The effect of ethnic density on health Laia Bécares, James Nazroo & Mai Stafford UPTAP/BURISA...

The effect of ethnic density on health

Laia Bécares, James Nazroo & Mai Stafford

UPTAP/BURISA Workshop

26th September 2008

0.5

1

1.5

2

2.5

3

3.5

4

Caribbean Indian Pakistani Bangladeshi Chinese

Od

ds

ratio

(95%

C.I.

)

Controlled for age and gender Source: Health Survey for England 2004

Odds of reporting fair or poor health compared with White English

Health Inequalities

• Socio-economic inequalities

• Migration effects

• Culture – lifestyle

• Genetic differences

• Access to and quality of healthcare

• Racial harassment and discrimination

Racial Discrimination in the UK

• Interpersonal or institutional

• 25% of ethnic minority people fearful of racial harassment

• 20% of ethnic minority people report being refused a job for racial reasons– 3/4 of them say it has happened more than once

• 20% of ethnic minority people believe that most employers would refuse somebody a job for racial reasons

Fourth National Survey on Ethnic Minorities, Moodod et al., 1997

Area deprivation and Health

• Segregation - social manifestation of individual prejudices and institutional discrimination3

• Caribbean, Pakistani, Bangladeshi, and to some extent Indian people, more likely to reside in disadvantaged wards

• Neighbourhood effects associated with risk of all-cause mortality, infant and child health, chronic disease among adults, and health behaviour4

3. Williams et al., 2000; 4. Pickett & Pearl, 2001

Sample Characteristics – Area Deprivation

Area Deprivation – 1999 & 2004 HSE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Most Deprived

2

3

4

5

Least Deprived

Ethnic Density Effect

• As the proportion of an ethnic minority group increases, their health complications will decrease5

• Associated with better mental health, better pregnancy outcomes, reduced mortality and morbidity

• Results not consistent – methodological and measurement limitations

5. Faris & Dunham, 1939; Halpern & Nazroo, 2000

Pathways between Ethnic Density & Health

UPTAP project hypothesises that ethnic density impacts on health through:

1.Social norms

2.Buffering effect against racism

3.Increased political mobility

1. Social Norms Model

Decreased likelihood that an ethnic minority person will experience racial harassment through:

Informal social control

Low tolerance against discrimination

2. Buffering Effect Model

• Social support protects from potentially pathogenic influence of stressful events such as discrimination

• Hypothesised to act through 2 ways:

– change in appraisal process of stressful event

– recognition and discussion of event with others

3. Increased Political Mobility Model

Stronger sense of community and belongingness produces and is fuelled by increased political mobility

Better services for the community

Data

• 1999 & 2004 Health Survey for England

• Fourth National Survey of Ethnic Minorities (1993-1994)

• 2005 & 2007 Home Office Citizenship Survey (forthcoming)

Ethnic Density

• From UK Census

• At ward & MSOA level

• Individual ethnic group density

• Overall ethnic minority density

• Continuous

• Categorical

Ethnic Density and Racism

Experiences of racism by a 10% increase in own ethnic density

0.6

0.65

0.7

0.75

0.8

0.85

0.9

0.95

1

1.05

Caribbean Indian Pakistani Bangladeshi

Unadjusted Age and sex

Age, sex and SES Age, sex and area deprivation

***

**

***

** **

**

Source: FNS data *p<.05, **p<.01, ***p<.001

Od

ds

Rat

io

Experiences of racism by a 10% increase in overall ethnic minority density

0.8

0.85

0.9

0.95

1

1.05




*

**** **O

dd

s R

atio


Ethnic Density and Mental Health

Reports of psychotic symptomatology by a 10% increase in own ethnic density

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4




****

** ** ***

****

***

Od

ds

Rat

io


Reports of psychotic symptomatology by a 10% increase in overall ethnic minority density

0.75

0.8

0.85

0.9

0.95

1

1.05

1.1




****

*****

Od

ds

Rat

io


Ethnic Density and Physical Health

Reports of fair, poor or very poor health by a 10% increase in own ethnic density

0.95

1

1.05

1.1

1.15

1.2

1.25




*

Od

ds

Rat

io


Reports of fair, poor or very poor health by a 10% increase in overall ethnic minority density

0.90.920.940.960.98

11.021.041.061.081.1




**

** ** ** **

Od

ds

Rat

io


Ethnic Density and Alcohol Use

0,4

0,5

0,6

0,7

0,8

0,9

1

1,1

Caribbean African Indian Pakistani

Od

ds

ra

tio

Adjusted for age, gender, SES, area deprivation, and generation

Odds of reporting current drinking by a 10% increase in own ethnic density

*p<.05, **p<.01, ***p<.001

***

***

0,8

0,85

0,9

0,95

1

1,05

Caribbean African Indian Pakistani

Od

ds

ra

tio

Adjusted for age, gender, SES, area deprivation, and generation

Odds of reporting current drinking by a 10% increase in overall ethnic density

*p<.05, **p<.01, ***p<.001

**

**

Conclusions

• Ethnic minorities who live in areas of greater ethnic density experience less racism

• Ethnic density protective of mental health and current alcohol consumption

• Ethnic density performs differently across ethnic groups and health outcomes

• Still to come: political participation, social networks and sense of community

Implications

• Protective benefits of ethnic density found but picture still inconclusive – further research

• Understanding pathways behind ethnic density can help us better understand healthy communities

• Additional evidence for the detrimental impact of racism on health

The effect of ethnic density on health

Laia Bécares, James Nazroo & Mai Stafford

UPTAP/BURISA Workshop

26th September 2008

The effect of ethnic density on health Laia Bécares, James Nazroo & Mai Stafford UPTAP/BURISA...

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