Professor Laia Bécares on the importance of a racially-just approach to collecting, analysing, and interpreting ethnicity data.
Ethnic health inequities are persistent in the UK. People from Pakistani, Bangladeshi, Black Caribbean, and White Gypsy or Irish Traveller ethnic groups experience poorer outcomes than the White majority population in health and healthcare.
Racism is a well-documented cause of these ethnic inequalities in health. Racism leads to poor health either directly, through physiological pathways, or indirectly, by patterning underlying social inequalities. In the UK, people from minoritised ethnic groups are more likely than people from the White majority group to live in more disadvantaged areas; have poorer housing or insecure tenures; have higher rates of unemployment; and work in less advantaged, lower paid occupations. All these factors have been associated with poor health, and evidence shows that socioeconomic inequalities make a substantial contribution to ethnic inequalities in health. However, most academic and policy discourses on ethnic inequalities rarely name racism as the underlying cause of socioeconomic disadvantage and poor health.
Current approaches to ethnicity in research and practice often conceptualise and analyse ethnicity as an individual-level risk factor without considering or theorising what is it about ethnicity that matters for health. Analyses such as these disregard the fundamental cause of ethnic inequalities: racism, and how it structures wider social, economic, and health outcomes over time. These analyses produce findings and policy insights that portray an essentialised notion of ethnicity as an individual characteristic that can’t be changed and that can only be acted on with policies that focus on modifiable characteristics like behaviour.
Racially-just approaches might instead frame analysis and interpretation in a way that conceptualises ethnicity not as a static individual-level risk factor, but rather as a medium by which difference is represented and otherness produced. Ethnicity matters for health, social, and economic outcomes not because of factors like genetics, behaviour or culture, but because it represents and captures how identities are racialised and societal inequalities are embodied. These approaches centre racism as the main explanatory – and changeable – factor leading to ethnic inequalities in health.
This difference in how ethnicity and ethnic inequalities are conceptualised and operationalised has important policy implications. Existent policy contexts have contributed a series of policies around culture, citizenship, and migration which are populist, essentialise ethnicity, and undermine the social status of ethnic minority people and communities. These policies reinforce processes of racialisation and are likely to have negatively affected social, economic, and health inequalities over time.
An example of analyses that apply a racially-just approach is this study, where we explored the direct and indirect effects of racism on health via socio-economic inequality. We used nationally representative, large-scale, longitudinal survey data from Understanding Society, to examine (i) the direct effect of experiences of racism and racial discrimination on physical and mental health of minoritised ethnic groups, and (ii) how these racist experiences affect their socioeconomic circumstances, which in turn influence health. In this work we centre racism as the fundamental cause of ethnic inequalities in health, understanding its effects on the health of minoritised ethnic groups over time, capturing both the direct effects of interpersonal racism on health, and the indirect effects of racism on health via socioeconomic inequality, which we measured using household income.
There were two key findings: first, we found indirect, long-term effects of racism on health, operating via reduced household income. This finding is important because it highlights the central role of racism in leading to reduced socio-economic positions for people from minoritised ethnic groups. Policy approaches to address ethnic inequalities in health cannot focus on socio-economic factors without also redressing the underlying processes of racism that reproduce them.
Second, we found that as it has been long-established, experiencing racial discrimination is harmful to health. Minoritised ethnic people who had experienced verbal or physical racist abuse, or who felt unsafe in public places due to their ethnicity, nationality, or religion had poorer health compared to people who did not report racist experiences. Associations between racial discrimination and poor health were direct and immediate.
Taken together, the findings demonstrate the persistence and pervasiveness of racism in severely and negatively impacting the health of people from minoritised ethnic groups in the UK. Academic and policy approaches that ignore racism as the fundamental cause of ethnic inequalities in health, social, and economic outcomes will only partially address ethnic inequalities in the long-term.
