New advice from NICE to help local authorities reduce the high levels of diabetes and cardiovascular disease in people from minority ethnicities is published today (Wednesday 22 January).

People of African, Caribbean and Asian descent are up to 6 times more likely to suffer from type 2 diabetes, heart disease and stroke, and they also develop these conditions at a younger age than the wider population. The briefing highlights that a lower body mass index (BMI) of 23 kg/m² should be used as a trigger to take action in helping people from these and other minority ethnicities to avoid ill health. This is a change from the usual threshold of 25 kg/m² signalling increased risk of chronic conditions - however this figure is still valid for flagging risk in white European adults.

The new Local Government Briefing published by NICE sets out effective ways to help local authorities prevent and tackle these serious long term conditions in their diverse populations. With local authorities' wider remit for public health in communities, the new briefing highlights the importance of taking steps to address diabetes, cardiovascular disease and stroke to improve the health of local people, and also save money.

Professor Mike Kelly, Director of the Centre for Public Health at NICE said: "Type 2 diabetes, heart disease and stroke are potentially life-threating conditions, which people of African, Caribbean and Asian descent and other minority ethnicities are significantly more likely to develop than the wider population. So it's vital that local authorities are supported in taking action to prevent these illnesses in people who have a high risk of developing them. Not only are people from these ethnic backgrounds up to 6 times more likely to be diagnosed with type 2 diabetes, they are 50% more likely to die from cardiovascular disease, and they also suffer from these conditions at a younger age. This briefing recommends that a BMI of 23 kg/m²should be the threshold to trigger action to prevent these chronic conditions in people of African, Caribbean and Asian descent and other minority ethnicities, as these individuals are at an increased risk at what is normally considered a healthy weight. In our diverse population, it's essential that decision makers, practitioners and individuals are aware of this difference, as it's lower than the 25 kg/m² BMI value routinely used to signal an increased risk of chronic illness.

"Local authorities and their partner organisations have an important role in helping ensure that services that they commission or provide include a focus on people from minority ethnicities, and particularly within the 25-39 age group. Lifestyle interventions targeting inactive lifestyles and diet have reduced the incidence of diabetes by about 50% among high-risk individuals, including people of South Asian, Chinese, African and Caribbean descent. As well as improving the health and wellbeing of individuals, taking effective action now also reduces future demand on health and social care services by enabling people to remain as independent as possible."

As well as improving health, there could be large potential savings from tackling these chronic conditions at an early stage. This is particularly true for local authority areas where people from minority ethnic backgrounds form a high proportion of the local population.

Professor Kelly continued: "Early intervention, using lower BMI thresholds could save over £6000 per person per year by reducing the number of people developing type 2 diabetes. The estimated savings from preventing type 2 diabetes are £8.8 billion each year in the UK including diagnosis, lifestyle interventions, ongoing treatment, management and complications. There is an additional estimated saving of £13 billion if mortality, sickness, and loss of productivity from those in work are included. These predicted future savings may not take account of the higher prevalence of obesity in children from minority ethnic backgrounds, so the projected estimated savings could be even higher. Following the briefing recommendations can help local authorities with diverse populations to tackle health inequalities and make the best and most efficient use of resources to improve the health of people in their area."

Examples of effective recommendations highlighted in the new briefing include:

• Raise awareness among decision makers, practitioners and people from African, Caribbean, Asian and other minority ethnic backgrounds about the importance of intervening at a lower BMI for these individuals
• Use lower BMI thresholds for people from African, Caribbean, Asian and other minority ethnic backgrounds to intervene to prevent type 2 diabetes, coronary heart disease, hypertension and stroke, and commission prevention services that include a targeted component for people from these ethnicities who are aged 25-39
• Develop an integrated regional and local plan to prevent non-communicable diseases and promote early intervention among people from African, Caribbean, Asian and other minority ethnic backgrounds, and provide training for staff on how to encourage people to have a risk assessment and to promote a healthy lifestyle.

Ends

For more information call Dr Tonya Gillis at the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

About the new Local Government Public Health Briefing

1. The new briefing, Body mass index thresholds for intervening to prevent ill health among black, Asian and other minority ethnic groups, is published on 22 January 2014, and will be available on the NICE website. Embargoed copies of the briefing are available from the NICE press office on request.

2. This briefing is based on recommendations from NICE public health guidance including Assessing body mass index and waist circumference thresholds for intervening to prevent ill health and premature death among adults from black, Asian and other minority ethnic groups in the UK and Preventing obesity and helping people to manage their weight.

3. The minority ethnicities covered in the briefing and guidance PH46 are defined here:

• South Asian people are immigrants and descendants from Bangladesh, Bhutan, India, Indian-Caribbean (immigrants of South Asian family origin), Maldives, Nepal, Pakistan and Sri Lanka.
• African-Caribbean/black Caribbean people are immigrants and descendants from the Caribbean islands (people of black Caribbean family origin may also be described as African-American).
• Black African people are immigrants and descendants from African nations. In some cases, they may also be described as sub-Saharan African or African-American.
• 'Other minority ethnic groups' includes people of Chinese, Middle-Eastern and mixed family origin, as follows:
  
  - Chinese people are immigrants and descendants from China, Taiwan, Singapore and Hong Kong.
  
  - Middle-Eastern people are immigrants and descendants from Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates and Yemen.
  
  - people of mixed family origin have parents of 2 or more different ethnic groups.

4. Facts and figures:

• Interventions to identify and manage pre-diabetes are cost effective. The cost per quality-adjusted life year (QALY) gained is consistently less than £10,000
• Excess body fat contributes to more than half of cases of type 2 diabetes, 1 in 5 cases of heart disease and between 8 and 42% of certain cancers (breast, colon and endometrial) (Department of Health 2003)
• Pakistani and Bangladeshi men and women and Indian and Chinese women were all less likely than white men and women respectively to meet the physical activity guidelines (Understanding Population Trends and Processes [UPTAP] 2010)
• People of black African, African-Caribbean and Chinese origin are more at risk of stroke than their white European counterparts (National Obesity Observatory 2011)
• Children of South Asian origin are over 13 times more likely to have type 2 diabetes than white children (Drake AJ, Smith A, Betts PR et al. 2002).

5. This new publication is part of a suite of briefing documents which NICE is producing to provide support to local government. This new area of workaims to help councillors and local authority staff find out which public health actions are most effective in improving the health of people in their area, while also providing the best value for money. Based on recommendations from existing NICE public health and clinical guidance, the briefings have been developed with input from the independentLocal Government Reference Group. The group comprises councillors, local government officers, and others with an interest in community health and wellbeing. The new briefings are in addition to NICE's ongoing programme producing public health guidance. Topics covered include tobacco, physical activity and workplace health, alcohol, health inequalities and behaviour change.

6. NICE is publishing a further local government briefing today: 'Improving access to health and social care services for people who do not routinely use them', also available on the NICE website.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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