly lighter, Pakistani infants had similar skinfold thicknesses and greater total fat mass, as indicated by cord leptin, for a given birth weight than White British infants. Any efforts to reduce ethnic inequalities in birth weight need to consider differences in adiposity and the possibility that increasing birth weight in South Asian infants might inadvertently worsen health by increasing relative adiposity.

Objective: To explore attitudes to quitting smoking and experience of smoking cessation among Bangladeshi and Pakistani ethnic minority communities., Design: Qualitative study using community participatory methods, purposeful sampling, interviews and focus groups, and a grounded approach to data generation and analysis., Setting: Newcastle upon Tyne, UK, 2000-2002., Participants: 53 men and 20 women aged 18-80 years, including smokers, former smokers, and smokers' relatives, from the Bangladeshi and Pakistani communities; and eight health professionals working with these communities., Results: Motivation to quit was high but most attempts had failed. "Willpower" was the most common approach to quitting. For some, the holy month of Ramadan was used as an incentive, however few had been successful in quitting. Perceived barriers to success included being tempted by others, everyday stresses, and withdrawal symptoms. Few participants had sought advice from health services, or received cessation aids, such as nicotine replacement therapy (NRT) or buproprion. Family doctors were not viewed as accessible sources of advice on quitting. Health professionals and community members identified common barriers to accessing effective smoking cessation, including: language, religion and culture; negative attitudes to services; and lack of time and resources for professionals to develop necessary skills., Conclusions: High levels of motivation do not seem to be matched by effective interventions or successful attempts to quit smoking among Bangladeshi and Pakistani adults in the UK. There is a need to adapt and test effective smoking cessation interventions to make them culturally acceptable to ethnic minority communities. UK tobacco control policies need to give special attention to the needs of ethnic minority groups.

Broad terms such as Black, African, or Black African are entrenched in scientific writings although there is considerable diversity within African descent populations and such terms may be both offensive and inaccurate. This paper outlines the heterogeneity within African populations, and discusses the strengths and limitations of the term Black and related labels from epidemiological and public health perspectives in Europe and the USA. This paper calls for debate on appropriate terminologies for African descent populations and concludes with the proposals that (1) describing the population under consideration is of paramount importance (2) the word African origin or simply African is an appropriate and necessary prefix for an ethnic label, for example, African Caribbean or African Kenyan or African Surinamese (3) documents should define the ethnic labels (4) the label Black should be phased out except when used in political contexts.

Internationally, there is a drive for equality in health care for ethnic groups. To achieve equality, produce sound policies, and provide appropriately targeted services good quality data are essential. Where data are based upon self report, especially from non-English speakers, there are major barriers to the accumulation of reliable and valid information. When data collection instruments designed for English speakers are simply translated into ethnic minority languages, measurement error can result from inadequate translation procedures, inappropriate content, insensitivity of items, and the failure of researchers to make themselves familiar with cultural norms and beliefs. More attention should be paid to conceptual and cultural factors especially in epidemiological and clinical studies where self report is used to gather data. More interdisciplinary collaboration is necessary as well as a modification of customary methods of data collection and the assumptions behind them. The essence of such modifications entails participatory research with members of the linguistic communities concerned.

This glossary focuses on the concepts and terminology used in the study of the health of minority ethnic and racial groups. It is hoped that it will stimulate debate on this subject so that an internationally applicable glossary may emerge.

Objective: To compare the prevalence of cardiovascular risk factors and coronary heart disease in Chinese and Europid adults., Design: Population based, cross sectional survey., Setting: Newcastle upon Tyne, UK, 1991-93., Subjects: Altogether 380 Chinese and 625 Europid adults, aged 25-64 years., Main Outcome Measures: Fasting lipid levels, blood pressure, body mass index (BMI), the proportions who smoked, and the prevalence of coronary heart disease based on the Rose angina questionnaire and major electrocardiographic abnormalities on resting 12 lead electrocardiogram (Minnesota codes 1.1-1.2). All figures were age adjusted to the 1991 England and Wales population., Results: Altogether 183 and 197 Chinese, and 310 and 315 Europid men and women respectively were seen. Compared with Europid men, Chinese men had a lower mean total cholesterol concentration (5.1 versus 5.6 mmol/l, p < 0.001) and LDL cholesterol (3.2 versus 3.6 mmol/l, p < 0.001); lower BMI values (23.8 versus 26.1 kg/m-2, p < 0.001); and smoked less (23% versus 35%, p < 0.01)). Compared with Europid women, Chinese women also had lower mean lipid levels (total cholesterol: 4.9 versus 5.4 mmol/l p < 0.001, LDL cholesterol: 2.8 versus 3.1 mmol/l p < 0.001); BMI values (23.5 versus 26.1 kg/m-2, p < 0.001); and far fewer were smokers (1.4% versus 33%, p < 0.001). Chinese women, however, had higher mean systolic (121 versus 117 mmHg, p > 0.05) and diastolic (75 versus 68 mmHg, p < 0.001) blood pressures. The prevalence of coronary heart disease was significantly lower in Chinese than Europid men (4.9% versus 16.6%, p < 0.001) but not significantly different in women (7.3% versus 11.1%, p = 0.16)., Conclusion: Strategies for UK Chinese are needed to maintain this favourable risk factor profile and prevent any potential increase in the risk of coronary heart disease associated with increasing acculturation.

Objective: To compare the prevalence of glucose intolerance (impaired glucose tolerance and diabetes), and its relationship to body mass index (BMI) and waist-hip ratio in Chinese and Europid adults., Design: This was a cross sectional study., Setting: Newcastle upon Tyne., Subjects: These comprised Chinese and Europid men and women, aged 25-64 years, and resident in Newcastle upon Tyne, UK., Main Outcome Measures: Two hour post load plasma glucose concentration, BMI, waist circumference, and waist-hip ratio., Methods: Population based samples of Chinese and European adults were recruited. Each subject had a standard WHO oral glucose tolerance test., Results: Complete data were available for 375 Chinese and 610 Europid subjects. The age adjusted prevalences of glucose intolerance in Chinese and Europid men were 13.0% (p = 0.04). Mean BMIs were lower in Chinese men (23.8 v 26.1) and women (23.5 v 26.1) than in the Europids (p values < 0.001), as were waist circumferences (men, 83.3 cm v 90.8, p < 0.001; women, 77.3 cm v 79.2, p < 0.05). Mean waist-hip ratios were lower in Chinese men (0.90 v 0.91, p = 0.02) but higher in Chinese women (0.84 v 0.78, p < 0.001) compared with Europids. In both Chinese and Europid adults, higher BMI, waist circumference, and waist-hip ratio were associated with glucose intolerance., Conclusions: The prevalence of glucose intolerance in Chinese men and women, despite lower BMIs, is similar to or higher than that in local Europid men and women and intermediate between levels found in China and those in Mauritius. It is suggested that an increase in mean BMI to the levels in the Europid population will be associated with a substantial increase in glucose intolerance in Chinese people.

Purchasing health care is at the core of the reforms of the UK NHS and yet there is little research evidence on which the policy is based. Research in this area is hampered by a lack of clarity over the aims of purchasing and the pace of change within the NHS. Purchasing developments such as general practice fund-holding are proceeding without a large scale evaluation of their impact. At a national level a research effort is required to investigate this key area of the NHS reforms.

Study Objective: The prevalence of asthma was assessed to investigate respiratory health effects of airborne emissions from a factory. A geographical information system allowed flexible definition of study areas in terms of their size, distance, and location in relation to the factory. The value of the approach for this type of investigation is focussed on., Setting: The factory is located in the south western part of a small market town in County Durham., Measurements and Main Results: A total of 1573 asthma cases were identified from general practitioner computerised repeat prescribing systems. Population denominators were defined from family health services authority patient registers. The area within 1 km and immediately to the north east of the factory had an age and sex standardised asthma prevalence 24% (confidence interval 4, 44%) in excess of the expected rate (p = 0.01). The increased prevalence was confined to middle aged and elderly adults living in the area between 0.5 and 1 km to the north east of the factory., Conclusions: The value of combining the skills of geographers and epidemiologists in addressing public health issues is shown, particularly through the use of geographical information systems which proved powerful and effective.

Objective: To determine whether there was excess ill health in people living near a coking works, and if so whether it was related to exposure to coking works' emissions., Design: Populations varying in proximity to the coking works were compared with control populations. Health data were correlated with available environmental data., Methods: Analysis of routinely collected mortality, cancer registration, and birth statistics; community survey using self completed postal questionnaires; retrospective analysis of general practice (GP) records; tests of respiratory function; and analysis of available environmental data., Main Results: Study and control populations were comparable in terms of response rates, gender, and most socioeconomic indicators. For adults, age standardised mortality and cancer rates of the population closest to the coking works were comparable with those for the district as a whole. Gender ratios, birthweight, and stillbirth rates were comparable in the study and control populations. For several indicators of respiratory health including cough, sinus trouble, glue ear, and wheeze (but not for asthma and chronic bronchitis) there was a gradient of self reported ill health, with the highest prevalence in areas closest to the works. For example, sinus trouble was reported by 20% of adults and 13% of children in the area closest to the works compared with 13% and 6% respectively in the control area. GP consultations for respiratory disorders increased when pollution (measured by SO2 levels) was high: annual consultation rates per 1000 varied from 752 in the top group of daily pollution levels to 424 in the bottom group. Analysis of locally collected smoke and SO2 data indicated that SO2 concentrations were highest closest to the works and, after closure of the coking works, the number of days on which SO2 and smoke levels exceeded 100 micrograms/m3 and 90 micrograms/m3, respectively, fell steeply., Conclusion: Routinely available indicators failed to provide convincing evidence that the coking works had harmed health. Self report and GP consultations indicated that respiratory ill health in the people living close to the works was worse than expected. Some of the excess probably resulted from exposure to coking works emissions. The health effects of relatively low level but intermittently high air pollution from a point source may be subtle, contributing to respiratory morbidity, but not apparent in analysis of routine health indicators.

Study Objective: To investigate the numbers and characteristics of patients with ophthalmological accidents and emergencies presenting to hospitals., Design: Prospective survey over eight weeks., Setting: Two general and one ophthalmic accident and emergency departments, two general outpatient departments, and an eye hospital ward consulting room (all in two teaching hospitals) in Newcastle upon Tyne., Measurements and Main Results: Consultation numbers by age, sex, health district of residence, source of referral, diagnosis, and disposal were determined. An average of 37 ophthalmological emergency patients were seen daily. The all cause consultation rate per 1000 population for Newcastle residents was 2.64 (17.2 per year); for injuries it was 1.10 (7.2 per year) and for inflammations the rate was 0.91 (5.9 per year). Consultation rates per 1000 were 3.5 for males and 1.8 for females, the excess being explained by the higher risk of injury to men. Most patients were self-referred (58%), consulted during office hours (79.6%), were attended by senior house officers working alone (83.9%), and were asked to return for follow up (66.1%). Patients in an accident and emergency department seldom saw a consultant in their initial management. The diagnoses of patients from outside Newcastle were little different from those who lived within the city. The 10 commonest problems accounted for 68% of all cases. Injuries were the commonest problem (40.9% of all diagnoses)., Conclusion: Ophthalmological accident and emergencies are an important component of an accident and emergency department workload. These patients are usually seen by junior doctors, some untrained in ophthalmology. The wide range of presenting problems poses a challenge for training and the organisation of effective referral chains, while the gender difference in injury rates points to the potential for prevention.

Objective: To compare common health experiences of a South Asian (predominantly Punjabi) population with that of the general population, according to sex, and to related patterns of health in the fourth decade of life to the pattern of hospital admission and mortality documented in the published reports., Design and Setting: A cross sectional survey with interviews and physical measures was undertaken in a two stage stratified random cluster sample in the city of Glasgow., Sample: This comprised 159 South Asians aged 30-40 years, mean age 35 (73.6% of those invited) and 319 subjects from the general population, all aged 35 years., Measurements and Main Results: Body structure, lung function, pulse and blood pressure, history of physical and mental health, results of standardised questionnaires on mental health, angina and respiratory health, recent and past symptoms, history of accidents, and sickness behaviour were determined. South Asians were shorter, broader, and more overweight (women); they had lower values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), a faster pulse, and higher diastolic pressure (men). Fewer South Asians had had accidents or digestive symptoms (men); more had psychosomatic and high total symptoms (women); fewer wore glasses, had lost teeth, or had long standing illness (men) (all p < 0.01). Women had a lower FEV1/FVC ratio (p < 0.05)., Conclusions: South Asians were consistently disadvantaged only in terms of anthropometric measures. Otherwise, the many differences were balanced, with disadvantage being concentrated only among South Asian women. The health gap between sexes in South Asians seems higher than in the general population. The findings show patterns of health in the fourth decade of life which are consistent with patterns of hospital admission and mortality documented in the published reports.