NICE chief criticises “one size fits all” approach to health promotion

BMJ 2009; 338 doi: (Published 10 June 2009) Cite this as: BMJ 2009;338:b2326
  1. Jacqui Wise
  1. 1London

    A targeted approach to delivering health promotion interventions for minority ethnic communities is needed, according to Mike Kelly, director of the centre for public health excellence at the National Institute for Health and Clinical Excellence (NICE).

    Speaking at a conference on Ethnicity and Health at the Royal College of Physicians in London last week, Professor Kelly said, “It has been the greatest challenge of my career to convince politicians that ‘one size fits all’ is not the answer.” He added, “There have been missed opportunities over the past 10 years.”

    Professor Kelly called for both a targeted and universal approach to health promotion. “It seems blindingly obvious, but we have had 50 years of not doing that.”

    Speaking at the conference organised by the University of Edinburgh, Professor Kelly said that a big problem is the lack of good quality research in this area. “Our knowledge of ways to target interventions to any specific group, including ethnic minorities, is sadly lacking,” he said.

    Chairing the conference, Aziz Sheikh, professor of primary care research and development at the University of Edinburgh, said, “The health promotion programme has worked in absolute terms but it has exacerbated the problem of health inequalities.” He told the BMJ, “It tends to be the middle class, educated, and, in general, white population who find it easier to take up these interventions. You will never narrow this gap unless you make additional efforts to target those groups who are harder to reach or easier to ignore.”

    Gina Netto, lecturer at the school of the built environment at Heriot Watt University in Edinburgh has carried out a systematic review of health promotion interventions modified for minority ethnic communities. She found a limited evidence base, with only 17 interventions identified. She told the conference, “Involvement of community organisations is key. It is important to use ethnic specific media and events to reach those people who are not aware of health promotion messages.”

    A group of researchers from the University of Edinburgh will build on Dr Netto’s work to develop an evidence based multidimensional framework that could be used to design future health promotion initiatives aimed at ethnic groups. The research programme, which is funded by the Medical Research Council, will be completed by the end of 2010 and aims to develop best practice guidelines to help deliver targeted interventions to patients from ethnic groups.

    Wayne Giles, director of the REACH (racial and ethnic approaches to community health) programme at the Centers for Disease Control and Prevention in Atlanta, United States, told the conference about the programme’s success. The programme has been going for 10 years, with funding for 40 community programmes throughout the United States. He reported that it has improved health outcomes. For example, in South Carolina a programme targeting diabetes produced a 54% reduction in amputations among African-American men and improvements in blood sugar testing. “REACH has proved that disparities are not inevitable and can be overcome. It is important to empower communities to understand their health and use their power,” he said.


    Cite this as: BMJ 2009;338:b2326