15th February 2007

Pathfinder Social Enterprise

Apnee Sehat becomes a Pathfinder Social Enterprise and is awarded funding from the Social Enterprise

Although just over two years old, the pioneering Apnee Sehat project is celebrating the latest addition to its tally of no less than five major awards, as a finalist in the Reducing Health Inequalities category of the 2006 Health and Social Care Awards run by the Department of Health and the NHS Institute for Innovation and Improvement to recognise excellence in the provision of frontline care.

Significantly, the project has also been awarded Pathfinder status by the Department of Health Social Enterprise Unit. Speaking for the Department, Health Minister Ivan Lewis commented: "The pathfinder projects selected cover a wide range of innovative services that work for the benefit of individuals and the community more widely. Each in some way brings entrepreneurial approaches to delivering health and social care services.

Apnee Sehat (meaning ‘our health’ in Punjabi) was set up to address a glaring healthcare inequality: the disproportionately high incidence of diabetes, strokes and heart attacks in South Asian populations in the UK. It consists of a broad-ranging campaign of imaginative patient education initiatives and community events designed around the specific needs and cultural preferences of Asian families.

"This is a broad-ranging campaign of imaginative patient education initiatives and community events designed around the specific needs and preferences of Asian families. Everyone who has been involved in the project has worked hard to ensure it has been a success and the achievements have been a credit to the partnership working between the community and a whole range of different organisations. It's important that the project now continues to reduce inequality and ensure that more and more people in Warwickshire receive the help and support they need in order to enjoy healthier lives" said Dr Tim Davies, Director of Public Health for NHS Warwickshire.

“By applying social marketing techniques, with straightforward emotive messages and simple practical advice communicated in a wide range of media (from posters, recipes, calendars and community events to health fairs, cooking classes and a Bollywood-style DVD), the project is already succeeding in changing the behaviours, dietary choices, exercise regimes and other lifestyle factors that exacerbate this serious problem for the South Asian diaspora,” added Dr Shirine Boardman, the consultant diabetologist at Warwick Hospital who masterminded the project in Leamington Spa with Warwickshire PCT, local community groups and support of the University of Warwick.

Pending the outcome of formal assessment of the project’s effectiveness, qualitative research by the University of Warwick indicates that Apnee Sehat is already making a difference in the family setting – ghee was banned after the first lifestyle presentation from the kitchens of the Gurdwara Sikh temple and community centre, which also houses a new Apnee Sehat DIABETES clinic staffed by doctors and nurses who understand the cultural and dietary needs of South Asians.

“Attracting government support through the Pathfinder initiative will allow Apnee Sehat to consider developing such services further afield,” according to the university’s press office.

As one of the companies that provided an unrestricted educational grant for the Apnee Sehat project, Satoru Noguchi, MD of Takeda UK, commented that: “Takeda strongly supports the idea of tailoring healthcare solutions to the requirements of local populations, and this initiative is exciting because it’s such a cohesive package of community-driven measures that meet a real need.”

Editor's notes

Diabetes and heart disease in South Asian communities Compared to the population as a whole, South Asian people in the UK are:

• 50% more likely to die of heart disease and strokes
• up to six times more likely to develop diabetes
• more likely to suffer diabetes-related renal, retinal and cardiovascular complications
• more likely to have central obesity and low levels of HDL cholesterol
• less physically active, because of practical, social and cultural factors The reasons are complex. Studies have pointed to a lack of culturally sensitive diabetes services adapted to the needs of this patient group. And because they’re not usually consulted about the healthcare they receive, South Asians who feel uncomfortable with mainstream appointment-driven healthcare are effectively excluded from the system.

Apnee Sehat

The South Asian community targeted for the Apnee Sehat lifestyle intervention programme in South Warwickshire is 90% of Sikh origin.

Objectives:

• To motivate this community to change its lifestyle
• To make it easier for this community to make healthy choices
• To involve the community in developing culturally sensitive/acceptable strategies
• To develop effective community communications to support sustained behaviour change
• To develop and evaluate an effective toolkit

Organisations involved:

• Warwick Hospital
• Warwick University
• Warwickshire PCT
• Temple Committee
• Council for Voluntary Services
• Local community groups
• Takeda UK and sanofi-aventis
• Qualitative Evaluation by University of Warwick

Key Findings

1. Generated general awareness of the importance of fundamental changes to health and lifestyles. “Me and mum now walk every day”
2. Participants noted changes at individual and household level. “I’m more aware of what I eat, …I teach my children,… my husband too…. involve the whole family”
3. Simple health messages were considered to be powerful and well received “We now just have green milk [semi - skimmed] - no blue [full fat]”
4. The variety of approaches within the project are fundamental to the sustainability of change “The more you attend such occasions, the more you are reminded…”

Conclusion:

The Apnee Sehat initiative not only raised awareness within a community of the particular health issues facing them, it also went on to provide them with the basic tools required in order to tackle those health issues, and has done so in a sustained fashion. This has proved to be a very successful formula with raised levels of knowledge and awareness and a whole community engaged in improving their health and lifestyle.

This is an example of effective partnership working, with a sustained and coordinated approach in order to maximise the health gain of a community. The drive and enthusiasm of a number of key people working in partnership has been of fundamental importance to the sustainability of the initiative so far.

The South Asian community have been motivated, and sensitively instructed on how change may be instigated and sustained. The Sikh temple is a novel venue for the introduction of a health initiative and has been found to be positively instrumental in sustaining momentum and providing support.

This project has, we feel, set new standards for working across organisation and in giving a local community the opportunity to take health care into their own hands. We are really proud of the extent to which the community have adopted this project and given it an impact that the NHS could not have achieved its their own.

The project is now reaching a point where it is truly public led with the community feeding in ideas of how to take the work forward and sharing what they have learnt between them helping each other to change. People are genuinely changing and although it will not change the statistics overnight in time this will improve the long-term health outlook for this community. It has also given rise to tools that can be shared nationally allowing others to benefit from these combined efforts.