Optimising co-design with ethnic minority consumers

Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process; however, involvement of diverse ethnic minority population in the process remains limited. While the need to engage with diverse voices is identified, there is less information available on how to achieve meaningful engagement with these groups. Ethnic minorities are super-diverse population and the diversity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with diverse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from diverse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population; 1) starting at the pre-commencement stage to ensure diverse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a diversity of contributions via the co-design process.

COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

“End the Dominance of the Uyghur Ethnic Group”: An Analysis of Beijing’s Population Optimization Strategy in Southern Xinjiang

Chinese academics and politicians in the Xinjiang Uyghur Autonomous Region have argued that the region’s “terrorism” problem can only be solved by “optimizing” southern Xinjiang’s ethnic population structure. High Uyghur population concentrations are deemed a national security threat. “Optimizing” such concentrations is achieved by embedding substantial Han populations. Scenarios that do not overburden the region’s population carrying capacity entail drastic reductions in ethnic minority natural population growth. The intent to “optimize” the population serves as a basis to assess the intent to destroy an ethnic minority population in part, as outlined in the 1948 U.N. Genocide Convention. The “destruction in part” is assessed as the difference between projected natural population growth without substantial government interference, and reduced growth scenarios in line with population “optimization” requirements. Based on population projections conducted by Chinese researchers, this difference could range between 2.6 and 4.5 million persons by the year 2040.

Biochemical abnormalities in COVID-19: a comparison of white versus ethnic minority populations in the UK

AimsPublic Health England has identified that in COVID-19, death rates among ethnic minorities far exceeds that of the white population. While the increase in ethnic minorities is likely to be multifactorial, to date, no studies have looked to see whether values for routine clinical biochemistry parameters differ between ethnic minority and white individuals.MethodsBaseline biochemical data for 22 common tests from 311 SARS-CoV-2 positive patients presenting to hospital in April 2020 in whom ethnicity data were available was retrospectively collected and evaluated. Data comparisons between ethnic minority and white groups were made for all patient data and for the subset of patients subsequently admitted to intensive care.ResultsWhen all patient data were considered, the ethnic minority population had statistically significant higher concentrations of C reactive protein (CRP), aspartate aminotransferase and gamma-glutamyl transferase, while troponin T was higher in the white group. A greater proportion of ethnic minority patients were subsequently admitted to intensive care, but when the presenting biochemistry of this subset of patients was compared, no significant differences were observed between ethnic minority and white groups.ConclusionOur data show for the first time that routine biochemistry at hospital presentation in COVID-19 differs between ethnic minority and white groups. Among the markers identified, CRP was significantly higher in the ethnic minority group pointing towards an increased tendency for severe inflammation in this group.

Education of French Colonialists with Ethnic Minorities in Cochinchine in the period 1862-1945

In the beginning of the article, we presented the picture of ethnic minorities in Cochinchina and the educational policy of the Nguyen Dynasty to ethnic minorities in Cochinchine before the French colonial invasion as well as the process of invasion and process of imposing a new educational model of French colonialists in Cochinchina. In the main content, the author presents educational policies in general and French policies for ethnic minorities in Cochinchine in particular, expressed in documents and decrees of colonial authorities on goals, manner and measures to be taken. The article also reorganized the implementation of French educational policies in practice for the ethnic minority areas in Cochinchine during the French colonial period, such as the opening of schools, classes, and the process of organizing activities of the French school system, class and results achieved in areas with a large ethnic minority population. The author made the comments and assessments about the results and limitations of the educational policy for ethnic minorities of the French colonialists in Cochinchina from 1862 to 1945.

How Policies Can Address Multiracial Stigma

Twenty years ago, Multiracial Americans completed the U.S Census with the option to indicate more than one race for the first time. As we embark on the second anniversary of this shift in Multiracial recognition, this article reviews the research related to known sources and systems that perpetuate Multiracial-specific stigma. Policy recommendations address the needs and the continued acknowledgment of this growing racial/ethnic minority population.

The importance of saturating density dependence for predicting SARS-CoV-2 resurgence

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated mortality data from England show evidence for an increasing trend with population density until a saturating level, after adjusting for local age distribution, deprivation, proportion of ethnic minority population and proportion of key workers among the working population. Projections from a mathematical model that accounts for this observation deviate markedly from the current status quo for SARS-CoV-2 models which either assume linearity between density and transmission (30% of models) or no relationship at all (70%). Respectively, these standard model structures over- and under-estimate the delay in infection resurgence following the release of lockdown. Identifying saturation points for given populations and including transmission terms that account for this feature will improve model accuracy and utility for the current and future pandemics.

Experience of discrimination and engagement with mental health and other services by Travellers in Ireland: findings from the All Ireland Traveller Health Study (AITHS)

Objectives: Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health. Methods: The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD). Results: In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001). Conclusions: Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.