Ethnic inequalities in mortality in England: a complex picture requiring tailored, evidence-based responses

The latest data from the Office for National Statistics (ONS) provides the most comprehensive and up to date national profile of ethnic inequalities in mortality overall and from common physical conditions. It shows a complex picture of ethnic inequalities in mortality in England, with differences between people from ethnic minority and the White British groups, between different ethnic minority groups, and across different health conditions.

The findings confirm earlier reports that people from ethnic minority groups, especially Black African and Chinese groups, have lower overall mortality than the White British group, often attributed to the ‘healthy migrant effect’. Beneath these headline figures, the data shows highly diverse patterns by ethnicity and health condition. There is further confirmation that, compared with the White British, South Asian but not Black groups experience high mortality from heart disease, and the reverse is seen for prostate cancer. Mortality from hypertension and diabetes (and chronic kidney disease that often results from diabetes), on the other hand, is high in both South Asian and Black groups. There are also differences between South Asian sub-groups, with Bangladeshi and Pakistani groups, but not Indians, having the highest mortality rates for many individual conditions, including Covid-19.

In contrast, most people from ethnic minority groups have lower mortality from some leading causes of death, eg, major cancers (such as breast, lung and colorectal cancer), chronic obstructive pulmonary disease, dementia and Alzheimer’s disease. However, the incidence of some less common cancers is higher in some groups, for example, liver cancer in Asian groups and prostate, uterine, blood cancer in Black groups.

'Ethnic minority groups are disproportionately affected by deprivation, a key determinant of health status in all communities.'

There is geographical variation too: ONS data shows the north of England and the Midlands having higher mortality than the south and London and repeats earlier ONS data findings that mortality overall and from most conditions is highest in deprived areas. Ethnic minority groups are disproportionately affected by deprivation, a key determinant of health status in all communities. The impacts of geography also need to be considered, as significant proportions of ethnic minority communities reside in areas of high mortality.

The ONS data is a powerful reminder that ethnic, deprivation-related and regional health inequalities are driven primarily by conditions that are largely preventable, eg, cardiovascular disease (CVD), diabetes and cancers caused by, eg, smoking and obesity. Moreover, this excess mortality reflects even greater burdens of ill-health, blighting the lives of individuals, families and communities. As the health, societal and economic impacts of long-term ill health continue to burgeon, pressures on NHS capacity and costs continue to mount, and health inequalities continue to widen, reducing the prevalence of potentially preventable conditions, especially among high-risk groups, has never been more urgent.

A complex interplay of factors drives ethnic differences in health, including the environment, socio-economic factors, where people live, health-related behaviours, susceptibility to disease, access to and uptake of services.

'There is no one-size-fits-all approach to improving the health of different ethnic communities.'

Therefore, there is no one-size-fits-all approach to improving the health of different ethnic communities. The government, NHS England and local government leaders, and others need to understand these nuanced differences. To improve the health of different ethnic minority communities, they must tailor policies to the specific needs of those communities, in the context of the multiple factors driving their health outcomes, including the local area in which they live. Without such evidence-based approaches, they will not be able to meet several of their key goals, for example, around improving population health and tackling unequal outcomes.

Policies to reduce the prevalence of behavioural risk factors (such as obesity, smoking, excess alcohol consumption, inadequate physical activity), which are the highest contributors to levels of and inequalities in mortality, must take precedence. Early detection and management of metabolic risk factors, such as obesity, high blood pressure, high cholesterol and blood glucose levels, also the leading contributors to mortality, is critical for reducing the onset and progression of common conditions that kill prematurely but are potentially preventable, eg, CVD, diabetes and cancer.

'It is imperative that government, health and care leaders and others work together to reduce the demand for health care, and do not focus only on meeting demand for health care.'

It is imperative that government, health and care leaders and others work together to reduce the demand for health care, and do not focus only on meeting demand for health care. The government’s major conditions strategy provides an opportunity for overdue improvements in the declining health of England’s population, and for reducing health inequalities, but it must be accompanied by adequate political resolve and resources to deliver more effective and timely interventions for preventing and managing ill health.