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Long read

The health of people from ethnic minority groups in England

Authors

This long read examines ethnic differences in health outcomes, highlighting the variation across ethnic groups and health conditions, and considers what’s needed to reduce health inequalities.

This explainer was originally written by Veena Raleigh and Jonathon Holmes. It was published on 17 February 2021 and updated on 17 September 2021. This latest update was written by Veena Raleigh and published on 17 May 2023.

Key messages

  • In England, there are health inequalities between ethnic minority and white groups, and between different ethnic minority groups.1  The picture is complex, both between different ethnic groups and across different conditions.

  • Access to primary care health services is generally equitable for ethnic minority groups, but this is less consistently so, for example dental health care. However, people from some ethnic minority groups are more likely to report being in poorer health and to report poorer experiences of using health services than their white counterparts.

  • Before the Covid-19 pandemic, life expectancy at birth was higher among ethnic minority groups than the white and Mixed groups. The headline figures conceal significant differences between ethnic groups, for example:

    • people from the White Gypsy or Irish Traveller, Bangladeshi and Pakistani communities have the poorest health outcomes across a range of indicators

    • rates of infant and maternal mortality, cardiovascular disease (CVD) and diabetes are higher among Black and South Asian groups than white groups

    • mortality from cancer, and dementia and Alzheimer’s disease is highest among white groups.

  • The Covid-19 pandemic has had a disproportionate impact on most ethnic minority communities. They experienced higher infection and mortality rates than the white population, in large part due to differences in location, occupation, deprivation, living arrangements and health conditions such as CVD and diabetes. Ethnic differences in Covid-19 mortality declined over the course of the pandemic, and by 2022 there was no excess in ethnic minority groups compared with the White British group.

  • In 2020, Covid-19 caused overall mortality in some ethnic minority groups to exceed that of the white population, reversing the pre-pandemic picture. However, by 2022 overall mortality rates returned to pre-pandemic patterns, with the white and Mixed groups again having the highest mortality.

  • Unpicking the causes of ethnic inequalities in health is difficult. Available evidence suggests a complex interplay of many factors including deprivation, environment, health-related behaviours and the ‘healthy migrant effect’2 . Most ethnic minority groups are disproportionately affected by socio-economic deprivation, a key determinant of health status in all communities.

  • Among ethnic minority groups structural racism can reinforce inequalities, for example, in housing, employment and the criminal justice system, which in turn can have a negative impact on health. Racism and discrimination can also have a negative impact on the physical and mental health of people from ethnic minority groups.

  • Covid-19 has shone a light on inequalities and highlighted the urgent need to strengthen action to prevent and manage ill health in deprived and ethnic minority communities. A cross-government strategy for reducing health inequalities (and the wider socio-economic and structural inequalities that drive them) and addressing the diverse health needs of all groups at risk of poor health and high mortality has never been more urgent.

  • Comprehensive, good-quality data is essential for enabling policy-makers and health care professionals to identify the specific needs of different ethnic groups, respond with tailored strategies for addressing inequalities, and track the impact of these strategies.

The references providing the evidence to support the contents of each section are listed at the end.

Introduction

In the 2021 census, 19 per cent of people in England identified themselves as belonging to a non-white ethnic minority group (see Table 1). Ethnicity is a complex, multidimensional concept, defined by features such as a shared history, origins, language, and cultural traditions. Although it is a social construct often used to describe distinct populations, it is a subjective identity based on how individuals define themselves.

Health patterns differ significantly between ethnic minority groups and the white population, and between different minority groups, reflecting the diversity of demographic, socio-economic, behavioural, cultural and other characteristics between ethnic groups.

This explainer provides an overview of health outcomes and their determinants among ethnic minority groups. It focuses on selected topics where ethnic differences are significant and affect large numbers.

This explainer describes ethnic differences in:

  • overall health

  • maternal and infant mortality, and child health

  • cardiovascular disease (CVD)

  • diabetes

  • cancer

  • Covid-19

  • determinants of health.

This is not a comprehensive review of all aspects of ethnic minority health. In particular, it does not cover mental health because of the challenges in summarising ethnic differences across diverse forms of mental illness in a short report.

Data on the health of ethnic minority groups

This explainer focuses on the health of ethnic minorities in England. Where articles and data sources refer to different geographies, eg, England and Wales or the UK, this is stated in the text.

The ethnic categories used here are those used in the original data sources. In most cases these are the 2011 census categories because, although the ethnic group classification was modified in the 2021 census, most data sources predate these recent changes. Sometimes data sources refer to aggregated ethnic groups. The aggregated white group includes British, Gypsy or Irish Traveller, Irish, Roma and Other White groups. The South Asian group refers to people from India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan. The Asian group generally also includes people from South East Asia. The Black group includes people of African and/or Caribbean origin.

Much of the data for examining ethnic differences in health comes from health records. However, its coverage and quality are imperfect. National data on mortality by ethnic group has not been available routinely because ethnicity is not recorded at death registration (although Scotland introduced this in 2012). Earlier analyses of mortality therefore used country of birth of migrants as a proxy for ethnicity, but this excludes second-generation migrants. Since 2021, the Office for National Statistics (ONS) has linked death records to other data sources from which ethnicity is derived, eg, census and hospital records; these provide the best available national data on mortality by ethnicity but the results are subject to caveats. These data limitations present barriers to understanding health issues among ethnic minority groups.

Following the Covid-19 pandemic, NHS England is taking steps to improve ethnicity recording in health records and the government has said it will introduce ethnicity recording in death certificates. These data developments should facilitate a better understanding of ethnic differences in health.

Overall health

General health can be measured by self-reported outcomes, such as how people perceive their health, and observed outcomes such as mortality. There are differences in health between ethnic minority groups, and between ethnic minority groups and the white group; the patterns vary depending on the aspect of health being measured.

People from some ethnic minority groups (especially Pakistani and Bangladeshi groups) are more likely than White British people to report having a long-term condition and poor health, with the White Gypsy or Irish Traveller group reporting the poorest health. Health-related quality of life scores at older ages, based on responses to the GP Patient Survey, are lower among most ethnic minority groups, especially the White Gypsy or Irish Traveller, Bangladeshi and Pakistani groups. Levels of diagnosed ill health are higher in Pakistani, Bangladeshi and Black Caribbean groups than in the aggregated . Poor health co-existing with lower mortality has often been reported for migrant groups, including in the UK.

’Experimental’ ONS statistics show that in 2011–14, life expectancy at birth among people of the white group and Mixed groups was lower than in all other ethnic groups (see Figures 1a and 1b below), and that the had higher mortality from most leading causes of death. Although overall mortality declined subsequently in all ethnic groups, ethnic differences remained similar through to recent pre-pandemic years: in 2017–19 the white group had higher overall mortality than any other ethnic group.

However, the pandemic reversed the all-cause mortality advantage in some ethnic minority groups over the white group because of the significantly higher Covid-19 mortality they experienced. Ethnic differences in Covid-19 mortality declined during the course of the pandemic, and by 2022 overall mortality rates reverted to pre-pandemic patterns with the White groups again experiencing the highest mortality.

Using more granulated ethnic categories, ONS data for the 2020–22 pandemic period shows that mortality rates from all causes were highest for the White Gypsy and Irish Traveller group; the Mixed White and Black Caribbean group and White Irish group also had higher all-cause mortality rates compared with the White British group.

The ONS findings are consistent with other evidence that most ethnic minority groups and foreign-born migrants in England and Scotland had lower overall mortality than white counterparts before the Covid-19 pandemic. This could be due to many factors including the ‘healthy migrant effect’, which might mitigate some impacts of socio-economic disadvantage. Moreover, some risk factors, eg, smoking and alcohol consumption, are lower among ethnic minority groups. Studies also show that this mortality advantage among migrants is reduced over time and in UK-born descendants – possibly because cultural assimilation over time leads to lifestyle changes, eg, in diet and smoking.

A graph showing male life expectancy at birth by ethnic group, England and Wales, 2011-14 A graph showing female life expectancy at birth by ethnic group, England and Wales, 2011-14

Source: ONS (2021) https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/articles/ethnicdifferencesinlifeexpectancyandmortalityfromselectedcausesinenglandandwales/2011to2014

Maternal mortality, stillbirths and infant mortality, and child health


Maternal mortality

More than one-quarter (28 per cent) of the 595,300 babies born in England in 2021 were to mothers of non-white ethnic minority origin (see Table 2).

Compared with the white group, the rate of women dying in the UK in 2018–20 during pregnancy or up to 6 weeks after the end of their pregnancy was 3.7 times higher in the Black group, and 1.7 times higher in the Asian group (although the number of such deaths is relatively low – fewer than10 a year in both the Black group and the Asian group). Deprivation and pre-existing medical problems are significant risk factors for maternal mortality.

Stillbirths and infant mortality3

Although stillbirth and infant mortality rates in England and Wales have fallen in all ethnic groups since 2007, they remain higher among ethnic minority groups. They are highest among babies from the Pakistani and Black groups (see Table 2).

The causes of infant mortality differ between ethnic groups. South Asian and Black mothers have higher proportions of premature and low birthweight babies than white mothers. Immaturity-related conditions, such as respiratory and cardiovascular disorders, contribute most to infant mortality in most ethnic groups; however, in the Pakistani and Bangladeshi groups congenital anomalies cause the most infant deaths. Babies of South Asian women have a lower rate of unexplained deaths in infancy. Explanations for these ethnic variations in infant mortality are complex, involving the interplay of environmental, physiological and socio-cultural factors. Deprivation is a significant risk factor: compared with white groups, higher proportions of mothers from ethnic minority groups, especially Black groups, live in more deprived areas.

Table 2 Live births, stillbirths and infant mortality by ethnic group, England 2021

Ethnic groupLive birthsPer cent of live births StillbirthsStillbirth rate per 1,000 total birthsInfant deathsInfant mortality rate per 1,000 live births
White British349,84058.81,2173.51,0353.0
White Other72,14412.12803.92072.9
Bangladeshi9,9861.7393.9434.3
Indian22,7223.81165.1914.0
Pakistani26,7454.51575.81756.5
Other Asian15,6412.6654.1543.5
Black African20,7333.51467.01426.8
Black Caribbean5,0670.9346.7254.9
Other Black3,7330.6266.9267.0
Mixed/Multiple42,1557.11814.31663.4
Other13,8172.3624.5433.1
Not stated12,7172.11118.712710.0
TOTAL595,3001002,4344.12,2093.7

Source: ONS (2023)

Child health

Health and wellbeing in the early years have a significant bearing on future health. Childhood overweight and obesity rates are higher among children in Black, Mixed White and Black, Bangladeshi and Pakistani groups (see Table 3). Some of these differences may be associated with higher levels of deprivation among ethnic minority groups, as children living in the most deprived areas are almost twice as likely to be obese than those in the least deprived areas. Children in Asian and Black households are more likely to live in persistent low-income households than children from white households.

South Asian children have lower levels of physical fitness than children in white European and Black groups, and physical activity levels are lower among children from ethnic minority groups compared with white groups.

Table 3 Prevalence of obesity by ethnic group, England, 2019/20

Ethnic groupReception (4–5 years)Year 6 (10–11 years)
White British22.935.5
White Irish22.738.3
Other White20.238.7
Bangladeshi22.247.7
Indian14.438.7
Pakistani20.243.7
Other Asian19.642.1
Black African30.349.6
Black Caribbean26.148.1
Other Black29.448.9
White and Asian16.234.2
White and Black African27.643.8
White and Black Caribbean26.643.5
Other Mixed21.638.7
TOTAL22.337.8

Source: NHS Digital 2022

Cardiovascular disease

Cardiovascular disease4  (CVD) is a leading cause of death nationally and in ethnic minority groups, causing 24 per cent of all deaths in England and Wales in 2019. It is a significant contributor to inequalities in life expectancy and a risk factor for poor outcomes from Covid-19. Up to 80 per cent of premature deaths from CVD are preventable through better public health and prevention of risk factors such as obesity, inadequate physical exercise and diabetes.

Prevalence of and mortality from CVD

Studies in the UK and across the Indian diaspora (eg, Europe, Fiji, Singapore, South Africa, the US and Canada) consistently show a higher incidence, prevalence and mortality from CVD in South Asian groups compared with the white group or national average. South Asian groups have the highest mortality from heart disease and also develop heart disease at a younger age. As with heart disease, stroke incidence and mortality are also higher in the South Asian population. CVD mortality is high and rising in South Asia, in contrast to the declining trend elsewhere.

These patterns are associated with a higher clustering in South Asians of risk factors5 that increase the risk of heart disease, stroke and diabetes. Although body mass index (BMI) levels are lower among South Asian groups compared with normal ranges, rates of excess abdominal fat and insulin resistance are higher. Hence National Institute for Health and Care Excellence (NICE) guidelines specify lower BMI thresholds for use by health care professionals for introducing preventive interventions in these groups. In terms of other risk factors, although smoking prevalence is lower among South Asian groups, they have low physical activity rates, especially among women. The causes of increased CVD risk among South Asian groups are multifactorial and include physiological susceptibility, environmental determinants such as deprivation, and adverse changes to lifestyle and diet following migration.

In contrast to South Asian groups, Black groups in the UK have a significantly lower risk of heart disease compared to the majority of the population, despite having a high prevalence of hypertension and diabetes (risk factors for heart disease and stroke). Lower cholesterol levels among people of African Caribbean heritage than white Europeans may protect them against heart disease. Heart disease rates are low in sub-Saharan Africa and the Caribbean.

However, Black groups have higher-than-average incidence of and mortality from hypertension and stroke, and they have strokes at a younger age. The prevalence of hypertension, a risk factor for stroke, is high in Africa and the West Indies. Obesity levels are also higher in Black groups, with NICE guidelines specifying lower BMI thresholds for them.

Care for CVD

Recent evidence suggests that greater awareness among health care providers of the CVD risk in South Asian populations, earlier diagnosis and improved management of diabetes and CVD, together with second-generation adopting healthier lifestyles than first-generation migrants, have reduced CVD mortality risks relative to white Europeans. Research also indicates that South Asian groups have equitable access to care for heart disease and better survival rates from it. Primary care audit data shows that the Asian group compares more favourably than other ethnic groups, including white groups, .

In contrast, Black groups have lower than expected rates of access to and use of cardiovascular care. Black and Mixed ethnic groups are also less likely than other ethnic groups to be prescribed drug therapy, receive regular monitoring, or reach target treatment thresholds (eg, blood pressure within target range) on various CVD measures in primary care.

Diabetes

Diabetes6  is a long-term condition that can cause serious secondary complications and premature death if it is not well managed. This explainer considers type 2 diabetes. Being overweight, abdominal obesity and physical inactivity are risk factors for diabetes. The prevalence of diabetes is higher among South Asian and Black groups than in the white population and people in these groups develop the condition at a younger age.

Prevalence of and mortality from diabetes

The risk of developing diabetes is up to six times higher in South Asian groups than in white groups and South Asian groups have higher mortality from diabetes. About 400,000 people of South Asian ethnicity in the UK have diabetes, one-fifth of the UK diabetes population. High diabetes prevalence is seen also in their countries of origin and across the South Asian diaspora worldwide, eg, in Europe, the US, Canada, the Caribbean, South Africa, Fiji. South Asians with diabetes have a higher risk of developing secondary complications of cardiovascular and end-stage renal disease. However, recent studies show that excess CVD mortality in South Asians with diabetes has reduced and overall mortality is lower than in the white group.

Explanations for the high prevalence of diabetes among South Asian groups include a mix of biological, lifestyle and socio-economic factors. As with CVD, these patterns are associated with a clustering in South Asians of risk factors (see footnote 3) that increase the risk of diabetes, exacerbated by socio-economic disadvantage and changing lifestyles after migration. Even though South Asians typically have a low BMI, excess abdominal fat increases the risk of diabetes and CVD. Accordingly, NICE, the World Health Organization and several national diabetes associations recommend lower BMI thresholds for introducing preventive measures in South Asians with diabetes.

Diabetes prevalence in Black groups is up to three times higher than in the white population and they have higher mortality from diabetes; they also have a higher risk of hypertension and stroke but, unlike South Asians, are less prone to heart disease. The physiological pathways and impacts of diabetes therefore differ between ethnic minority groups. Diabetes-related co-morbidities in Black groups are similar to or lower than in white groups, except for higher rates of end-stage renal disease. Like South Asians, excess mortality associated with diabetes is lower in Blacks groups than in the white population.

Care for diabetes

One study found improved diabetes outcomes in South Asians are attributable, in part, to earlier diagnosis and risk factor management, indicating increased awareness among health care providers, equity of access and standardisation of care for long-term conditions incentivised in the Quality and Outcomes Framework for GPs. It also found little evidence of inequalities in the management of diabetes among Black patients at initial diagnosis, indicative of a wider trend of shrinking inequalities in diabetes care.

However, it is also reported that although diabetes treatment was initiated earlier in South Asian and Black groups than in white groups, they were slower to receive subsequent longer-term treatment which can contribute to worse outcomes.

Cancer


Cancer incidence

The incidence of cancer overall is generally lower among ethnic minority groups in England than in white groups. Asian, Chinese and Mixed groups have a significantly lower risk (of 20–60 per cent) of getting cancer than the white group; smoking rates are generally lower in these groups. Cancer incidence is also lower among Black women compared with white women but similar in Black and white men.

In terms of specific cancers, Asian groups have a higher incidence than the white group of cancer of the liver and mouth (females only), and a lower risk of the four major cancers (breast, prostate, lung, colorectal) and several less common cancers.

Black groups have a significantly lower incidence of three major cancers (breast, lung and colorectal) and several less-common cancers. However, the incidence of and mortality from prostate cancer is significantly higher among Black males than white males. Black men in Africa, the Caribbean and the US are also at greater risk of prostate cancer for reasons that are unclear.

Although lower breast cancer incidence in Asian and Black women is associated with a lower risk profile (such as lower alcohol consumption, breastfeeding, childbearing), cultural assimilation over time can lead to changes in health behaviours. Some evidence suggests cancer rates in South Asian groups are converging towards those in the white population.

Cancer screening

Screening is an important part of efforts to reduce cancer mortality. Screening rates for breast and cervical cancer are lower among women from ethnic minority groups, particularly South Asians. South Asians also have lower rates of bowel cancer screening.

Poorer awareness of risk factors for cancer and symptoms, and socio-cultural and practical barriers such as language, contribute to lower cancer screening rates among ethnic minority groups.

Stage at diagnosis

The stage at which cancer is diagnosed can have an impact on treatment outcomes and mortality. It may be related to a patient’s route to diagnosis, including through screening. Although data for 2012–13 showed the Black Caribbean group was more likely than White British to be diagnosed late for some cancers, 2017 data shows the proportion of early-stage cancer diagnoses among Asian and Black groups (55 per cent) was similar to the white group (52 per cent). Research has also found weak evidence of ethnic inequalities in times to cancer diagnosis and staging.

However, higher rates of late-stage diagnoses are reported for Black and Asian women for breast, ovarian, uterine and colon cancers compared with White British women. Possible reasons suggested include poorer symptom awareness, delays in seeking help or referral and lower screening uptake. Conversely, men from Black groups had lower rates of late-stage diagnosis for prostate cancer.

Cancer mortality

Cancer mortality rates measure cancer deaths in relation to population size, and reflect both cancer incidence (ie, the numbers who develop cancer) and the deaths from it. Overall cancer mortality rates are lower among ethnic minority groups compared with white groups. However, lung cancer mortality is higher among Bangladeshi males and prostate cancer mortality is higher among Black males.

Cancer survival measures the proportion of people with cancer who survive, and reflects many factors including deprivation, stage at diagnosis and quality of care. Cancer survival in ethnic minority groups is reported to be similar to the white population.

Covid-19

The Covid-19 pandemic had a disproportionate effect on ethnic minority groups, with Black, Asian and most other ethnic minority groups more likely to be diagnosed with Covid-19, become severely ill and die compared to the white population. Several factors contributed to these patterns.

Outcomes of Covid-19

Exposure to infection was higher among ethnic minority groups because, for example, they are more likely to work in public-facing jobs such as transport and health and social care, use public transport, and live in high-density housing, multi-generation households and urban areas where transmission is higher. People from South Asian and Black groups also have a higher prevalence of obesity and long-term conditions such as CVD, hypertension and diabetes, which increase the risk of adverse outcomes and death from Covid-19.

In the early stages of the pandemic when Covid-19 mortality was at its highest, most ethnic minority groups had significantly higher Covid-19 mortality rates than the White British group, explained in large part by ethnic differences in factors such as location, occupation, deprivation, household arrangements, pre-existing health conditions and vaccination status. Covid-19 mortality rates declined in all ethnic groups over the course of the pandemic, and by 2022 rates in ethnic minority groups were no longer higher than in the White British group. The reduction of ethnic differences in mortality risks points to the mitigating effects of public health measures including vaccination. Over the 2020–22 pandemic period as a whole, Covid-19 mortality rates were highest among Pakistani and Bangladeshi groups.

Determinants of health

Here we examine ethnic differences in some key determinants of health, namely behavioural risk factors, access to health care services, and socio-economic factors.

Selected behavioural risk factors

Smoking, high alcohol consumption, physical inactivity and a poor diet are principal behavioural risks to health; the latter two also cause obesity. Their prevalence varies across the population, although they tend to cluster in more deprived communities.

Smoking

Smoking prevalence is lower in most ethnic minority groups than in the white group, and highest in the Mixed group (see Figure 2).

A graph showing the percentage of people over 18 who smoke in England in 2021
Alcohol consumption

Adults in ethnic minority groups are less likely to drink alcohol at a hazardous, harmful or dependent level compared to white groups (see Figure 3).

Percentage of people aged over 16 who drink at harmful levels in England
Physical activity

Physical activity levels differ between ethnic groups and genders. People from Asian and Black groups, women in particular, are least likely to report being active (see Figure 4).

A graph showing people over 16 years of age who were physically active
Healthy eating

The proportion of people eating recommended portions of fruit or vegetables per day is lower in ethnic minority groups than in white groups (see Figure 5).

Graph showing amount of people over 16 who eat 5 a day
Obesity

Compared with the White British group, the proportion of people who are overweight or obese is higher in Black adults and lower among most other minority groups (see Figure 6).

A graph showing the percentage of people over 18 who are overweight or obese

Access to services and patient experience

Free, universal access to health care and standardised treatment protocols have improved equity of access and outcomes across ethnic groups, especially in primary care, but less consistently across other health services. Patients from some ethnic minority groups report a poorer experience of using some health care services than the White British group. However, the patterns differ between ethnic groups and services, with no ethnic differences, from some ethnic minority groups compared with the white group, in some NHS patient surveys.

As we have shown, there are different patterns of health across different ethnic groups. Moreover, ethnic minority communities experience a higher burden of some conditions that are potentially preventable. For example, much of the excess morbidity and mortality from CVD and diabetes among Asian and Black groups is associated with modifiable risk factors. Prevention should therefore be a priority for public health and health care services. Low health literacy, potentially exacerbated by language barriers, can lead to unhealthy behaviours and poorer uptake of preventive services. Modes of disease presentation and therapeutic needs may also differ by ethnicity.

Health care services therefore need to be aware of the specific health care needs, risk factors and treatment requirements in different communities and ensure services are culturally tailored to promote adherence. For example, the incidence of diabetes among ethnic minority groups can be moderated through dietary and physical activity modifications, and culturally tailored diabetes programmes are effective at improving outcomes. Research shows that culturally adapted interventions can improve participation in cancer screening.

Socio-economic inequalities

There is a strong, systemic relationship between health and deprivation, with more deprived communities experiencing worse health and a shorter life-expectancy than less deprived groups. Deprivation levels are higher among most ethnic minority groups and these groups are over-represented in more deprived communities. In 2019, people from all ethnic minority groups except the Indian, Chinese, White Irish and White Other groups were more likely than White British people to live in the 10 per cent of neighbourhoods in England.

There are significant socio-economic differences between ethnic minority groups, and below we give some examples.

  • Data for 2018–21 shows that the proportion of households with a low weekly income (below £600) is highest in the Black groups. The proportion with a weekly income over £1000 is highest (about 40 per cent) in Indian and Chinese groups, and lowest in Bangladeshi (18 per cent), Black (22 per cent) and Pakistani (25 per cent) groups; this compares with 29 per cent of White British households.

  • In 2021 unemployment was highest in Black, Mixed, Pakistani and Bangladeshi groups, and lowest in white and Indian groups. Most ethnic minority children had higher attainment scores at Key Stage 4 (GCSE level in 2020-21 than the White British group, with the exception of White Gypsy/Roma, White Irish Traveller and Black Caribbean pupils. White pupils on free school meals had the lowest score.

Data from the 2021 census shows the following.

  • The proportion with a higher educational qualification is highest in Chinese and Indian followed by Black African groups, and lowest in the White Gypsy or Irish Traveller and White Roma groups.

  • The proportions in professional occupations (eg, doctors, teachers, lawyers) or working as managers, directors or senior officials is highest in the Chinese, Indian and White Irish groups; the proportion working in occupations requiring fewer qualifications is highest in White Gypsy or Irish Traveller and White Roma groups.

  • Patterns of home tenure vary significantly between ethnic groups: the proportion of people living in social rented housing is highest in Black, Mixed White-Black and White Gypsy or Irish Traveller groups, and lowest in the Indian and Chinese groups; the proportion owning their home is highest in Indian and White British groups and lowest in Black and Mixed White-Black groups; overcrowding is highest in Bangladeshi households.

Structural racism and marginalisation

The wider social context contributes to ethnic and other social inequalities. Evidence documents the prevalence of racism and discrimination in the UK, and the negative effects these can have on the physical and mental health of people from ethnic minority groups. They can also create barriers to accessing health information and health care services. Structural racism can also have an impact on health outcomes, operating via exclusionary frameworks that marginalise minority groups in, for example, the housing, employment and criminal justice systems.

Conclusion

This explainer describes some ethnic inequalities in health, such as higher mortality among infants, a greater disease burden from diabetes and CVD among ethnic minority groups, and higher cancer mortality in the white group. Strategies for improving the health of England’s deprived and ethnic minority communities need to address the multiple factors that have an impact on their health. 

  • The role of public health and NHS services: the Covid-19 pandemic has highlighted the urgent need to strengthen action to prevent and manage ill health in deprived and ethnic minority communities, with their active engagement to ensure that the planning and delivery of services takes account of their needs, experiences and expectations.

  • Addressing the wider determinants of health: the disproportionate impact of Covid-19 on deprived and ethnic minority groups has highlighted the urgent need for a cross-government strategy to address health inequalities and the wider socio-economic and structural inequalities that drive them, and which addresses the diverse health needs of all groups at risk of poor health and high mortality. The government, NHS organisations and local authorities have a key role to play in implementing this agenda.

  • Tackling structural racism: this requires action across national, local and societal levels. The NHS has a significant role to play in ensuring that health service provision is equitable and meets the needs of all communities, including ethnic minority communities. 

  • Data: comprehensive, good-quality data is essential for enabling policy-makers and health care professionals to identify the specific needs of different ethnic minority communities, respond with tailored strategies for addressing inequalities, and track their impact.

 

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