Zero discrimination day

How Community focussed programs can help tackle racial discrimination as a determinant of health

Racism and racial discrimination can have profound implications for the development and prevention of non-communicable Diseases (NCDs), also known as chronic diseases. C3 is examining the role discrimination plays in widening health disparities and how our community-based programs can play a role in mitigating the adverse health outcomes related to racial discrimination.?

Racial discrimination can act as a social determinant of health (SDOH) in various ways, most notably concerning the stress it puts on a person's mental and physical well-being and the ways in which it places people into disadvantageous social and socioeconomic positions, leading to less access to resources that would support good health. Stress, in particular, can increase the likelihood of engaging in certain behaviors, such as smoking, excessive alcohol intake, and poor exercise and dietary habits that put those affected by racism at risk for chronic conditions such as cardiovascular disease (CVD) and diabetes. A 2023 study by UK epidemiologist Veena Raleigh found that “diabetes prevalence in Black groups is up to three times higher than in the white population and they have higher mortality from diabetes,” and that these groups also “have higher-than-average incidence of and mortality from hypertension,” which may lead to cardiovascular events. In South Asian groups, the study found that there is “a higher incidence, prevalence and mortality from CVD,” with these groups having “the highest mortality from heart disease” compared to white groups in the UK. Raleigh concludes that many of these health outcomes have to do with “environmental determinants” and behaviors that result from deprivation. In the case of increased South Asian CVD risk, some of the causes she noted had to do with “adverse changes to lifestyle and diet following migration.” As for the Black groups she studied, Raleigh found that Black groups had the lowest proportion of people eating the recommended five servings of fruit or vegetables per day and that the proportion of people who are overweight or obese is higher in these groups than in white groups and all other minority groups.

Racism isn’t just outward discrimination. It is also structural discrimination that is ingrained into society and affects medical and social systems, which leaves minority communities disadvantaged. These minority groups are often disproportionately affected by socioeconomic deprivation, according to Raleigh. As such, the principle of equity is important to apply when seeking interventions to improve minority communities' health. This means recognizing that some groups need more specific assistance than others, offering them resources that meet their specific needs to bring them to the same level as their peers in different communities instead of providing the same resources to all communities, as the principle of equality would suggest. In this way, it is clear that preventing these health outcomes is not primarily a problem of clinical care; it must take place in the community, improving the built and social environment in which these people live and grow.?

At C3, we have facilitated many community-focused projects that work to tackle the problems rooted in these health inequities. One of the most effective is CHESS?, an innovative, evidence-based approach that engages local communities as ‘citizen scientists’ to investigate their health and how their built environment - the environment in which we are born, live and work - affects it. In 2022, C3 held CHESS? in Brent which is 66.4%? Black, Asian and minority ethnic and has higher than average childhood obesity rates and has a higher than average prevalence of type 2 diabetes in its adult population. In fact,? Brent has a lower than average life expectancy and a person born in Harlesden is expected to die more than 10 years before an individual born in Kensington, showing the profound role socioeconomics can play in our lives. CHESS includes a mobile tool that aids local communities in identifying and mapping the barriers they face when making choices about living more healthily. In Brent the community members involved identified an issue with the affordability and quality of local food. The walk also generated a more profound understanding of other barriers to residents aiming to live healthier lifestyles. This included lacking access to the information, tools, and skills necessary to improve their community's health outcomes. Engaging the Brent community through CHESS generated many ideas, calling for change to facilitate healthy lifestyles. Since the CHESS walk, this insight has informed the discovery phase of work in Brent and has been a lever for?ongoing talks with Brent Council and community members?subject to further funding. Another C3 program, Nurses for Healthier Communities (N4HC), was also implemented in north London (including Brent, Harrow, & Ealing), where many people are from Asian, Black, and other ethnic minorities.? The project initially targeted the same north London Boroughs as our COVID-19 Supporting Nurses’ Resilience project (Brent, Harrow & Ealing), where a large percentage of people from Asian, black and other ethnic minority backgrounds live experienced high rates of COVID-19 infection. The program, funded by the Burdett Trust for Nursing, worked to connect nurses with each other and with their communities, helping the nurses to understand the communities' health risks better and promote NCD awareness and prevention. N4HC organized events, seminars, workshops, and classes that helped improve nurses' health and, in turn, their communities. One such event partnered with the London Community Kitchen to provide free healthy cooking classes for nurses and their families.?

?Going forward, it is crucial to recognize the role that racial discrimination and wealth disparity plays in the health of communities in order to best fit our programs to meet their specific needs. Programs such as CHESS are extremely valuable to this cause, as they give people the knowledge and tools to affect change in their built environment based on what they know to be true about their needs, as opposed to being told what they need by an outside actor who is not aware of the daily challenges these communities face.?

Visit c3health.org/our-programmes to learn more about CHESS? and our other community-based programs that aim to mitigate the social and environmental determinants of health.