Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
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Section V--Two International Comparisons18 Ethnic Disparities in Aging Health: What Can We Learn from the United Kingdom?
Section V--Two International Comparisons18 Ethnic Disparities in Aging Health: What Can We Learn from the United Kingdom?
Pages 675-702
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Section V Two International Comparisons
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. Nevertheless, given both a concern about the policy implications of ethnic inequalities in health, and the academic interest in using the additional diversity in experience provided by ethnic comparisons to help understand causes, the experiences of older ethnic minority people are very important.
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How far are ethnic inequalities in health related to the specific historical context of a new migrant population?
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Data from the 2001 Census, which included a fairly comprehensive assessment of ethnicity, have only recently become available. The 1991 Census asked respondents to indicate which ethnic group they belonged to from a range of fixed choices that encompassed both skin color and country of origin, but it did not identify white minority groups.
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· Greater London contains 44.8 percent of the ethnic minority population and only 10.3 percent of the white population. · Elsewhere, the West Midlands, West Yorkshire, and Greater Manchester display the highest relative concentrations of ethnic minority people.
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, which contrasts with much lower rates in the Caribbean, white minority, and white English groups (all 4 to 5 percent)
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682 White English 63 88 67 39 8 36 17 White minority 47 84 74 43 6 30 20 Chinese 62 88 39 49 1 35 15 Bangladeshi 16 55 49 9 4 39 48 (percent) Class Pakistani 31 78 47 26 12 29 33 2001)
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The most stark finding is that only 2 percent of Bangladeshi women in this age group are in paid employment compared with about 10 percent of Pakistani women, just over a third of Indian women, and nearly two-thirds of Caribbean, white minority, and white English women (there were too few Chinese women in this category in the sample to provide an estimate for them)
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. Indian 53 29 18 55 29 17 Prior, Households and Income: Caribbean 8 72 20 54 36 10 ,Primatesta, (Erens HSE Household 1999 18-3 tertile tertile tertile tertile equivalized tertile tertile SOURCE: TABLE Not Bottom Middle Top Equivalized Bottom Middle Top
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A study by the Commission for Racial Equality has suggested that white minority groups, such as the Irish, also face extensive racial harassment (Hickman and Walters, 1997)
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686 Women 32*
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These inconsistencies could be a consequence of a number of factors, including the following: the data cover different groups (the mortality data are restricted to those born outside the United Kingdom the morbidity data cover all ethnic minorities) ; the morbidity data measure prevalence while the mortality data measure a combination of incidence and survival (in the United Kingdom)
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The pattern shown is one that is similar to that demonstrated in the 1991 Census and the FNS (Nazroo, 1997) , with all nonwhite minority groups reporting poorer health than the white English group, Age and Gender Standardized 4.0 English 3.5 White 3.0 with 2.5 Compared CI)
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100 Caribbean 90 Indian Pakistani 80 Bangladeshi Chinese 70 White minority White English 60 Percentage 50 40 Absolute 30 20 10 0 2-5 6-9 10-12 13-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-60 61-70 > 70 Age FIGURE 18-2 Fair/bad health by ethnic group and age. SOURCE: 1999 HSE (Erens, Primatesta, and Prior, 2001)
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Table 18-6, which also uses data from the 1999 HSE, shows differences in rates of smoking and alcohol consumption for those aged 50 or older. The first half of the table shows that among women, the two white groups have the highest rates of current and ever smoking, with around three-fifths of white women having smoked at some point in their lives, and one-fifth of white English and a quarter of white minority women currently smoking.
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. Prior, Consumption: and Indian 57 23 20 95 3 1 59 12 0 19 Alcohol ,Primatesta, and Caribbean 33 35 31 79 12 9 83 18 4 66 (Erens HSE Smoking the the 1999 18-6 limit limit smoker smoker alcohol over alcohol over recommended weekly recommended weekly SOURCE: TABLE Men Never Ex-smoker Current Women Never Ex-smoker Current Men Drinks Drinks Women Drinks Drinks
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Given the overall pattern shown in Table 18-6, it is unlikely that the poorer health experience of ethnic minorities in the United Kingdom can be explained by differences in health behaviors. EXPLAINING THE RELATIONSHIP BETWEEN AGE AND ETHNIC INEQUALITIES IN HEALTH A Migration Effect?
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. was a small but significantly increased risk of fair or bad health with increasing years since migration, which would be consistent with a health selection effect wearing off over time.
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. The implication is that a change in the strength of traditional ethnic identities is not an explanation for ethnic inequalities in health in general, and does not contribute to the emergence of ethnic inequalities in health at older ages.
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There is an extensive literature on socioeconomic inequalities in health and how these might relate to ethnic inequalities in health (Davey Smith, Wentworth, Neaton, Stamler, and Stamler, 1996; Lillie-Blanton and Laveist, 1996; Navarro, 1990; Nazroo, 1998, 2001; Rogers, 1992)
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These findings are consistent with other explorations of the contribution of socioeconomic position to ethnic inequalities in health in the United Kingdom, which have suggested that across ethnic groups and across health outcomes, socioeconomic in 1.4 Not adjusted for socioeconomic effects 1.2 Adjusted for socioeconomic effects English 1.0 White 0.8 with 0.6 Compared 0.4 Ratio Odds 0.2 0.0 Caribbean Indian Pakistani Bangladeshi Chinese White minority FIGURE 18-5 Odds ratio for reported fair or bad health compared with white English: All ages. SOURCE: 1999 HSE (Erens, Primatesta, and Prior, 2001)
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, shows that reporting experiences of racial harassment and perceiving employers to discriminate against ethnic minorities are independently related to likelihood of reporting fair or poor health, and that this relationship is independent of socioeconomic effects. This may represent three dimensions of inequality operating simultaneously: economic disadvantage; a sense of being a member of a devalued, low-status group (British employers dis
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The fact that socioeconomic effects appear to be greater when all ages are considered, rather than just older people, might be a consequence of this -- contemporary measures of economic position may have less predictive value for outcomes that are a consequence of early or accumulated socioeconomic effects. So it may be that early life experiences are crucial, which in turn may mean that it will take a few generations of upward social mobility for ethnic inequalities in health at older ages to diminish.
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However, one context that does not appear to be changing dramatically in the United Kingdom is experiences of racial harassment and discrimination. The impact of this on health was briefly illustrated earlier, and shown to be a potentially very important determinant of ethnic inequalities in health.
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was the fourth in a series of studies on the lives of ethnic minorities in Britain, conducted by the Policy Studies Institute. It was a representative survey of the main ethnic minority groups living in Britain, together with a comparison sample of
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Topics covered included economic position, education, housing, health, ethnic identity, and experiences of racial harassment and discrimination.
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Explaining ethnic inequalities in health. Sociology of Health and Illness, 20(5)
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