Table 4 Low visibility and relative priority of the disease and Chinese population

Visibility of the issue

How the community is perceived by clinicians and commissioners

“I think the culture within each group makes a difference as well. I think rightly or wrongly, the perception is that the Chinese immigrants tend to be more self-sufficient. The community takes on … new entrants and support them in a way that means they are not as visible to things like safeguarding or those other issues that flag them as a vulnerable group.” (Commissioner interviewee, local commissioning manager)

“I think they probably do keep themselves to themselves… They are a quiet, self-contained group it seems to me…So because they haven’t upset people their needs aren’t immediately heard or seen.” (Clinician interviewee, general practitioner)

How the community behaves that reduces its visibility

“(Eastern Europeans) … tend to demand more because they expect that … they ask a lot of things when they see the doctor. Whereas the Chinese population … if you are a doctor they do give you the respect. So that respect is there, which can be a barrier as well because then you know some of their hidden frustration may not surface...” (Clinician interviewee, Chinese-ethnicity general practitioner)

Level of public discourse of the disease

“In China, HBV is frequently mentioned in everyday conversations, mass media, and internet. HBV is a hot and heavy topic, rumours of transmission together with tragic stories of suicidal HBV carriers encompassing people’s life.” (Community focus group) 

“In the UK (Hepatitis B) is hardly mentioned anywhere and has caught no public attention.” (Community focus group)

Role for advocates

“There’s something about an advocate from within the community being a more successful voice for the change in terms of within the community … It’s something about a partnership between somebody who is willing to speak up for the community and somebody who’s willing to represent the community in the discussions to get a priority for it ...” (Commissioner interviewee, regional public health consultant)

“Well I do believe we need the help from the (Chinese) population to push their own cause because other ethnic minority groups, when there’s a push from inside it’s more difficult to argue against I think.” (Clinician interviewee, general practitioner)

Competing priorities

“They will make you take lots of medicine, and all the tests. I really haven’t got that much time.” (Community focus group) 

“If it’s only one or two cases in the city, frankly it’s not going to get the attention it deserves. If it’s hundreds or thousands, then it is more likely to. If it’s tens of thousands, it certainly will.” (Commissioner interviewee, local public health director)