Active for life Promoting physical activity with black and by dlas32


Promoting physical activity with black and
                   minority ethnic groups

T h l s guide w a s produced for the H E A by S h a m a Sahrif, with contributions from G l i a Cooper,
and Chaman Verma. Thanks go to all who commented on early drafts, including N i c k C a v i l l ,
Hamid Rehman,JennyDouglas,           Stan Thompson, Susan Thompson, S u s a n Bishop-Rowe, and
Michelte C l o s e .

    The Purpose of this Guldc                                     2
    The background to ACTIVE for LIFE                             3
    Why do we need specItic targeted stmtegws?                    4

1   Black and Minority Ethnic Groups
    Who arc the main black and minority ethmc groups’?            5
    Where do people from black and nmwrity cthmc groups Iivc?     6
    How active strcpeople from black and mmorlty ethnic groups?   6
    Atmudcs to physical activity                                  7

2   Promoting physical activity among black and
    minority ethnic groups
    General principles for prrrmohng physical actn.vty among
          black and mmority ethmc groups                          10
    Specific Issues for 1. AsIan women                            12
                          I1. Older people                        12
    Effectiw strategies                                           13
    Methods of working                                            13
    Kcy partners” developing alliiinces                           14
    Monilrmng/Evaluiition                                         Is

    Four case studies                                             16

    Appendix                                                      19

    References                                                    20

                                          The Purpose of this Guide

This guide is intended to help people working at a local level to plan                         .4CT/VE    for LIFE initiatives that target
people from black and minority ethnic groups.

The document provides guidance on developing local programmed to target black and minority ethnic
groups. As well as presenting some outline facts and background research about the main black and
minority ethnic groups in the U.K.. it will offer a number of principles for the effective planning and
implementation of projects. These will outline how to go about mobilizing. influencing and developing the
capacity of local groups and communities to promote health. It aims to set out the key issues in ensuring
that strategies and programmed are culturally appropriate and clearly targeted at black and mmority ethnic
groups. Due to the availability of information, the focus throughout the booklet is mainly on communities
of South Asian, African or Caribbean descent. However. a number of more general principles are presented
however. that are of relevance to working with other commumties. such as the Chinese.

This guide should be read in conjunction with the other campaign documents, which include a broader
background on the campaign. and more detailed data on the importance of physical activity to public health.

                         Promoting   physical    octl~lty     w,l[h   black   and   mlnorlly    cthnlc   groups
While this guide is intended primarily to support those working on the campaign, it is hoped that the
principles set out in the guide will be applicable to broader work in promoting physical activity among
minority populations.

                                            The background to ACTIVE for LIFE

The ACTIVE for LIFE campaign was launched in 1996 to encourage people in England to take part in more
moderate intensity physical activity – like a brisk walk – for half an hour on at Icast five days of the week.
This level of activity has been shown to confer sigmficant health benefits, notably in helping to reduce rates
of coronary heart disease and obesity – two key Health of the Nation targets. While the first year of the
campa]gn ( 1996/7) took a deliberately broad approach to targeting (all adults 16-74 years) the second year
of the national campaign strategy has Identified two clear target groups: older people and people from black
and minority ethnic groups.

  Why is physical activity important to people from black and minority ethnic groups?

Physical actwity is important for all people. However. as the Department of Health document “Ethnicity
and Health in England”” (Balarajan et al, 1995) shows. black and minority ethnic groups suffer
disproportionately higher rates of certain health conditions that can be improved by participation in
physical activity.
    “ The death rate from coronary heart disease anmn~~the South Asian population in the U.K., is
        about    4(.WO   higher thun in the geneml population.
    q   Caribbean         people are at much greater risk of stroke than the population nationally.
        In England und Wales death mtes fiwn                             stroke, bet}i’een 1979 and 1983 were about double the
        nat[onal uwruge for Englund und Wales while people born in the Indiun ~ubconlinent und African
        Conmmnt’ealth hud sign! ficant!vhigher dealh rates>wn                                      stroke.
    q   Caribbean          have a higher than average risk of hypertension                                                (high blood pressure).
        Death rates-fiwn hypertensi~’e disease in England and Wules during 1979-83 in Caribbean nlen were
        Jwr tinws higher than the national avemge and seven times higher in Caribheun wonwn. People
        born in Af}ica anti the lndian subcontinent al.~osu~ered higher death rates.
    q   Diabetes is more common among Asians and African Caribbean.                                                             Contpared m peuple oJ’
        European origin, the prevalence               uf diabetes is three to ,/ow tinles higher among .4sians, and over
        three tinles higher anlong African Caribbean.                             This is nlain!v non itl.vlili~l-deper~det~tdiabete.r. For
        these groups. and uthers a! high risk cfl”developing diabetes. physical acti}’iy can help tu reduce the
        risk   qf developing the condition (as it can. for the geneml population). Pl!\:vical activity alsu inlproves
        contrul and n~anugenwnt ofdi<ibetes in those }rhu huw alreadv develuped it (BDA 1996)
    q   Increaaed physical activity (in association with healthy eating) is thought to be the
        most effective strategy in reducing levels of obesity (McKeigue et al, 1994) and can benefit
        individuals       in terms    of printa~y,        secondarv               and tertia<v prevention                  in relation   to the above
        health conditions.
    q   Most people are not sufficiently active to benefit their                                                     health. The nzajorig’      of the
        population       is not current!v active at a level that ivill signi~cantlv benq?t their healtil. Among sonle
        black und nlinorih” ethnic grwps (notub!\. .%uth Asian ~~”onlen)he proportion                                               uf “people that are
        sedentary. is /hr higher thun in the gener~il jmpulation.

                               Prontutfng    phi, sIcul   UC:II   III     w{th hluck   unti   m{norifv     cthIII<   KIOUI.IS
                                                                        —-    .—
                             Why do we need specific targeted strategies?

There are a number of reasons why a general approach is not the most effective one. and hence why it is
important to develop specific targeted strategies.

    q   There   are important       cultural differences that may make more general approaches
        inappropriate.      1)1sonw cultures.   certain sports or activities   are inappropriate.   which could
        influenee uptake.                                                                                          .,
    q   Language may provide a barrier to effective communication.                 lj~vaur main taiget graup do
        not speak Englis}l us a first language, resources will need to be adapted or designed spec(jicul!v.
    q   ‘Mass’ media may not communicate              effectively to all sectors of the population. Son?e
        peaple find ‘mass” metiia images or tnessages inapprapriute     or irrelel’ant, which tngv lead to thenl
        rejectwg such nwssage.s.

The ACTIVE for LIFE campaign aims to assist co-ordinators working at a local level in developing specific
targeted initiatives when working with people from black and mmority ethnic groups in their localities. This
guide is intended to be a first step.
                                                            Section    one

                        IBLACK AND                   MINORITY              ETHNIC           GROUPS

                          Who are the main black and minority ethnic groups?

In      there were just over three million people from black and minonty ethnic groups m the U.K.

forming approximately (WO of the total U.K. population (Owen. 1993).

The main groups being:

                                   The Ethnic Composition    of the Population of England and Wales
ETHNIC      GROUP                                             Numbers (000s)                     Percent
WHITE                                                         46,933                             94.I
BLACK CARIBBEAN                                               499                                I.0
BLACK AFRICAN                                                  210                               0.4
BLACK OTHER                                                    176                               0.4
INDIAN                                                         830                               I.7
PAKISTANI                                                     “455                               0.9
BANGLADESHI                                                    162                               0.3
CHINESE                                                        146                               03
OTHER ASIAN                                                    I93                               0.4
OTHER                                                          28 I                              0.6
AND WALES                                                     49,890                             I00
Source:     199 I Census, from   Balarajan   et al, 1992.

Indians are the largest minority ethnic group in this country. Next in population size come Caribbetms and
Pakistanis. followed by Africtins. Bangladeshis and Chinese.

                  Where do people from black and minority ethnic groups live?

The geographical distributions vary between groups. Carlbbeans. Africans and Bangladeshls hve mainly in
inner London. whilst one third of the Indian community lives m the outer London Boroughs. WestMidlands and
Leicestershire. Most Pakistanis live in the West Midlands. WestYorkshire and a small proportion in London.

Just under half of all people from minority ethnic groups were born in the U.K. The remainder of the groups
described here were born in a number of countries in South Asia (Indians, Pakistanis and Bangladeshis) and
East Africa. in the West Indies and Guyana (African-Caribbeans). and West Africa (Black Africans). and
migrated to the U.K. after about 1950.

The countries of origin, main religions and languages/dialects of the major U.K. South Asian communities
are shown in Appendix 1.

                 How Active Are People from Black and Minority Ethnic Groups?

    q   Among   African-Caribbeans aged 16 to 74 years, 62 per cent of men and three quarters of
      women do not participate in enough phys]ctd activity to benefit their health* (HEA 1995a), compared
      with the general population (59 per cent of men and 68 per cent of women (HEA 1995b).
    q Among African-Caribbeans aged between 16 and 74, nearly a third (32 per cent of men and
      31 percent of women) are sedentary - they do less than half an hour of physical activity a week (HEA
      1995a), compared with nearly a quarter (24 per cent) of the general population (HEA 1995b).
    q Activity levels among South Asian women aged between 16 and 74 vary 83 per cent of
      Indians, 86 percent of Pakistanis and 82 per cent of Bangladeshis do not take part in enough physical
      activity to benefit their health* (HEA 1995a). compared with about two thirds (68 pcr cent) of
      women in the general population (HEA 1995b).
    “ Among South Asian men aged between 16 and 74, about two thirds (67 per cent) of Indians,
      and three quarters of Pakistanis (72 per cent) and Bangladeshis (75 per cent) do not take part in
      enough physical activity to benefit their health* (HEA 1995a). compared with 59 pcr cent of the
      general population (HEA 1995b).
    “ About half of all South Asian women aged between 16 and 74 years, (47 per cent of
      Indians. 50 per cent of Pakistanis and 53 per cent of Bangladeshis) are sedentary (HEA 1995a).
      These rates arc much higher than for the general female population (24 per cent) (HEA 1995b).
    q Among South Asian men aged between 16 and 74, just over a third (38 per cent) of Indians
      and half (47 per cent) of Pakistanis and Bangladeshis (50 per cent) are sedentary (HEA 1995a),
      compared with 23 per cent of the male general population (HEA 1995 b).

*   The recommended          umount ofj]hy.vital       activi(v   is to participate    in at least 30 minutes of
    nlotierale    intwsi(v   p]l.v.vital activity   on at Iwst.five    da-vs a week.
                                     Attitudes to physical activity

Peopleqs current attitudes to physical activity are important in determining how IIkely they may be to bc
more active in the future. To investigate this. a study was carried out by the HEA (Rai et al. 1995) using
group discussion with black people from the Caribbean and West Africa. and South Asian people. from
India, Pakistan. Bangladesh and East A~~ca.

This study will be used as the basis for the following section which explores current attitudes to physical
activity among these groups. While the study was by no means exhaustive. it does provide a valuable
overview of some of the key issues.

The study found that there arc no significant cultural or religious reasons that would actually prevent
people from black and minority ethnic groups from taking part in physical actwity. There are. however,
many important cultural and religious reasons or factors that may affect the manner of participation in
physical activity.

Among people from black and minority groups there is a high degree of acceptance of the idea of physical
activity as part of every day life (i.e. activities such as walking to get around). However, people from these
groups frequently tend to think more of sport and exercise when assessing their own level of participation
in physical activity. This implies that reinforcement of the value of more moderate level physical activities
could be a valuable strateb~.

                               Perceived benefits of physical activity

As with the general population, awareness of health benefits seems high, especially m relation to coronary
heart disease. with physical activity considered to be on a par with healthy diet but less important than non-
smoking. There are generally mixed views of its importance in relation to drinking. Physical activity is
generally believed to increase and enhance social opportunities.

In relation to health. people from black and minority ethnic groups tend to consider physical activity on a
par with a healthy diet but less important than non-smoking, but had mixed views of its importance in
relation to drinking. Physical activity is generally believed to incrcme and enhance social opportunities.

                                  Beliefs about physical activity

Beliefs about physical activity come from a number of sources. The media. both television and press. plays
a key role. Attitudes towards role models, and the extent to which they encourage participation in physical
activity vary considerably. For African-Car] bbeans, role models tlom their own communities are often seen
as a source of inspiration and encouragement. South Asians however, identified a noticeable lack of Asian
role models. For both groups, older people identified family and friends as a major source of influence.

Women under 30 tend to be influenced by the portrayal of a slim female body shape. and some feel pressure to
conform to this. Over-30s”views are more mixed. including positive views of strength and health related to big
body size in their cultures. although this belief Is declining with tune.
                                 Levels and types of physical activity

People generally agree that physical actiwty should be done regularly. They think the type should be chosen
and the level graded according to individual preference and ability. There are mixed views. and an
expressed need for more information, about the significrmce and mfcty of heartbeat changes and
breathlessness. and about the exact Icvels of actiwty that are appropriate.

Physically active people from black and mmority ethnic groups secm to be motwated by enjoyment. habit.
a desire to look good for health and social benefits and to be a role model for children.

Physically inactive people think active people are mainly self-motivated and have Iike-minded friends.
Some inactive South Asian people do not believe there are other South Asian people more active than
themselves because of their general lack of wsibility in fitness or sport. Most people arc involved in a
narrow mngc of activities, especially Caribbean and West African people (mainly aerobics, weqjht training
and swimming).


                                   Main barriers       to physical activity

The main barriers to physical activity among black and minority ethnic groups are thought to be lack of
time, from long working hours and home respouslbi Iitics, especially childcare. These form important
barriers especially when people are tired and view physical activity as something that is not relaxing
in itself.

Many of the major barriers to physical activity identified by African-Caribbean and South Asian people are
no different from those of the general adult populahon in England for whom the key barriers are lack of
time. energy. or an appropriate companion, a desire to relax in their spare time or a self perception of not
being sporty.

The main barriers relating to faci Iitics identified by respondents from black and South Asian groups are:
    “ Availability, cost and opening hours. People .finnl black and minotvy ethnic communities tend
         to he .general!~’ munvare of plly.vital activit-v pmgramtnes,   their cost or where and when they are
         taking place
    q    Fears for personal safety in public open spaces. People ure deterred fmm tuking up p}(~sical
         activi(v: jear of being attucked is a major concern.
    q    Absence of other people from one’s own community                    using facilities. People j&l     more
         cotn/i]rtubie and less i}ttitni(iuted (f thq’ use, facllitie.~ where there are more people Jtwtn thetr own
    “ Concerns about not ‘fitting in’. Facilities that are perceived           to he on!rjix” slinl and fit people
                                 jd thev ure not tile ‘ideal’ shupe.
      wi[[ ojte)l deter those M41O
    “ Actual or potential experiences of racism. E.rpetvence oj- raci.wn deters people jhnn usin~y
Further barriers identified by South Asian respondents arc:
    q Dress codes. When exercising Mmnen want to wear clothes which meet vt’ith their reli~~ious and
        cultural requirements.
    q   Lack of privacy in changing areas. The                              is un expressed requirement jbr proper!v segregated
        areus.for men and ~t”omen.
    q   Lack of single gender provision (older South Asiun women. Muslim women qf all agm and older
        Muslim men). To these groups mixed gender provision is unacceptable.                                        Their preference is for men-
        onlv pltysicul activiv groups it’ith mule instructors, and women on!v \i’ith female instructors.

It is important that these barriers are borne in mind when physical activity programmed are planned for
black and minority ethnic groups.

                           I’rumot{ng   phl   >1, al   LZCIII III    wjth   hluck   und   mIIIOrt   Ijn ethnic   grotfpv

                                                         Section            two

       AMONG   BLACK                         AND MINORITY   ETHNIC  GROUPS

This section outlines a number of key principles intended to assist those people working at a local level on
projects supporting the ACTIVE for LIFE campaign.

Any programme promoting physical activity in the population should ensure that principles of equity are
taken on board in relation to ALL sections of the community, including black and minority ethnic groups.
It is, however, recognised that some barriers to engaging in physical activity and barriers to promoting
physical activity amongst black and minority ethnic groups are likely to be different, requiring a different
set of approaches and solutions compared to a project targeting the general population.

For programmed to be effective, the individuals or groups who are the recipients of the programme need to
perceive that the interventions are carried out in partnership with them, with their support and consent.

                         Prnmotlng   ph)   steal   uct IvII.r   with   bluck   and   mtnorlfv   ethnic   group~
              Key general principles for promoting physical activity amongst black
                                   and minority ethnic groups

q   Equity.     All people, regardless uf age, gende~ ethnicity or socio-economic          stutus should be provided
    with equal opportunities to participate        in physicui uctivity.
q   Breadth        of Provision.       Prevision    within a Ioculi@ should give older people .fmm black und
    minority ethnic groups u range of opportunities           to impmve their physicul und mental health. Older
    people fmtn black and minori(v ethnic gtvups will have d([j?rent needs, interests and aspirations. This
    will i)lfluence their involvement.
q   Coherence.           Purchasers, providers, other k.eyprofe.wionul.v and ugencie.s should give high priority
    to promoting physical activity umongst people jiom black und minority ethnic groups by deiseloping
    coherent, collaborative      und uppmpriate      strategies and pmgmmtne.v. should be based on good
    practice, lung term andjimded        adequate!v.
q   Use     of local data.       The physical uctivi(v needs of people jhm         bluck and minori~ ethnic groups
    should be determined at a 10CUIIe\”el using local quuntitutive und qualitative data. HoweveE in the
    absence of this, national sources of injwmation           are available to provide u base[ine and support-for
    local initiatives. l%es.e are shown in the rg$?rences.

Specific principles for promoting physical activity among black and minority ethnic groups

Besides applying general principles, health promoters and coordinators of physical activity specifically
working with people from black and minority ethnic groups need to:
    “ involve people, fmm black and minori~ ethnic groups in an on-going consultative process to develop
        und evaluate progrummes.
    q   Develop and o~fer a mnge of uppmaches,             interventions und options which best suit the needs of
        people fmm black and minority ethnic groups.
    q   Involve respected     and valued members fi-am black und minori(v ethnic society as role models
        or alliunce.v.
    q   Use a variev oj’settings that are appropriate        to the ta~eted     communities, e.g. comtnuni~ centres,
        gurdawars, rnandirs, mosques, churches, health c.entres etc. As well us giving consideration to home
        based schemes.
    “ Ensure advice givers are h-nowledgeable, skilled, consistent and conjident.
    “ Tuilor programmed         spec(j?c to the group k circumstances         undressing the cultural, religious, and
        .mcio-economic barriers which hinder the cupaci~fior people jiam black and minority ethnic groups
        to purticipute in physical activi~.
    “ Consider the provision of tmnsport to and jirtm the selected venue.ibr participants.
    “ Create a climate which combines socializing with exercise.
    “ Celebmte      successes    and share u.ith people fmm         black and minori(v ethnic groups as well us
        purchasers, providers and ugencies involved.
                                        Specific issues for Asian women

Older Asian women and many Muslim women of all ages feel unable to use facilities because of the
perceived dress requirements for exercise. There is also anxiety about the general lack of privacy and the
possibility of mixed gender classes which is unacceptable to them for cultural and religious reasons.
To encourage and enable Asian women to participate more. physical activity programmed should:
    “ W4ere requested ensure single gender specijic classes are made available with stajj of the
        appropriate      gender instructing.    Ffv example, jiw exercise and swimming,            ~vomen-on!v sessions
        supervi.wxl by.femule stafi
    q   Muke provismn for allawing the choice Oj-dress in which participants                ji?ei most ccnqfortable, e.g.
        Sahjur Kameez and trousers and tunic tops f?orswimming and e.rerei.sing.
    q   .41[ow for the language of the participants           and make appropriate       translating facilities    available
        ~rhere necessan:
    q   Be .wnsitive to the need Jw prit~aqv and the (VIWof pllysica) activi(v preferred by the participant
        (provide a range aftuster activities so that personal pr.ejivwnces can be made).
    q   Ensure that the time schedule of the pmgmmme             is planned around participams” abili(v to take part,
                                                                                   going to pra]’ers, work etc.
        avoiding time }vhen children ma-v have to be taken or collectedji-om SCI1OU1,
    “ Consider         .mfe(v in relation    to the venue, travel      and distance      to the venue. Ahvuys          check
        with participants.
    9 O#er a range of”activities, in particula~           those ~vhich are jiwtn the South Asian and Caribbean und
        We.vtAfrican cultures e.g. Clddha and traditional dance. ithangra, folk song recital, praver activifi
        voga. h-ubbadi und brisk \ralking.
    q   Ensure that all audio visual materials            are uppmpriate    and appropriate@       used. They sho141d be
        ones ~rhieh participants        can identl~l with und understand           and meet with require(i cultural
        quali(l. stundards.
If possible involve the whole family, in particular, elders. younger adults and children.

                                         Specific issues for older people

    q   Value the e.rp.eriences of ohier people from black and minari(v ethnic groups. Encourage dual roles
        as recipient    uf pmgrumme.s as well us helpers.
    “ Muke physical activi(v promotion part qf u larger health promotion package. There is a general lack
        ofhealth inibrmatian amongst the South Asian an[i Caribbean and West A.fricun communities e.g. on
        risk jactors associated    ~i’itilcomna~y heurt disease, management of diabetes, hypertension etc.
    q   Musiim peopie see IVamaz (praving.five tunes a da-v) as a form oj’e.rercise. Acknowledge,                  and build
        on this.
    q   Vaiue existing uttitude.s and beliefs, e.g. sweating is seen b-v older Asians as a sign qf achieving good
        health. Although      i~’estern scientljic    research does not support       this, such beliefi   can provide     a
        discussion point and heip.laciiitate         communication and understanding.
    q   Ciwrche.v are a good meeting place jar Caribbean                and West African communities.             Women get
        together jor iuncheon club.v and other saciui events. This couid prm”ide ideai opportunities                       to
        undertake pl(vsical activity pmgrammes           in a.jamiiiar environment.
    q   Del ‘elop and promote pl~isical activiv pmgrammes peop!e will enjo.v, that are non competitive and
        where people cun relax and have fhn. .4bove ail, promote activitie.f thut people will enjoy.
    “ Utilise conununiW specific chunnels of communications                e.g. make use of tnusic. advertise physical
        activity pragramnws ut commutut-v events, muke use of bluck media and net~itn-ks.
                                Initiatives have been most effective where:
    q   There is a commitment at a strategic level, i.e. fmm purchasers/providers            and udequate resources are
        made available.
    q   The pmgramme is not]”ust a one 01]1but is part of ‘a longer term strateg~s undplan.
    q   Black and minori~ ethnic groups have been involved jiom the onset and the targeted comnumi~
        understands and perceives the potential ben@s               of the intervention programme.
    q   There is trust and respect in the deference oj’people fbtn d&rent             cultures.
    q   Pmgrammes promoting phvsiral actiwty ure brell thought out. plunned and are SMAR E Sp.ecljic.
        Measumble, Attainable, Resourced and Time bound.
    q   Pmgranunes meet with cultural~r specific qualip standards.
    q   There is co~ztitll!olts.jtiedback to black und minori(v ethnic communities qf ‘successes andjkilures          and
        a ivillingness to continue partnerships.
    q   Professionals fmm black and minorit]’ ethnic backgmumis                  are involved in the development      and
        delil’e~v of pmgmmmes.

                                                Methods of working

Ideally. projects should be part of an overall strategy. However. they may (for a variety of reasons) need to
be carried out as more ad hoc. one-off campaigns, focused programmed etc.

Short term, small, discrete projects or campaigns targeting black and minority ethnic groups have to
recognise their success in raising awareness as well as their limitations in achieving behaviour change. A
longer term strategy would be more effective in achieving the latter.

The principles underpinning discrete campaign-focused projects seeking to promote the health of black and
minority ethnic groups are similar to ones which would underpin a much broader strategic policy initiative
and include the following key elements:
    q   Involving the appropriate level of mpm.~entatii’es.~httl black und minority ethnic group.v themselves.
    9 Setting priorities —this needs to be in discussion n“ith ke.vpurtners and the tatget audience.
    q   Choosing the most appropriate         set~ing and venue to enable the targeted black und minority ethnic
        groups ta participate    a.~.fid!v as possible.
    q   Developing      appropriate   interventions       to ensure that national recommendations       are adopted    or
        adapted to the needs of black and minorifi ethnic grnup.s.
    _ Ensuring       that the relevant stafl are working to high professional               standards   und are tmined
    q   Monitor existin~xaccess and utilisation mtes by black and minori(v ethnic groups.

                                               Strategy development

A first step to check whether there are existing strategies and policies relating to black and minority ethnic
groups that can be influenced and adapted to include physical activity work.

Ideally, a strateb~ should be produced and agreed by all parties to guide the work. An ideal strategy should
include the following elements:

    q   A swnmuty of the po!entiul benefits to physical and mental health oj’people jiwm black and minori~
         ethnic .group,v based on national re.~earc},~.
    8 A swnmaty of “theparticular benefits. for people.lium            black und minori~ ethnic graups in the locali~’
         based on evidence fittm local research.
    q   .4 summaty of”the rele~’ante and importance of the promotion oj-pllysical uctivi~” -for people ji-am
         black and minority ethnic group.v.jar each qf the purtners involved.
    9 A .iwnmla~r of notional guidelines
    “ .4 stutement of the principles       underpinning the strategv (tvhen working Jvith people from black and
        nlinori(j’ ethnic groups).
    9 .4 description       of the aims and objectives      qf the struteg-v }t’hlch are spec(jic and measurable. An
        indication qf the time scale required should be included.
    “ A list qf partners and contact addresses.
    “ A A$ossarv of terms used and kc-r rej;rence.s.

The cost ot’funding a small campaign may be found between alliances or allocated from existing funds.
Funding for much broader strategies to improve the health status and experience of black and minority
ethnic groups requires comrnissloners, planners and strategists to allocate mainstream resources to key
health concerns relating to black and minority ethnic groups over a period of time.
     “ Good cotnmunicution is e.wential in promoting heulth messages to anv target group. ]n terms oj”
        bla~~k und tninorit>’ ethnic groups thgv \ril[ need to kna~t hcm’ thgv ~~illbenefit. jiom physical activi~,
        ~t,)lereajld /lo\j. tcj be inl,olved (Is ~vell as the cost.
    q   Ensure that the Asian and African-Caribbean newspapers, radia stations etc. are used to pramote health
        messages as well as cmnnnmi[v and religious centre.s, Itbraries, G.P wgeries,          pharmacies and shaps.
    “ Ensure that appropriate performance           indicators are developed.
    q   Ensure that appropriate qualiv standards are dtivefoped.

 Key partners:            developing       alliances for black and minority                 ethnic group work

Identifi key partners for alliances and partnerships to develop shared vision, goals. targets. strategy and to
share expertise. experiences and costs of developing and promoting phys]cal activity programmcs targeting
black and minority ethnic groups.

Key partners can include:
    “ Health Authority commissioners, provider trusts, local G. P.s, public health and health
        promotion        departments.      These will hcwe access to kno~vledge, mfitrmation on lij~.s[vles and
        provide guidance,      e.vpertlse. .w~pport, specialist   skills and resources and funds. as ii’ell as jitture
        policy and strategic development.
    “ Local Authority            departments:         Leisure     and     Community        Services,    Housing      and
        Transpo%         Social Services and Education can prm”i(ie skill.v, access to appropriate
        facilities,   iniiwmation, delermine policy, provide resources an(ljunds.
    q   The Sports Council cunprovide expertise and support in promoting                   specific initiatives targeting
        black and minori(v ethnic communities
    q   Local community          and voluntary groups canproi.ide support in pmmotitg               and communicating
        programmed Iocal!\;
    q   South Asian and black businesses eun c@r                      support,   he involved, either in taking part or
        providing some junds.
    q   Local religious and community             leaders can encourage black und nlinori(v ethnic groups to be
        involved. q[fir cottll~ll!tti(v-haseti. facilities \vhich nla>’be more appropriate.
    9 Asian Women%            Groups can provide inpw inta the develapnwnt            of pragrammes and
        Asian \roltletl/conl)llltnitie~ to tuke part.

                                              Monitoring and evaluation

Monitoring is an on-going process and uses a number of performance indicators to show where quality
standards are being met or where difficulties may be arising. Discussions with users and non-users of the
service can give warning of where remedial action needs to be taken to improve the programme.

                                 Those responsible for monitoring should:

    _ Observe ~i’hatis happening.
    “ Obtain .ftiedhack jlmn users and non-mers.
    “ E.ranline any relevunt recordf.
    q   Decide, i~’ithpnmiders qfth.e opportunitieshen       ’ices }i’hat action neeli,s to be taken.

Monitoring involves a method of rewewing for taking stock at a given time in the lifetime of a programme.
lt is quite usual to have a mid-term review to relate what has been achieved against the original objectives
of the programme or to new information about needs. Decisions can bc made during the review process
about rc+digning the programme with its objectives.

                                 Evaluation can provide information aboufi

    q   Achieve         a
                    nwnts nd jailings —hu \’e the prokyzwune ohiecti\’e.~/tuigel,~ been uchie~’ed?
    “ Inlpact —}i’as the ~twrk worth doin~~;~
    9 Eficiency – wereresourcesused eQective&? Did the investnwnt tnatle have returns in tetms qfheaith
      gains und health henejit.~.ibr people, fitxn black and minority ethnic graups?
    q   Future —what still remains to be done?
    8 Spin -t?fji —}i’ere there unanticipated benefits?

Summary         of Guidelines       for Evaluation
    “ Plan how to evaluute at the beginning of the pwgramtne            —nat at the end
    q   Make sure .vour progratntne objectives ure clear and specjfic.
    “ Prepare a set of “realistlc, measurable indicators.
    q   Impossible set ztp control groups NIhOda not receive the pmgramtne                – to help detnonstrate   that
        changes took place beruuse of that ptvgramtne.
    “ Looh- /br short-tertn and lon~v-tertn chan~res.
    q             of
        Find ?~”u.vs mi’olving \ht+tafget group at all stages qf the evaluation.
    q   Learn jkm     success atui.lailure.
    8 Share suca-m and. failme with others.
                                                     CASE      STUDIES

Shown below are four projects which highlight models of good practice working with black and minority
ethnic communities m promoting physical activity.

Project:     Look After        Yourself       Programme           - Greenwich
The Look After Yourself Progmrnme is a Healthy Alliance Project. a]med at erudb]ingwomen from black
and minority ethnic communities to take part in a package of healthy hfestyle actiwt]es. The project
encourages women. who are not currently taking any form of regular exercise or only a minimal level of
physical activity to be more active. The programme consists of swimming lessons, gym instruction.
exercise to music. stress management and nutritional advice. The focus of the project is to empower
indiwduals and give them options in order to enable them to make healthy Iifc style choices. The Healthy
Alliances partnerships includes Greenwich Leisure Services. Greenwich Community College and
Greenwich Leisure Ltd.

The courses are run at subsidised rates to enable members of the community, who are on low income (for
example, those receiving income support or family credit), to benefit from the programme. Publicity for the
programme includes use of local press. posters in libraries and other leisure centres. To encourage
participants to continue using the Leisure Centre facilities following the completion of the course, a year’s
free membership is provided. Women-only swimming lessons are facilitated and interpreters arc provided
when required.

The project has developed further and has made the programmc of activities available to ALL women. This
is with a view to encouraging women from black and minority ethnic communities to engage m activities
with Caucasian women. Following the formal courses. the Asian women are also encour-agedto rdke part in
exercise classes being run as part of the Leisure Centre’s normal programme of activities and also to use the
Gym facilities during women only sessions. As swimming sessions proved to bc more popular. the time
spent on this activity has been increased.
Further details from: Steve Johnson (tel. 018I 8544888) and Neehra Deepak (tel. 018 I 8542966), Greenwich Leisure
Sports Development.   151, Powis Streer. Woolwlch,   London, SE 18 6JL

Project:     The      Sandwell      Asian     Women’s          Exercise   and Recreation   Activities   Project
The SAWER4 project began three years ago as a response to a need that had been articulated within the
Asian community of Sandwell. This need was highlighted by research carried out by the Leisure
Department of the Department of Education and Community Services.

The Department’s resources. together with funding from the Sports Council (West Midlands) made it
possible for the project to start in July 1992 with the appointment of an Asian Womcn”sSports Worker. The
aim of the project was to develop partnerships between the Sports Council (West Midlands), the Local
Authority, voluntary organisations and others with the view to increasing the opportunities for participation
in sport and recreation by Asian women.

The SAWERA project facilitated a diverse range of regular activities for a diverse range of Asians.
These included swimming, Iiccp fit. aerobics. bhangra aerobics and giddah dance. In addition the project
laid on a range of ‘one off’ activities which includc(i Looli Atler Your Heart. Health Screening, Personal
Safety and Self-Defense. LoCdl Indian (Sikh and Hindu), Pakistani, Bangladcshi and Ycmeni women
benefited from the project. The ages of the women taking part ranged from 16 to 50+. The sessions were
held at various centres so that the venues would be accessible. appropriate and acceptable to women. Thus.
sessions were held at leisure and swimming centres. statutory and voluntary community centres. sheltered
accommodation and places of worship.

The project actiwtles resulted in a level of demand from the Asian women which was difficult to meet.
Some of the problems encountered were related to providing transport to the Centres and staffing levels at
the Centrcs.
Further    details from   Flick Davis and Tahra     Nasreen   (tel. 012 I 5693875),   Department of Education and Commumty Serwces,

Sandwell Metropohtan Borough Council, P.O. Box 41, Shafiesbury House, 402 High SC West Bromwlch, West Midlands,B709LT

Project:        Look After        Yourself,        in Bradford
The Look After Yourself programmc is a national initiative which supports the training of Look After
Yourself tutors who are able to provide structured courses, over a number of weeks. These focus on the
learning of a comprehensive range of exercises. familiarisation and taking part in relaxation training. and
participating in a number of health topic based group discussions. In Bradford Look After Yourself has
been developed in an appropriate way that has become very popular with Asian communities in the District.
The social nature of Look After Yourself and the development of gentle exercise teamed with the training of
Asian tutors working in Asian languages has made the Look After Yourself model in Bradford a success.
Classes arc run throughout Bradford at community centres. meeting places and places of worship for the
Pakistani. Bangladcshi. Tndianand Aftican-Caribbean communities. The classes are popular with both men
and women and a number of participants have gone onto train as Look Atler Yourself tutors.

The Bradford Encouraging Exercising People Scheme (B. E.E.P.)
BEEP is Bradford”s Exercise    on Prescription Scheme. As present 40 GPs arc involved in the scheme in 12
practices and over 10 local Ieisurc centres, sports facihtles and private gyms are also involved. The exercise
on prescription model in Bradford centres on the role of the Community Health and Fitness Officer
(C.H.F.0.) as providing detailed support and advice to referred patients as well as supporting GPs in
implementing the scheme and ensuring the involvement of local leisure facilities.

BEEP is primarily targeted at communities who are at a disadvantage. which includes the Manningham
area of Bradford. an inner city area with a predominantly Asian population. The project particularly benefits
patients who may be unsure of the exercise to take and unfamiliar with using leisure facilities. Patients are
referred on the basis of susceptibility to coronmy heart disease. that is, a patient with one or more risk
factors. including smokmg, high Body Mass Index, high Blood Pressure, family history of CHD. and stress.
Further     details form: Di Moody (tel. 01274 223908) Naseem Tounsend (tel. 01274 223923) or Simon Rowlands
(01274 223907) Health Promotion Service, Bradford Community Health Serwces NHS Trust and Amanda                   Ashworth-Plant

(tel.   01865   226060)   Project Officer.   Helping People Change/Look After Yourself, HEA     Block 10, The Churchill, Headmgton,

Oxford, 0X3     7LZ.
Project:      Asian Women            and Physical Activity             Project
This project’s aim has been to develop physical activity opportunities for Asian women. The first phase of
the project included reviewing the local leisure opportunities available to Asian women and establishing
their needs with regard to appropriate Ieisurc provision. The second phase of the project included liaising
with Ieisurc providers and recommending ways of improving access for Asian women as well as. on an
inter-agency basis. establish exercise programmcs.

As pm-tof establishing exercise opportunities, a 13 week Royal Society of Arts (RSA) validated Exercise to                      i
Music pre-foundation course was organised for AsIan women. One of the participants went on to complete
the RSA Exercise to Music Instructor’s course. Classes in exercise and swimming are currently being run.
Taster sessions around ‘Life Style” are being planned on a Sunday evening. as requested by the Asian
women themselves. The exercise opportunities are being convened at centres frequented by the Asian
community and where required interpreters have been made available.
Further details from: Alison Brookes or Roz Woolven (tel. 01494 464404) Health Promotion,               Buckmghamshlre Health

Authormy, Sefton House. I I 3 Totterldge   Rd, High Wycombe,   Bucks HP 13 6EY.


     q   Mm itor provision        of pll.vsical activity programnm          tarb~eting black and ethnic minori(v
     9 Monitor e.vistinbr take-lip rates oj’physical uctivip pro~ynmles                 targeting black and ethnic minori(v
     q   HoJr are Local Authori@YHealth Authority physicul activi(v, fucilitles and pmgramnws                 hemg taqy+ted
         at black anti minori~ ethnic grmy)s?
     q   .4re the ptqyammes      reaching and engagin~xpeople in pl~~xical uctivit-v el]ictive!v?
     “ Are biack and minorit?~ ethnic cmnnntni(v otganisations.                   husinesse.s and net}~wrk~ useti to channel
         health promotion prugrammes and infitrmation?
     q   [S investment made m peopieJronl bluck und nlinori(~~ethnic communities in the !orm qftruining and
         development      to promote physical activity in their convnunities;>
                                          South Asian Communities in Britain

AREA OF ORIGIN                                 MAIN RELIGION              MAIN LANGUAGES SPOKEN
                                                                          OTHER THAN ENGLISH
PAKISTAN                                       Mushm                      Punjabl, Urdu. Also
(Punjab, Mirpur,                                                          Mm-puri, Pushto
NW     Frontier)
BANGLADESH,                                    Muslim                     Bengali
(mainly Sylhet district)                                                  Sylhetl
EAST     AFRICA*                               Musllm                     Pumabl. Urdu
INDIA - (?Vest Bengal)                         Hindu                      Punjabl
INDIAN      PUNJAB,        HARYANA             Hindu                      Punjabl
INDIA     - GUJARAT                            Hindu                      Guiaratl
INDIAN PUNJAB                                  Sikh                       Punjabi
EAST     AFRICA*                                                          Hmdl
*Kenya, Tanzama, Uganda, Zambia, Malawi

[Adapted from MOR1. Bluck and Asiatl Commtmitie.f in Britain, 1992]’

Most African-Caribbean people born outside the U.K. are from Barbados. Jamaica. Trinidad Antigua.
Guyana, St Lucia and St Vhcent. and speak English, with some French and Creole. Most Black Africans
are from a number of West African countries, and speak a wide range of languages. through many
speak English.

Balarajan R. Soni Raleigh V ( 1992). The ethnic population of England und Wales in the 1991 Censm.
Health Trends 24:113-6.

Balarajan R, Soni Raleigh V (1995). Ethniciry and Health in England. NHS Executive, NHS Executive
Health Unit. HMSO.

BDA ( 1996). Counting the Cost: The Real Impact of”Ncm-Insulin-Dependent          Diabetes.    British Diabetic
Association/King’s Fund 1996.

Health Education Authority (1994). Black and A4inari[v Ethnic Groups in England. London: Health
Education Authority.

Health Education Authority ( 1995b). Physical activity evaluation panel survey (unpublished). Health
Education Authority.

Health Education Authority (1995a). Second survey of Black and Minority Ethnic Groups in England.
(unpublished) Health Education Authority.

McKeigue ~ Secvak L (1994). Cmrma~        Heart Disease in South Asian communities.           Health Education

MORI. Black andA.sian Communities in Britain. 1992 (unpublished).

Owen, D ( 1993). Ethnic Minorities in Great Britain, Age and Gender Structure 1991 Census Statistical
Paper No 2, Centre for Research in Ethnic Relations, University of Warwick.

Rai D, Finch H ( 1995). Attitudes   and barriers   to pl!vsical   activity   umong South Asian und Black
Communities in England. London: Social and Community Planning Research, Health Education Authority.

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