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Background: Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. Methods: We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35–74 years old men and women. Results: South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37–1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05–1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64–0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Conclusions: Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe’s multiethnic populations. [ABSTRACT FROM PUBLISHER]

Background: Important differences in cardiovascular disease (CVD) mortality by country of birth have been shown within European countries. We now focus on CVD mortality by specific country of birth across European countries. Methods: For Denmark, England and Wales, France, The Netherlands, Scotland and Sweden mortality information on circulatory disease, and the subcategories of ischaemic heart disease, and cerebrovascular disease, was analysed by country of birth. Information on population was obtained from census data or population registers. Directly age-standardized rates per 100 000 were estimated by sex for each country of birth group using the WHO World Standard population 2000–25 structure. For differences in the results, at least one of the two 95% confidence intervals did not overlap. Results: Circulatory mortality was similar across countries for men born in India (355.7 in England and Wales, 372.8 in Scotland and 244.5 in Sweden). For other country of birth groups—China, Pakistan, Poland, Turkey and Yugoslavia—there were substantial between-country differences. For example, men born in Poland had a rate of 630.0 in Denmark and 499.3 in England and Wales and 153.5 in France; and men born in Turkey had a rate of 439.4 in Denmark and 231.4 in The Netherlands. A similar pattern was seen in women, e.g. Poland born women had a rate of 264.9 in Denmark, 126.4 in England and Wales and 54.4 in France. The patterns were similar for ischaemic heart disease mortality and cerebrovascular disease mortality. Conclusion: Cross-country comparisons are feasible and the resulting findings are interesting. They merit public health consideration. [ABSTRACT FROM AUTHOR]

Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research. Active involvement of migrant and ethnic minority populations in European population health research is necessary, for data show important inequalities but evidence, particularly on effectiveness, is sparse and strategic overviews rarer still. Ethnically disaggregated health surveillance systems are developing slowly, and pragmatically, often using country of birth. The principles to adopt, given the gaps between the ideal and the current reality, need wider discussion. Ethics may provide both principles and impetus. Doing no harm, doing good, respecting the research participants' autonomy are good starting points. More emphasis is needed on justice, fairness and equality, participation and communicating effectively. Ethnic minority groups are willing participants in trials once linguistic and trust-related barriers are overcome, though recruitment costs are higher. Guidelines and strategies by European bodies with research funding or enforcement responsibilities are needed. The research community needs an infrastructure within which to collect and utilize evidence. Research can help migrant and ethnic minority groups to participate more fully in our multi-ethnic societies. [ABSTRACT FROM AUTHOR]

Europe largely shifted from being a region of net emigration to one of net immigration during the second half of the 20th Century. Multi-ethnic societies in Europe are faced with a multiplicity of challenges, including meeting the diverse health and healthcare needs of ethnic-minority groups. A major issue facing Europe is filling the current gap in the availability of high-quality data on health determinants, health status and health service use among migrant populations throughout the region. As evidence-based decision making in public health and healthcare greatly depends on the availability of relevant health information, improving the collection of valid and comparable ethnic-minority health data should be regarded as a high priority. Migration, ethnicity and health researchers across Europe have been building alliances, particularly through the migrant health section of the European Public Health Association (EUPHA). The 2007 EUPHA Conference in Helsinki highlighted the public health challenges and opportunities facing an ever-growing and increasingly diversified European region, and provided public health professionals and researchers a platform to share their work, concerns and visions for the future. As the ethnic diversification of Europe continues, the challenges to the unification of its many populations become even more unpredictable. Such diversity may ease unification or could exacerbate existing political and economic tensions. It behoves us to take the actions now that will make Europe a more cohesive and successful place in the years to come. [ABSTRACT FROM AUTHOR]

The author examines racism in health and health care in Europe. Possible factors that stimulate racism in health and welfare services are cited, including an increase in ethnic minority populations in European cities. Also stressed is the use of race and ethnicity to address racism and achieved equity. He suggests that researchers as well as legislators should contribute to international discussions in the light of European legislation promoting equality.

Aims/hypothesis: Individuals of South Asian origin have a high risk of type 2 diabetes and of dying from a diabetes-attributable cause. Lifestyle modification intervention trials to prevent type 2 diabetes in high-risk South Asian adults have suggested more modest effects than in European-origin populations. The strength of the evidence of individual studies is limited, however. We performed an individual participant data meta-analysis of available RCTs to assess the effectiveness of lifestyle modification in South Asian populations worldwide., Methods: We searched PubMed, EMBASE, Cochrane Library and Web of Science (to 24 September 2018) for RCTs on lifestyle modification interventions incorporating diet and/or physical activity in South Asian adults. Reviewers identified eligible studies and assessed the quality of the evidence. We obtained individual participant data on 1816 participants from all six eligible trials (four from Europe and two from India). We generated HR estimates for incident diabetes (primary outcome) and mean differences for fasting glucose, 2 h glucose, weight and waist circumference (secondary outcomes) using mixed-effect meta-analysis overall and by pre-specified subgroups. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence of the estimates. The study is registered with the International Prospective Register of Systematic Reviews ([PROSPERO] CRD42017078003)., Results: Incident diabetes was observed in 12.6% of participants in the intervention groups and in 20.0% of participants in the control groups. The pooled HR for diabetes incidence was 0.65 (95% CI 0.51, 0.81; I 2  = 0%) in intervention compared with control groups. The absolute risk reduction was 7.4% (95% CI 4.0, 10.2), with no interactions for the pre-specified subgroups (sex, BMI, age, study duration and region where studies were performed). The quality of evidence was rated as moderate. Mean difference for lifestyle modification vs control groups for 2 h glucose was -0.34 mmol/l (95% CI -0.62, -0.07; I 2  = 50%); for weight -0.75 kg (95% CI -1.34, -0.17; I 2  = 71%) and for waist -1.16 cm (95% CI -2.16, -0.16; I 2  = 75%). No effect was found for fasting glucose. Findings were similar across subgroups, except for weight for European vs Indian studies (-1.10 kg vs -0.08 kg, p = 0.02 for interaction)., Conclusions/interpretation: Despite modest changes for adiposity, lifestyle modification interventions in high-risk South Asian populations resulted in a clinically important 35% relative reduction in diabetes incidence, consistent across subgroups. If implemented on a large scale, lifestyle modification interventions in high-risk South Asian populations in Europe would reduce the incidence of diabetes in these populations.

This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.

Health systems are serving increasingly ethnically diverse populations. This requires cultural sensitivity/competence. Sharing insights from multi-ethnic countries is important. Insights from Scotland, discussed in this paper, include that the creation of culturally sensitive health systems requires reduction of stigma associated with immigration and immigrants; the wider use of ethnicity alongside, or instead of, race, country of birth, nationality and immigrant status; prioritization of actions using the concept of inequity; understanding that meeting the needs of minorities improves health systems for everyone; more use of anti-discriminatory laws to drive national policy and locality planning; research to assess needs and effectiveness; evaluation of processes and outcomes; institutional and professional sincerity and confidence, and monitoring that policies are implemented and working. Even when conditions are favourable, as in Scotland, the challenges are many, implementation is tough and timescales long. Scotland's record is, nonetheless, comparatively strong in Europe. Sharing experience across national boundaries should spur on progress globally.

Background: Ethnic inequalities in health status and healthcare remain substantial in Europe, and addressing them is becoming a priority. However, the best way to respond to such a challenge is, as yet, unclear. The research community is grappling with the contribution of socio-economic discrimination to ethnic inequalities., Methods: The authors present a new theoretical analysis, based on the landmark work of Charles Tilly on 'Durable Inequality,' and we apply it to the public-health goal of reducing ethnic health inequalities., Results: Tilly claims that, for organisational reasons, ethnic categories and socio-economic categories are tied together. The theory of Durable Inequality claims that the matching of ethnic categories with socio-economic categories helps to enforce exploitation, leading to durable inequalities. The authors present the theory, focus on its main components (categories, exploitation, opportunity hoarding, emulation and adaptation) and discuss the implications for health inequalities by ethnic group. In essence, the theory leads to four recommendations for the study of ethnic health inequalities: (1) to investigate organisational processes that create ethnic health inequalities; (2) to investigate the role of networks and ties on health behaviours, healthcare use and their psychological factors; (3) to define ethnicity through flexible, multidimensional binary categories, which should vary according to context; (4) to assess cumulative inequality within a domain, across domains and across generations., Conclusions: This paper, to our knowledge, is the first attempt to analyse Tilly's theory in relation to ethnicity and health, and opens up a debate on refining the implications of these ideas prior to empirical testing.

Background: Data on differences by ethnicity in cardiovascular diseases (CVDs) and diabetes, reflecting the influence of diverse cultural, social and religious factors, are important to providing clues to disease aetiology and directing public health interventions and health care resources., Methods: Through a network of European public health researchers and searches of bibliographic databases and internet sites, we determined the availability and characteristics of ethnically relevant data on mortality and morbidity from coronary heart disease (CHD), stroke and diabetes, in current European Union countries; data from the four countries comprising the UK were assessed separately., Results: In total, 25 countries had one or more relevant data sets (72 in total); however, two-thirds (n = 47) of the data sources came from only eight Nordic and Western European countries. For several countries, no data could be identified. Ethnically relevant, national death registers were available in 24 countries. Country of birth was the most common indicator of ethnicity. Data on CHD, stroke and diabetes morbidity among migrant and ethnic minority populations are currently scarce; both between and within countries, there are important differences in how ethnicity as well as disease outcomes are defined and measured which limits data comparability., Conclusion: Reliable routine data are key to evidence-based public health policies at both national and EU level. EU countries have a relatively weak base for assessing needs and planning health care interventions for its migrant and ethnic minority populations. The lack of ethnically relevant data on CVD and diabetes across the EU needs to be addressed urgently.