Mapping Muslim health in Britain is extremely difficult, as studies are generally done along racial and not religious grounds. But one common thread runs through almost all the stories you hear from Muslims: the deficit in faith-sensitive mental and physical healthcare.
"When Muslim migrants came here in the 1950s and 1960s they didn't realise that the basic services that were met by the family in their countries of birth were met by the state. So the task was to make the mainstream sensitive to their needs," says Khalida Khan of the An-Nisa society, an organisation that tries to reconcile the Muslim community with mainstream British society.
"But there was no political activity in the community. What made it worse was the 1976 Race Relations Act, which didn't include safeguards against religious discrimination. For the Muslims it was catastrophic. For example, they were all seen as being Asian, which was not true, especially in multicultural places like London.
"So what you got was Asian or Afro-Caribbean provision, lumping together people who were really diverse. What was Asian here in Brent was mainly Hindu Gujarati, and what was Asian in Tower Hamlets was Bangladeshi. It developed along the lines of the predominant community; everybody else was invisible."
British Muslims are known to have higher levels of coronary heart disease, diabetes, obesity, perinatal mortality, psychological distress, respiratory problems and tuberculosis than any other religious groups. Some of the differentials may be explained biologically, as is the case with diabetes, but some, such as those relating to heart disease and mental illness, are also rooted in socio-economic inequalities; Muslim groups are also among society's poorest, suffering disproportionately from overcrowded households and unemployment.
But even these indications are at best a poor approximation of the actual state of Muslim health. Since most faith-sensitive healthcare provision is ethnically driven and monitored, all the statisticians can do is extrapolate from the two largest ethnic groups that are predominantly Muslim: Pakistanis and Bangladeshis. Anyone belonging to a smaller ethnic group or forming part of the growing number of white British or European Muslims, is simply left out of the equation.
The diversity of the Muslim community offers a considerable challenge to the new client-led NHS. Last year, for example, Faiq Anwari, 45, went into hospital in Hammersmith, west London, for a double coronary bypass. "One of the other patients on the ward was also a Muslim. He was praying in his chair and the nurse came in and told him to get up because it was time for his tea. I had to stop her and tell her he was doing his prayers. She didn't know."
The food was also culturally inappropriate, he says. "The halal option on the menu turned out always to be Indian food. Why do they assume that halal means Asian? Sometimes I'd rather have had a good English meat and two veg," he says.
The national picture is, of course, more varied. Muslims in Bradford and Leicester enjoy - even if their children may not - an infant male circumcision service, devised in part to eliminate back-street operations. In Wales, the National Assembly has approved free eye tests for certain ethnic groups because of the high incidence of diabetes and cardio- vascular disease. Both conditions increase the risk of glaucoma.
Many of the most encouraging initiatives are being undertaken in the field of mental health. Last weekend An-Nisa held a two-day seminar to train counsellors in Islamic psychotherapy. In London, Camden and Islington mental health and social care trust has launched a project aimed at enhancing its staff's knowledge of Islamic cultures and religion and translating this into providing culturally-sensitive health care. Muslims form the borough's second largest group of service users.
"We're very concerned about having a service that is sensitive to the needs of Muslims," says the project's co-leader, Sue Salas. "Apart from doing a literature search we'll also be looking at issues such as prayer on the wards, diet, gender, privacy, dignity and fasting during Ramadan.
"Our geographic area in central London is ethnically very rich. We have lots of Bangladeshis, but this is such a cosmopolitan area and we have Pakistani Muslims, Balkan Muslims, Iranian Muslims. Muslims from everywhere, really."
So what does it mean in practice to have a faith-sensitive healthcare service for Muslims? Among those groups attempting to make it work in practice is Nafas, a Bangladeshi anti-drugs initiative in Tower Hamlets, east London. While the service is aimed primarily at one ethnic group, it also places heavy emphasis on the religious beliefs of its target audience.
Staff at the offices in Bethnal Green are visibly Muslim, with women wearing headscarves and men sporting beards. The project provides a vital service in offering advice that is culturally appropriate, according to drug worker Abdur-Rahman Kolonji, who, as a Jamaican, is one of Nafas' two non-Bangladeshi Muslim staff.
"For example, in Ramadan, if a drug addict needs to ask if it is all right to stay on methadone, this is not something he's going to ask a non-Muslim, because they won't know the answer. That's the first thing. The second thing is that you are going to be more comfortable if you come through the door and you smell a certain type of cooking, hear certain references to your language, talk to people who are familiar about issues in your life."
Crack and heroin are a growing problem among second- and third- generation Bangladeshis in Tower Hamlets, as they are among Muslim youth nationwide. Maqsood Ahmed, the Muslim adviser to the prison service, reported in June 2000 that one in four of the 4,003 Muslim inmates had committed drug-related crimes.
At the heart of Nafas is an approach that borrows just as heavily from Islamic spirituality as it does from Bangladeshi culture, drawing on "the values and the meanings and rationale from Islam without preaching" or without being coercive.
"To replace heroin with methadone is not enough. This is only dealing with the physical side of withdrawal," says Kolonju. "Meanwhile, the client is saying, 'What about my head?' The psychological addiction is not being dealt with.
"At the core of our whole rationale is that services need to be tailored to different communities, what they are about, what their beliefs are. If you go to a people who are a certain way, then that has to be your starting point, not what you think they should be like. That's the basis of inter-cultural therapy."
