Chronic diseases in Europe's migrant and ethnic minorities: challenges, solutions and a vision

The pattern of chronic disease varies hugely internationally, and this is now reflected in Europe's multi-ethnic populations. This is creating challenges for epidemiology, public health and clinical care. Human rights legislation and health policies are mandating equity of service i.e. equal needs being met equally well. Indicators of race and ethnicity demonstrate important variations in health and health care, but the data are sparse, especially in Southern and Eastern Europe, and for some ethnic groups across the continent. Ethnic coding of routine health databases is required. The task will best succeed as a national one, with European level coordination and guidance on concepts. Pending this achievement, data linkage techniques can help fill the information gap. One of many ongoing debates that need resolution across Europe is on the preferred indicator of ethnicity, related terminology and mode of measurement. Original research also needs expansion, especially in relation to cohort studies and trials and boosted samples of ethnic minority groups in large scale European health surveys. Such work may require European legislation of the kind that has been effective in the United States (NIH Revitalisation Act 1993). A dialogue between policy makers, funders, researchers and practitioners is needed urgently as a precursor to engaging the public.