Inequalities in NHS Health Check participation in a multiethnic city

Introduction
The NHS Health Check programme targets adults aged 40–74 to reduce the risk of cardiovascular disease, diabetes, and stroke. Uptake is uneven, especially among minority ethnic and deprived communities. Birmingham, one of England’s most diverse and disadvantaged cities, provides a key setting to examine participation. This study explored ethnic and gender differences in NHS Health Check uptake.

Methods
A cross-sectional study design was used. Aggregated data were collected from ten ethnic groups: Arab, Bangladeshi, Black Caribbean, Chinese, Ghanaian, Indian, Nigerian, Pakistani, Somali, and White British. Variables included eligibility, actual uptake, and gender. Descriptive statistics, Pearson correlations, paired-samples t-tests, and a chi-square test of independence were conducted to explore patterns of uptake and the association between eligibility and attendance.

Results
Of 153 eligible participants, 45 completed the Health Check. Uptake varied widely across ethnic groups, from 6.7% (Arab) to 87.5% (Ghanaian). Eligibility was not significantly related to uptake (r = 0.33, p = 0.345) and paired-samples t-tests confirmed large gaps between eligibility and attendance (p < 0.001). Gender differences were minimal, with both males and females showing low uptake relative to eligibility. A significant association between ethnicity and uptake was found (χ² = 26.26, p = 0.002).

Conclusion
NHS Health Check uptake was low and varied sharply across ethnic groups. Eligibility did not predict attendance, and gender had limited influence. Cultural and structural factors strongly shaped engagement. Targeted, community-focused, and culturally tailored strategies are needed to improve awareness, trust, and accessibility, especially for groups with the lowest uptake.