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  • Author or Editor: James Nazroo x
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The relationship between ethnicity and health has received intermittent focus in work concerned with ethnic inequalities. However, a close examination of issues related to health is particularly useful for three reasons. First, it is here that we can see how broader social and economic inequalities translate into profound outcomes for ethnic minority people; and also how policy and practice typically translate the two deeply social phenomena of ethnicity and health into essentialised constructs that are typically reduced to biology. Second, by examining the ways in which health and social care are provided, and the outcomes of that care, we can explore how an institution that is central to our lives serves to address, or amplify, broader racialised social structures. Third, the provision of health and social care services continues to rely heavily on the labour of ethnic minority and migrant people, therefore an examination of the experiences and outcomes for ethnic minority employees in the NHS sheds light on the broader context of ethnic inequalities in the labour market. In this context, it is worth noting that a mix of racialised discourses have: framed ‘migrants’ as intruders and a drain on the NHS; located the prevalence of certain diseases in cultural norms; and positioned ethnic minority health care staff as ‘fillers’ and as less competent and desirable than White British workers.

Regrettably these discourses have had a surprising persistence and have been promoted in political and popular arenas. In 1948, those arriving on the Windrush to help rebuild after the Second World War and fill the gaps in health and transport were subject to explicit crude and violent racism and this hostility was not limited to personal prejudices.

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This chapter examines the patterning of ethnic inequalities in health in Great Britain. It discusses some of the assumptions that have underpinned much of the research and policy debate in relation to ethnic differences in health, and illustrates how far such differences are likely to be a consequence of the social inequalities faced by minority ethnic people in Britain. The chapter demonstrates how socioeconomic inequalities are too-readily dismissed as a potential explanation for ethnic inequalities in health, and shows how experiences of racial harassment and discrimination might also lead to an increased risk of poor health.

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State of the Nation

Available Open Access under CC-BY-NC licence. 50 years after the establishment of the Runnymede Trust and the Race Relations Act of 1968 which sought to end discrimination in public life, this accessible book provides commentary by some of the UK’s foremost scholars of race and ethnicity on data relating to a wide range of sectors of society, including employment, health, education, criminal justice, housing and representation in the arts and media.

It explores what progress has been made, identifies those areas where inequalities remain stubbornly resistant to change, and asks how our thinking around race and ethnicity has changed in an era of Islamophobia, Brexit and an increasingly diverse population.

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  • Younger (aged 25-49) White men had a consistent advantage in the labour market between 1991 and 2011 compared with those in other ethnic groups, who were more likely to be not working or working in less secure employment.

  • White women aged 25-49 also had a consistent employment advantage over the last 20 years compared with women in other ethnic groups.

  • Exceptions to the pattern of White advantage were Indian and Chinese men, whose initial high unemployment and self-employment rates converged with those of the White group over the 20-year period. Black Caribbean women had similar labour market participation rates to White women from 1991 to 2011.

  • At older ages (50-74), Black African men and women had the highest rates of labour market participation over the past 20 years. This is likely due to the age structure of the Black African group, where there are relatively few people aged over 65.

  • Younger Pakistani and Bangladeshi men saw large falls in unemployment rates over the period 1991-2011 (respectively, from 25 to 10 per cent and from 26 to 11 per cent), but unemployment rates for these groups remain much higher than for White men.

  • Black Caribbean and Black African younger men had rates of unemployment consistently more than double those of White men throughout the period 1991-2011.

  • For Bangladeshi men, the fall in unemployment was balanced by a rise in part-time work; the 11-fold increase in part-time work for this group between 1991 and 2011 was larger than for any other ethnic group.

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Associations between ethnicity and health status have been noted from the time when quantitative health data were first recorded. Thus in 1845 Frederich Engels noted the poor health and mortality record of the Irish living in England.1 Engels also drew attention to the miserable social and environmental circumstances in which the majority of the Irish population lived and it is clear that he considered these to underlie their poor health. Similarly, in a 1916 report from the US, John W. Trask concluded that the lower death rates among white people than black people reflected more favourable socioeconomic circumstances, rather than any inherent ethnic differences.2 Since then the complex interrelationships between ethnicity, social position and health have remained a central concern of studies in this area, as the material presented in this chapter indicates.

The approach we have taken is an epidemiological one. Descriptive epidemiology provides data on how disease, disability and death are distributed between and within populations. Analytical epidemiology aims at uncovering the causes of disease and thus the reasons for the distribution of disease that are seen. Epidemiological studies concerned with ethnicity have taken both descriptive and analytical approaches. There are now extensive data demonstrating differentials in health status between ethnic groups and a growing body of literature analysing the contribution of socioenvironmental factors to this.

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