Sheila Hillier

Ethnicity, socio-economic status, overweight and underweight in East London adolescents.

Background The developed world is experiencing an ‘epidemic’ of childhood obesity but little is known about the prevalence of obesity, or underweight, amongst adolescents from minority ethnic groups in the UK. An understanding of the prevalence of obesity and overweight in these populations is important since some ethnic groups may be particularly vulnerable to the adverse health effects associated with obesity. Study Objectives To examine levels of extreme obesity, obesity, overweight and underweight amongst a representative sample of adolescents from different ethnic groups in East London and to explore the association between socio-economic status and body mass index (BMI). Design A school-based survey of adolescents aged 11–14. Obesity and overweight were estimated using the 1990 UK growth reference (UK 90) and the International Obesity Task Force (IOTF) cut-off points. Extreme obesity was defined as a BMI more than three SD above the UK 90 mean. Underweight was examined by looking at those with a BMI below the 15th or the 5th UK 90 percentiles. Main Results A total of 2,482 adolescents were surveyed (response rate 84%), 73% from non-white ethnic groups. Although there were significant differences in BMI between ethnic groups, high levels of overweight were seen in all ethnic groups. More than one-third were overweight and one-fifth were obese using the UK 90; and over a quarter were overweight and almost one-tenth were obese using the IOTF cut-offs. Two per cent were extremely obese. Indian males were at higher risk of being overweight than white British males. The prevalence of obesity and overweight was similar in white British and Bangladeshi males. Overall the prevalence of underweight was slightly lower than that predicted by the UK 90, but South Asian ethnic groups, especially males, had a higher prevalence of underweight than other groups. No associations between BMI and measures of socio-economic status were found in this relatively deprived population. Conclusions The ‘epidemic’ of childhood obesity observed in the UK involves adolescents from all ethnic groups, although there are some differences between ethnic groups in the prevalence of overweight. Indian males appear to be at increased risk of being overweight. There is no evidence of a simultaneous increase in underweight amongst this population overall, but Bangladeshi, Indian and Pakistani boys appear to be at increased risk of being underweight.

Cultural identity, acculturation, and mental health among adolescents in east London’s multiethnic community

Study objective: To investigate cultural identity as a risk factor for mental health problems among adolescents. Design: A cross sectional school based population survey. Mental health problems were measured using the strengths and difficulties questionnaire. Pupils were classified into one of four cultural identity types on the basis of friendship and clothing choices. Setting: East London. Participants: 2623 adolescents (aged 11–14) from a representative sample of 28 schools in east London. Results: In comparison with marginalised adolescents who chose friends from neither their own or other cultures, fewer mental health problems were found among adolescents making culturally integrated friendship choices (friends from own and other cultures: OR = 0.6, 0.4 to 0.9), boys making integrated friendship choices (OR = 0.45, 0.22 to 0.91), and specifically among Bangladeshi pupils with integrated friendship choices (OR = 0.15, 0.04 to 0.55). Conclusion: As measures of cultural identity, integrated friendship choices overall, and specifically for boys and Bangladeshi pupils, are associated with lower levels of adolescent mental health problems.

The reforms of the Chinese health care system: County level changes: The Jiangxi study

A survey of the economic performance of county hospitals in middle income counties in Jiangxi province was undertaken in 1989. The survey considered the impact of health policy changes in the P.R.C., especially cost recovery, decentralization, managerial changes and the promotion of traditional medicine. The financial records of county level hospitals and traditional medicine hospitals for the period 1980-89 were examined, as were patient expenditures. Opinions of those responsible for policy execution were surveyed. The data showed that hospitals from which state subsidy had been removed had become dependent on medicine sales and increasing itemization of treatment to recover costs. The insurance status of patients influenced the length of stay and levels of payment. Uninsured peasants had a shorter stay and were charged more for items of treatment. Traditional Medicine hospitals saw more outpatients than County hospitals, but were more likely to have a deficit. They were also very dependent on medicine sales for income. Most officials questioned felt that the changing system caused problems, but at the same time were eager to invest in equipment as a source of revenue.

Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong.

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kongs TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.

Kan-Wen Ma

Kan-Wen Ma was a distinguished authority on the history of Chinese medicine. In China, he is credited with establishing the term “traditional Chinese medicine” (TCM) for the treasure house of knowledge that exists in ancient texts. He introduced Western audiences to a wider understanding of the antiquity of TCM and the complex and subtle contributions of its practitioners. His special academic interest was comparisons between traditional Chinese medical thinking and European and Islamic medical thought from the earliest times. In his lifetime, he published or edited 12 books and 160 academic papers despite suffering and having his career blighted by the chaos of the Cultural Revolution in China in the 1960s and 1970s. Few academics could have experienced the vicissitudes of life in 20th century China and created not one, but two successful careers, first in Mao’s China and later in the more peaceful environment of the University of London. Towards the end of his life, at UCL, he was working to complete a wide ranging study of the interaction between the Western medical missionary movement in China and traditional Chinese medicine in the 19th and early 20th centuries. Kan-Wen Ma was born in Beijing in 1927 into a family who numbered traditional physicians among its members. His father was head of a secondary school in Beijing. He was at school when the Japanese invaded China in the 1930s. This made home life challenging and studies difficult, but in 1945 he gained entrance to the elite Yenching University, where he studied history and philosophy of science. Yenching, founded by Christian missionaries and funded through American philanthropy, offered a Western style university education. He became fluent in English and appreciative of British and American culture, …