Equalities in Health

An Asylum Seeker is a person who has submitted an application for protection under the Geneva Convention and is waiting for the claim to be decided by the Home Office.

A refugee is someone who has had their asylum claim accepted.

While it is relatively easy to account for the number of people seeking asylum living in Glasgow, it is more challenging to establish the number of refugees. There are no reliable figures available on the number of refugees in the UK, Scotland or Glasgow.

Issues for Asylum Seekers and Refugees

Many of those arriving in Scotland are families with children who are fleeing violence and persecution in their own country. They are coming here because they are vulnerable. We are well-equipped to help. A support structure is already in place for all nationalities seeking asylum. Central government meets the reasonable costs of looking after asylum seekers, so local services will not suffer.

Recent research in Glasgow showed that key issues for people from minority ethnic communities include:

• safety – racism, hate crime and relationships with the police;
• social opportunities – culturally appropriate sport and leisure services;
• health – awareness of services, issues around isolation, lack of culturally sensitive services;
• employment – high priority issue, some variations in employment levels across ethnic groups;
• learning – English language classes and culturally sensitive learning opportunities; and
• other priority areas – suitable housing. 

Key Resources

• Healthcare for Refugees & Asylum Seekers – NHS Inform
• Tell It Like It Is – busting the myths about Asylum Seekers and Refugees
• Asylum Seekers and Refugees Useful Web Addresses
• Equality Act 2010 – a Briefing for Refugee and Migrant Community Organisations
• Glasgow Asylum Destitution Action Network – help and support for destitute asylum seekers in the Glasgow area

Data from a range of support organisations indicate that many ex-service personnel can be vulnerable to a range of health and social inequalities, for example homelessness or mental health problems such as depression and stress. They can have difficulty finding employment, claiming benefits and with social isolation.

Health Concerns regarding ex-service personnel

Research has found that depression is a more common mental health condition than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, mainly from their GP. Only a small number of individuals seek help from specialists.
A considerable number of people leaving the forces or finishing a posting find it difficult reintegrating into their communities and to civilian life in general. In Glasgow, research showed that armed forces veterans made up more than 1 in 10 of the homeless population in the city.

Key Resources

A number of national organisations provide a range of information, advice and practical support including the Ministry of Defence, Soldiers, Sailors, Airmen and Families Association and Veterans Scotland. Local councils will provide housing support and advice.

And a wide number of national and local charities also offer specialist support

• Glasgow’s Helping Heroes
• Glasgow Homelessness Network
• ‘Goodbye and good luck’: the mental health needs and treatment experiences of British ex-service personnel
• A Scottish housing guide for people leaving the armed forces
• Veterans Scotland Home Page

How many Scottish Gypsy Travellers are there?

Organisations that work with Gypsy/Travellers believe Scotland’s community comprises 15,000 to 20,000 people. Numbers are uncertain because people are reluctant to self-identify as a Gypsy for fear of prejudice or official interference.

Who are Gypsy Travellers?

Gypsy Travellers refers to all travelling communities who regard ‘travelling’ as an important aspect of their ethnic/cultural identity. They come from Scotland, other parts of the UK and other parts of Europe. Other groups of travellers include new travellers (previously new age travellers) or occupational travellers (show or fairground). Gypsy Travellers are the only one of these groups to be protected by equalities legislation.

Discrimination and Prejuduce

Gypsy Travellers experience discrimination in health, housing, education, work and from settled communities. This is due to negative stereotypes and prejudice towards Gypsy Travellers. Many Gypsy Travellers face harassment and verbal and physical hostility from local communities.

The following points highlight a few key areas of concern from among the severe, wide-ranging inequalities and problems faced.

• Gypsies and Travellers die earlier than the rest of the population.
• They experience worse health, yet are less likely to receive effective, continuous healthcare.
• Children’s educational achievements are worse, and declining still further (contrary to the national trend).
• Participation in secondary education is extremely low: discrimination and abusive behaviour on the part of school staff and other students are frequently cited as reasons for children and young people leaving education at an early age.
• There is a lack of access to pre-school, out-of-school and leisure services for children and young people.
• There is substantial negative psychological impact on children who experience repeated brutal evictions, family tensions associated with insecure lifestyles, and an unending stream of extreme hostility from the wider population.
• Employment rates are low, and poverty high.
• There is an increasing problem of substance abuse among unemployed and disaffected young people.
• There are high suicide rates among the communities.
• Within the criminal justice system there is a process of accelerated criminalisation at a young age, leading rapidly to custody. 
• Policy initiatives and political systems that are designed to promote inclusion and equality frequently exclude Gypsies and Travellers. 
• There is a lack of access to culturally appropriate support services for people in the most vulnerable situations, such as women experiencing domestic violence.
• Gypsies’ and Travellers’ culture and identity receive little or no recognition, with consequent and considerable damage to their self-esteem.
• The lack of systematic ethnic monitoring of Gypsies and Travellers who use public services

Health Impact

Although little Scottish specific data exists on the health of Gypsy Travellers, wider UK studies consistently show that Gypsy Travellers have significantly poorer health even when compared to other economically disadvantaged UK residents from minority populations. 

Key Resources

Publications

• Improving the Lives of Gypsy/Travellers – 2019-21
• MECCOP GGC evaluation 2025

Links

www.gypsy-traveller.org

Why do people become homeless?

The reasons why people become homeless can be varied and complicated, however some of the most common factors might be-

• A person losing their job and the resulting financial and personal health problems
• Relationship problems
• Harassment by neighbours
• A disaster such as fire or flooding

Some groups of people are more likely to become homeless because they have fewer rights, have particular needs or are less able to cope by themselves. These include:

• young people
• old people
• people with children
• people with physical or mental health problems
• people on benefits or low incomes
• people leaving care
• ex-armed forces personnel
• ex-prisoners
• asylum seekers and refugees

How many Scottish homeless people are there?

The Scottish Government has published the latest round of homelessness statistics covering 1st April 2020 to 31st March 2021, available here: Homelessness in Scotland: 2020 to 2021 The figures show that Glasgow City remains the local authority with the most households assessed as homeless, and West Dunbartonshire had the highest rate of households assessed as homeless and East Dunbartonshire the lowest.

Health and Homelessness

Poor health is not only a consequence of homelessness but can also contribute to someone becoming homeless. More generally there is a greater risk of ill health and of premature death amongst the homeless population than amongst the population at large. There are a wide range of health problems which are more common amongst homeless people. These include persistent conditions as well as anxiety, stress, self-harm, other mental health problems and infectious diseases.

Homelessness and other forms of inequality

As well as being associated with homelessness, certain forms of inequality such as poverty and unemployment, gender based violence, disability, mental health and addictions can also be the main cause of a person becoming homeless. Homeless people can feel that there is a stigma attached to being homeless. This perception of social stigma is something that is common to a number of marginalised groups.

Useful contacts

• Homelessness Network Scotland
• Shelter Scotland
• Simon Community Scotland

What is prostitution?

Prostitution is the act of sexual activity in exchange for some form of payment such as: money, drink, drugs, consumer goods or a bed or roof over the person’s head for a night. This may take place in a variety of settings including private accommodation, brothels or on the street. NHS Greater Glasgow & Clyde considers prostitution to be a form of commercial sexual exploitation which is created by demand and is harmful to the person involved.

The Scottish Government, CoSLA and key partners including NHS Scotland are committed to preventing and eradicating all forms of violence against women and girls, as detailed in the Equally Safe strategy. Prostitution in Scotland is predominantly caused by men’s demand to purchase sex from women. In Scotland, prostitution is also caused by men’s demand to purchase sex from men. Men’s privilege to purchase sex is a form of structural inequality, which primarily takes advantage of gender inequality, and is further compounded by various life circumstances and vulnerabilities including poverty, homelessness and experience of other forms of gender-based violence.

Health Impact of Prostitution

The physical, emotional and psychological consequences of prostitution can be profound and include rape and sexual assault, addiction, anxiety and depression, post-traumatic stress disorder, self harm and suicide.

Poor health consequences also impact on vulnerable young people, the families of the individuals involved, on the men who purchase sex, their partners and on the social health of the wider community.

Many individuals involved in prostitution have reported experiences of emotional abuse, physical violence, sexual abuse and rape and sexual assault perpetrated by men purchasing sex. The core harm of being involved in prostitution is the psychological trauma of having to repeatedly submit to unwanted sex. Given this, the health consequences of involvement in prostitution are significant and enduring.

Women and men involved in prostitution are denied positive experiences of sexual health as defined by the World Health Organisation, namely:
“The possibility of having pleasurable and safe sex experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

Prostitution and other marginalised groups and protected characteristics

Many individuals are criminalized as a result of their involvement in prostitution and this makes it more difficult for them to exit prostitution and to access the labour market. There is also a correlation with other marginalised groups such as prisoners and ex- offenders.

What NHSGGC is doing to respond to prostitution

NHS Greater Glasgow & Clyde recognises that prostitution is a significant health and social concern which can affect individuals and communities across Scotland. As with other health concerns the NHS has a lead role to play in tackling the causes and impact of prostitution.

Many people affected by prostitution are reluctant to come forward to agencies, often through fear or shame, but do present across the whole range of primary and acute health settings. Consequently, health workers are in a unique position to provide help and support.
NHS Greater Glasgow and Clyde provide a range of activities aimed at identifying individuals involved in prostitution in order to assess and address their health needs. These actions include sensitively enquiring of service users about any current or previous involvement in prostitution as part of core practice within key services, and ensuring care pathways adapt care and treatment to take any disclosures into account.

We also provide specific services for women and men involved in prostitution via the G3 Priority Clinic provided by Sandyford Sexual Health Services G3

To eradicate the harm caused by prostitution, the circumstances which allow prostitution to exist must be challenged and we work with partner agencies to challenge male demand for prostitution through involvement in White Ribbon Scotland and local multi-agency partnerships on violence against women.

Resources

• Equally Safe – Scotland’s strategy to eradicate violence against women 
• Equally Safe – challenging men’s demand for prostitution: consultation analysis
• Scottish Social Attitudes Survey 2019  – violence against women key findings

Adult literacy issues have a direct impact on access to health information and to the quality of patient experiences of using NHS and other healthcare services.

Literacy is defined in Scotland as:

“the ability to read and write and use numeracy, to handle information, to express ideas and opinions, to make decisions and solve problems, as family members, workers, citizens and lifelong learners”.

The Adult Literacy and Numeracy in Scotland report published back in 2001 estimated that 23% of the Scottish population have significant difficulties with reading, writing and numbers. The report also estimated that up to 40% experience some difficulties.

The latest research on Literacy in Scotland found that one of the key factors linked to lower literacy capabilities is poverty, with adults living in 15% of the most deprived areas in Scotland more likely to have literacies capabilities at the lower end of the scale.

Literacy issues are therefore linked to socio-economic inequality and social class inequality. This can be due to poor experiences at school and lack of opportunity or other barriers early in life.

Other groups such as asylum seekers or refugees may have additional needs in relation to literacy. Also, some disabled people may have support requirement in relation to literacy, such as someone with a learning disability.

Why does literacy matter to health?

The way the health service produces information and the way practitioners communicate with their patient’s needs to take literacy issues into account. Otherwise this might impact on people’s health by-

• Reducing access to health services or limiting people’s health choices;
• Leading to poorer health outcomes by not giving appropriate information on screening, prevention, medication or treatment.
• People with limited literacy skills may find it difficult to:
• Understand and use health information such as instructions for medication, food labels and safety warnings;
• Access services which support their health needs;
• Keep appointments;
• Find their way through complicated health systems;
• Interact with health care providers;
• Seek appropriate medical attention. Some people with limited literacy skills may use health services more frequently, while others often wait until their health problems reach crisis point.

Most research shows that adults with lower literacy capabilities are also more likely to have health problems, including problems with sight, speech, hearing and learning, as well as other disabilities or health problems lasting more than six months.

Key Resources

• NHS Greater Glasgow and Clyde’s Clear to All Accessible Information Policy
• Education Scotland – Adult Literacy Resources
• Glasgow Life – Glasgow’s Learning

Prisons in Scotland

There are 15 prisons in Scotland – . Greater Glasgow & Clyde currently has three prisons – HMP Barlinnie and HMP Greenock and HMP Low Moss.

Prisoners in Scotland

During the year 2019-2020 there were 8600 prisoners in Scotland. Of this total 8198 were male and 402 female.

Prisoners and Health

People in prison have poorer health than the population at large. Many will have had little or no regular contact with health services before coming into prison, and research within prison populations reveals strong evidence of health inequalities and social exclusion.

• The majority of prisoners are male with an average of 35.9. The proportion of prisoners aged over 55 has doubled in the last 10 years. In Scotland males account for around 95% of the prison population.
• Most prisoners are in custody for periods of weeks or months, rather than years.
• Prisoners are six times more likely to have been a young father.
• A high percentage of prisoners will have experienced physical or sexual abuse in younger years.
• 34 per cent of male prisoners and 30 per cent of female prisoners had previously been in care.
• In 2019, black, Asian and minority ethnic (BME) offenders represented 4 per cent of the Scottish prison population.
• Approximately 80 per cent of prisoners in Scotland have some kind of mental disorder with 14 per cent having a history of psychiatric disorder
• Between 20 and 30 per cent of offenders have learning disabilities or difficulties that interfere with their ability to cope with the criminal justice system.
• The majority of people (70 per cent) received into prison test positive for illegal drugs.
• People aged 60 and over are now the fastest growing age group in the prison population.

Links to other Inequalities

Scotland’s prisoners, like prisoners everywhere, are more likely to come from the most deprived areas. In fact a prisoner is 3 times more likely to come from the most deprived 10 per cent of areas. It almost invariably follows that the communities which suffer most from crime are the poorest communities, and that the people who are most likely to be victims of crime are poor people. Those who are released from prison will be, almost invariably, released into poverty, inequality and social exclusion. Against this backdrop it is perhaps unsurprising that for many, prison offers respite care from their experiences in the community.

Though female offending rates had gone through a period of growth, the fact that men account for 95% of the prison population must be considered as an issue in its own right. The key messages that are given to young boys around what it means to be a boy or a man appear to be failing significant numbers if this is the result.

Access to primary health care

Access to coordinated health services within prison and on leaving prison can significantly impact the likelihood of re-offending and further imprisonment. Half of those sentenced to custody are not registered with a GP prior to being sent to prison.

Re-offending

Prison can exacerbate the factors that affect re-offending. Mental and physical health can deteriorate. A third of prisoners lose their house. Two-thirds lose their job. More than a fifth experience increased financial problems and over two-fifths lose contact with their family.

People serving a year or less make up 60 per cent of those received into prison under sentence. Forty-seven per cent of adults are re-convicted within one year of being released. For those serving sentences of less than 12 months this increases to 66 per cent.

Into the community

Many ex-offenders and offenders suffer from many complicated, interrelated problems and require input from a wide range of agencies. These include housing, addictions, mental health, health and social care, and benefits services. Many prisoners will be in prison for short periods of time. They return to their communities as residents with repeated and often disjointed contact with local agencies.

Around 30 per cent of people released from prison will have nowhere to live. Those with sentences less than 12 months frequently have no planned care management plan and are prone to falling through the ‘gaps’ in care provision.

Links

• Offender Health Research Network
• Scottish Prison Service 
• World Health Organisation 

It is the responsibility of NHSGGC staff to book an interpreter for patients attending any of our healthcare services.

• Information for staff
• Information for BSL patients

• BSL Online interpreting

It is vital to ask a patient who may appear to be deaf how they would like to communicate. You can do this using paper and pen or a notepad app on a tablet or mobile.

Deaf people have different ways of communicating. They may want to lip read, use BSL or bit of both. You can also ask if they would like to write things down (avoiding sharing writing tools).

For more information please refer to Communication for people with sensory loss during the COVID-19 pandemic: advice for health and social care staff in Scotland

We can offer a short deaf awareness session that can be delivered online or face to face. The session lasts 30 minutes and is open to all staff.

The learning session covers how to work with BSL interpreters, deafness as a cultural identity and exploring BSL as a language as its own right. This learning will enable staff to communicate more confidently with our Deaf patients and ultimately provide the best possible care.

For more information please contact Paul Hull Paul.Hull@ggc.scot.nhs.uk

Deaf people can be at higher risk of mental health problems due to communication barriers and isolation. We also know from talking to Deaf patients that they face barriers to accessing mental health services because of a lack of information in British Sign Language and understanding of Deaf culture in general. NHSGGC wants to improve access to mental health services and ensure that they are the best they can be for the Deaf community. We have recently introduced a glossary of BSL signs for mental health on our BSL You Tube channel.

Introducing Paul Hull, Health Improvement Practitioner for the Deaf Community regarding Mental Health

A Deaf Mental Health Peer Support Worker has been employed to work across 5 Community Mental Health Teams (CMHT) in Greater Glasgow & Clyde. They will use their lived experience to support patients from the Deaf community in accessing CMHT’s and also in their own recovery journey.

The Peer Support Worker is part of the multi-disciplinary team in Adult Mental Health Services with in-reach to patients whilst in hospital. It is hoped that this support may help patients avoid admission to hospital or reduce the length of stay. 

• BSL Mental Health A-Z Guide

• A wide range of information is available in BSL on our NHSGGC You Tube channel.

Translated versions of any NHSGGC resource or information relating to individual clinical care can be obtained by asking a member of staff. General health information in also available from British Sign Language (BSL) | NHS inform

Staff can request information in BSL via the Clear to All web page.

Our popular beginner’s BSL classes are once again being offered to NHSGGC staff.

The 6 week course will be held at various locations across NHSGGC from March 2024.

Classes offers an insight into how Deaf people communicate and covers the alphabet, how to introduce yourself, colours, numbers and role playing.

For information on how to book, go to our Staff Training page.

The BSL Health Champions are a group of volunteers from the Deaf BSL community who are patients of NHS Greater Glasgow and Clyde. The Champions advise NHSGGC about the main issues and concerns for BSL patients when using our hospitals and other health services. They also work with us to make information about health accessible for BSL users.

Group meetings are public and any Deaf BSL user who lives in the NHS Greater Glasgow and Clyde area is welcome to attend. The group also has a Facebook page which is used to share information and to get feedback from the BSL community.