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Contact:
Professor George Davey Smith
Department of Social Medicine
University of Bristol
Canynge Hall
Whiteladies Road
Bristol BS8 2PR
Tel: +44 (0)117 9287329
Fax: +44 (0)117 9287325
Click to email
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Principal
Researchers:
Professor George Davey Smith
Dr. Steve Fenton
Dr. Helen Lambert
Professor Waqar Ahmad
Duration of
Research:
February 1997 - February 2000
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Background
There are important differences in the health experiences of different
ethnic groups. Explanations for these differentials remain partial
and contested. In particular, the role of socio-economic position
in accounting for differences in health within and between ethnic
groups is not clearly understood. A major reason for this is the
lack of meaningful measures of socio-economic position which are
valid across different ethnic groups and can be used to relate health
outcomes to ethnicity. The project is designed to address this gap.
It is built around studies in which the views of different ethnic
communities will play a central part in the development and testing
of alternative measures of socio-economic position.
Aims and
Objectives
The project aims to improve research methodology relating to the
measurement of socio-economic differentials within and between ethnic
groups. The objectives are:
- to develop
more appropriate measures of socio-economic position applicable
across different ethnic groups;
- to apply
these measures to the analysis of available datasets, thus increasing
the usefulness of these datasets;
- to contribute
to the formulation of policy and practice aimed at reducing socio-economic
and ethnic differentials in health.
Study Design
This study is developmental in nature and uses both qualitative
and quantitative methods. The research focus will be on three broadly
defined ethnic groups - white, Asian and Black Caribbean - in Bristol
and Leeds. The project comprises four overlapping stages. First,
a review of ethnographic work into the health experiences of different
ethnic groups will be undertaken, involving contact with the original
researchers where possible. Second, ethnographic studies of the
relationship between socio-economic position and health will be
conducted in the three groups in Bristol and Leeds. Third, a survey
instrument designed to measure socio-economic position and health
will be developed and piloted. Finally, a quantitative survey of
health and socio-economic position in a stratified sample from the
three ethnic populations will be conducted.
Policy Implications
This research will contribute to debates on, and strategies for
reducing, socio-economic and ethnic differentials in health status
and health care. It will provide important insights into the social
and cultural meanings of socio-economic status and health within
and between the ethnic groups. One aim of the research will be to
develop methods for increasing the usefulness of information contained
in existing datasets. To ensure policy relevance, the project team
will be supported by one national and two local advisory groups
composed of potential research users, including representatives
from the health, local authority and voluntary sectors.
Project Summary
It is increasingly recognised that inadequate measures of socio-economic
position and ethnicity are holding back research on, and policies
to address, ethnic inequalities in health. This project aimed to
improve the measurement of socio-economic differentials in health
between different ethnic groups. Ethnographic research in two cities
in England (in Leeds and Bristol) informed 162 in-depth interviews
across three ethnic groups. These interviews in turn informed the
development of socio-economic indicators, which were then used in
a new survey in Leeds and in the secondary analysis of existing
datasets.
Key findings
- Ethnicity
is complexly related to conventional indicators of socio-economic
position, and shows variations between ethnic groups. As a result,
indicators based on occupation, education, housing tenure and
income do not necessarily provide an accurate picture of lifetime
social circumstances in minority ethnic groups (and their impact
on health).
- Loss of employment
position, and therefore earnings and career prospects, often accompanied
immigration. Education may therefore relate to SES differently
between ethnic groups, 'purchasing' a poorer labour market position
for minority groups.
- The migration
and settlement process for respondents from minority ethnic groups
often exerted a downward drag on living standards. For example,
the large financial burden of remittances, together with saving
for housing, made heavy demands on household income. Racism experienced
by migrant parents resulted in some relatively poor parents accepting
lower standards of living in order to pay for their children's
private education. Household income may therefore relate differently
to disposable income and living standards in minority ethnic groups
than in the majority ethnic group - and between new and established
settlers.
- At a given
level of reporting of subjective ill-health, minority ethnic group
members tended to have a greater number of limiting conditions.
- The meaning
of socio-economic indicators across ethnic groups needs to be
considered in the particular studies in which they are used, as
no general rules can be made regarding the comparability or non-comparability
of particular measures.
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