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Background
Some ethnic minority groups in Britain, including African-Caribbean
and some Asian communities, are at greater risk of experiencing
the disadvantaged socio-economic circumstances that are associated
with poor health. Yet little is known about the impact of socio-economic
disadvantage on the health of ethnic minority people. Standard indicators
of socio-economic status such as occupational class and housing
tenure do not operate consistently across different ethnic groups
and inadequately reflect the position of some ethnic minority groups.
Consequently, measures of socio-economic status that take account
of the differences in the occupational, housing and spending patterns
of different ethnic communities need to be designed. Beyond socio-economic
status, marital and parental roles are also crucial when considering
health variations among women. However, family patterns vary among
ethnic groups, so gender is an important dimension to be included
in an analysis of the health of ethnic minority groups.
In addition,
the social disadvantage faced by ethnic minorities is likely to
involve more than material circumstances. Other important dimensions
include alienation and racial harassment, which may be occurring
on an almost daily basis in the lives of some. It is also likely
that much of the social disadvantage faced by ethnic minorities
is structured by their geographical location, which differs markedly
from that of the white population. Aspects of the physical and social
environment may affect health by influencing attitudes, structuring
social interaction, limiting access to resources and increasing
exposure to hazards. On the other hand, the concentration of ethnic
minority groups in particular locations may allow the development
of a community with a strong ethnic identity that enhances social
support, reduces the sense of alienation and protects against the
direct effects of racism.
Aims and
Objectives
The project has four aims:
- to describe
the extent to which different dimensions of ethnicity are related
to health;
- to explore
how far the relationship between ethnicity and health is mediated
by the social disadvantage faced by ethnic minority groups;
- to assess
the influence of ethnic variations in family structure on variations
in health;
- to assess
the extent to which ethnic variations in health can be attributed
to differences in where people live.
Study Design
The study will be based on secondary analysis of the Fourth National
Survey of Ethnic Minorities. This is a fully representative survey
of the main ethnic minority groups in Britain, involving interviews
with 5200 people together with a comparison sample of 2800 white
people. It contains extensive information on ethnicity, health,
socio-economic status, racial harassment, family structure and area
of residence. It can be readily linked to the 1991 Census data at
Enumeration District level and above, allowing the Census to be
used in the analysis of geographical effects. The data will be used
to develop indices of individuals' health and of their position
in the four dimensions under consideration: ethnicity, socio-economic
status, gender and family structure, and geographical location.
The analysis will use multivariate techniques and, to differentiate
area from individual effects, multi-level modelling.
Policy Implications
Ethnic variations in health have important policy implications for
the distribution of resources and the provision of services. Our
current work, which shows that levels of ill-health vary markedly
between and within ethnic minority groups, has already indicated
that a broad targeting of resources and services on all ethnic minorities
may not be the most effective and equitable solution. The proposed
research will build on these earlier findings, allowing identification
of groups within particular ethnic minority communities who are
most at risk of poor health. These analyses will help inform the
assessment of health needs and the effective targeting of resources
to particular groups and geographical areas.
Project Summary
Tackling ethnic inequalities in health is central to the government's
commitment to improving overall levels of health in the UK and to
narrowing the health gap between rich and poor. However, policies
to take forward this commitment are hampered by lack of data on
the health experiences of ethnic minority people. The project drew
on a large and nationally-representative sample which, for the first
time in a UK study, enabled the identification of the social factors
shaping the health of ethnic minority groups.
The research,
based on the 4th National Survey of Ethnic Minorities and the 1991
census, investigated the complex relationship between ethnicity
and health through analyses which took account of the potential
influence of socio-economic position, gender and area.
Key findings
- Higher rates
of mortality for ischaemic heart disease among South Asian people
are well established and appear to be unrelated to socio-economic
position. However, indicators of socio-economic status (SES) may
be inappropriate when making comparisons across ethnic groups.
The 4th National Survey allowed analysis of differentials in diagnosed
heart disease and reported severe chest pain using more sensitive
measures of SES. The findings suggested that South Asian people
do not share a uniformly greater risk of heart disease. The better
off South Asian group (Indians) have rates which are similar to
those found among white people, while the poorest groups (Pakistanis
and Bangladeshis) have rates which are considerably higher. Socio-economic
position predicts risk in each group and makes a contribution
to the higher risk found for Pakistani and Bangladeshi people.
- Other analyses
confirmed that socio-economic position is an important determinant
of health within minority ethnic groups. Socio-economic disadvantage
makes a substantial contribution to ethnic inequalities in health.
- Important
dimensions of ethnic identity were consistent across Caribbean,
Pakistani, Bangladeshi, Indian and African Asian people. However,
the findings suggested that ethnic identity was not related to
health. Rather, there were strong independent relationships between
health and experiences of racism, perceived racial discrimination
and social class.
- Disadvantages
not captured by measures of socio-economic inequality, like racial
harassment and discrimination, are important to the health of
ethnic minority people. Findings suggest that both experiences
of racial harassment and perceptions of racism have a large impact
on health, and one that is independent of socio-economic position.
For example, those who had been verbally harassed had a 60% greater
chance of reporting fair or poor health, while those who reported
racially-motivated damage to their property or physical attacks
had a more than two-fold greater likelihood of reporting fair
or poor health.
- Further analysis
indicated that the different ways in which racism may manifest
itself (as interpersonal violence, institutional discrimination
and socio-economic disadvantage) all had independent detrimental
effects on health.
- Gender combined
with ethnicity and socio-economic position to shape people's health.
For example, the analysis pointed to the influence of domestic
responsibilities on women's health. Informal caring responsibilities
emerged as a risk factor for all ethnic groups, with having four
or more children an additional risk factor for ethnic minority
women. Divorce and lone parenthood were risk factors for white
and South Asian women (but not for Caribbean women), with their
poorer economic circumstances largely explaining the negative
health effect of lone parenthood.
- Area characteristics
appeared to make little contribution to ethnic differences in
health. Despite the geographical concentration of ethnic minority
populations in the urban areas of Greater London, West Yorkshire
and the West Midlands, it was individual factors, like social
class and gender, which emerged as the major influences on health.
- The methodological
contributions of the project included its development of measures
of ethnic identity and of socio-economic position (based on occupation
and standard of living).
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