Introduction

The study investigates health inequalities amongst older people from different ethnic groups in Britain. This is a critical issue with widespread policy implications. The 2001 Census indicates that 27% of people aged 50-64 report a limiting long-term illness such as diabetes, hypertension and stroke. This proportion rises to 54% amongst people of Bangladeshi origin, 49% amongst those of Pakistani origin, 36% amongst Black Caribbeans and 28% amongst Black Africans. Interestingly, only 20% of Chinese individuals of the same age report such ill health condition (Census, 2001; Evandrou, 2005; Nazroo, 2006). Thus, differences in health across ethnic groups in Britain is an established area of study, however there had been less of a focus on ethnic inequalities in health at older ages compared to inequalities amongst younger age groups of the population (Cooper et al., 2000; Evandrou, 2000; Ginn & Arber, 2000; Grundy & Holt, 2001; Nazroo, 2003). Data limitations have had a significant impact on investigations of ethnic inequalities in health (Davey Smith, 2000; Nazroo, 2003). Some commentators argue that the number of older people from minority ethnic groups is currently small and that migrants tend to return to their homeland in old age (Cooper et al., 2000; Curtis & Lawson, 2000). As a result, the research on the association between poor health and socio-economic status (SES) at older ages amongst minority groups remains rather fragmented.

The ageing of the UK population is well documented and a better understanding of ethnic minority health is essential given the growing numbers (figure1.1.1) in the UK and their current anticipated age profile (2001 Census; Davey Smith et al., 2000; Evandrou, 2000; Nazroo 2003). However, the ageing of ethnic minority communities and the implications for health and health care needs has received far less attention. In fact ‘ageing’ and ‘ethnicity’ are rarely integrated within health research. There are over 4.6 million individuals belonging to minority ethnic groups in the UK, with a quarter million aged 60 years or over (2001 Census).

The ageing of these communities over the next two decades places greater emphasis on the importance of empirical evidence on their health status and the policy implications in providing older ethnic elders with appropriate health care. Thus, older people from ethnic minority groups are the focus for the study because they remain to some extent under-researched. Several studies (Cooper et al., 2005; Davey Smith et al., 2000; Evandrou, 2000; Nazroo et al., 2003), have identified SES and health as complex and multifaceted. However, ill-health amongst ethnic minorities becomes more marked with increasing age (Nazroo et al., 2003; Nazroo & Williams, 2006). Research on the health of ethnic minorities indicates that individuals who are poorer and have fewer socio-economic advantages are more likely to suffer from diseases, and experience higher morbidity (Read & Gorman, 2006; Nazroo et al., 2002). In other words, the poorest groups experience marked health inequalities.

Research aims

The Black Report (Townsend & Davidson, 1982), a major landmark in UK health research, widens the debate on the causes of health inequalities. However, since the Black Report, there has been extensive development in the measurement of SES and health inequalities (Bowling, 2004; Ebrahim et al., 2004, Evandrou, 2000; Graham, 2005; Grundy & Holt, 2001; Macintyre, et al., 1997; Nazroo, 1997; Vagero & Illsley, 1995). Health inequalities are often defined by health differentials by a broad range of socio-economic measures, such as education, occupation and income (Bowling, 2004; Ebrahim et al., 2004, Evandrou, 2000; Galobardes, et al., 2006; Grundy & Holt, 2001; Macintyre, et al., 1997; Nazroo, 2003; Vagero & Illsley, 1995). However, the salience of these indicators for measuring health may vary for different ethnic groups and appear less sensitive to their socio-economic circumstances (Graham, 2005; Nazroo, 2003). For example, people from ethnic minority groups do not experience the same returns as whites for higher SES achievements (Farmer & Ferraro, 2005; Nazroo, 2003). Instead, minorities experience lower returns on the resources that they procure (e.g. educational attainment) in terms of income (Davey Smith et al., 2000; Powers, 2005) compared to their white counterparts.

Thus, this study will investigate how different socio-economic characteristics may be better explanatory factors in assessing the national evidence on health inequalities amongst older people from different ethnic groups. The research will explore the sensitivity of different measures of socio-economic status for understanding health inequality in later life.

Research Questions: The study investigates the following research questions:

1. What explains health inequalities amongst ethnic groups in later life?

1.1. Does the association between health and socio-economic status (SES) amongst ethnic groups decrease with increasing age?

1.2 What is the relative importance of factors such as demographic, cultural, socio-economic, behavioural, psycho-social, environmental and migration status, in explaining health inequalities?

2. To what extent is the concept of SES useful in explaining health inequalities in later life?

2.1. How do different SES measures perform in explaining health inequalities in later life?

3. What are the policy implications of the research?

3.1. What role can policy play in reducing health inequalities in later life amongst ethnic groups?

Theory, Data and Method : Different theoretical models (e.g. health, psychosocial, environmental, deprivation etc.) will be explored and critically assessed in terms of their relevance for understanding health inequalities amongst ethnic groups in later life. In addition, where appropriate, the empirical research underpinning the different theoretical models and approaches will also be evaluated and the gaps assessed.

The research will analyse high quality nationally representative survey data to examine the determinants of health inequalities amongst older ethic elders in Britain.

The research will contribute original empirical research investigating the impact of different measures of socio-economic status on health using high quality national surveys (Health Survey for England (HSE). For example, in 1999 and again in 2004, the focus of the HSE was on the health of minority ethnic groups. The ethnic boost sample was designed solely to yield additional interviews with members of the most populous minority ethnic groups: Black Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish. Black African was covered in 2004 only. Other survey data (i.e. General Household Survey (GHS) will also be consider for the analyses. The secondary analysis of the data will include bi-variate (eg cross-tabulations with chi-square tests) and multi-variate analysis (eg logistic regression) using SPSS.

Policy relevance

A clear understanding of health inequalities is fundamental for the development of policies and interventions if we are to have a better understanding of the health of ethnic minority older people, as well as directing services, treatment and care in proportion to needs. Thus, the topic of health inequalities amongst older people from ethnic minority groups is a key policy relevant topic. The findings will be useful in informing which national policies (e.g. health promotion campaigns, housing, occupationally based services, social assistance) and locally based interventions (e.g. health campaigns for Pakistani older women) would be better targeted at which ethnic groups of older men and women. Improving health inequalities can have a significant positive effect on the quality of life of older ethnic minorities.

Acknowledgements

Supervised by Prof Maria Evandrou, Director, Centre for Research on Ageing, School of Social Science, University of Southampton

References

Bowling, A. (2004). "Socioeconomic differentials in mortality among older people." Journal of Epidemiology and Community Health. 58 (6): 438-440.

Cooper, H., Arber, S., Daley, T., Samje, C., and Ginn, J. (2000). Ethnicity, health and health behaviour: a study of older age groups . Summary report of main findings. Available at:

http://www.nice.org.uk/niceMedia/documents/ethnicity_studyolder.pdff [Access: 30 October, 2007].

Curtis, S., & Lawson, K. (2000). "Gender, ethnicity and self-reported health: the case of African-Caribbean population in London." Social Science & Medicine, 50 (3): 365-385.

Davey Smith, G. (2000). "Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States." American Journal of Public Health, 90 (11): 1694-1698.

Davey Smith, G., Charsley, K., Lambert, H., Paul, S., Fenton, S., & Ahmad, W. (2000). ‘Ethnicity, health and the meaning of socio-economic position’, in Hilary Graham (ed.) Understanding health inequalities, Maidenhead: Open University Press.

Ebrahim, S., Papacosta, O., Wannamethee, G., & Adamson, J. (2004). "Social inequalities and disability in older men: prospective findings from the British regional heart study." Social Science & Medicine, 59 (10): 2109-2120.

Evandrou, M. (2005). “Health and well-being amongst older people in Britain at the start of the 21 st Century”. 1-27. Available at :

http://www.lse.ac.uk/collections/SAGE/pdf/DP22.pdf [Access: 21 September, 2007]

Evandrou, M. (2000). "Ethnic inequality in health in later life." Health Statistics Quarterly 08 (Winter): 20-28.

Farmer, M. M., & Ferraro, K.F. (2005). "Are racial disparities in health conditional on socioeconomic status?" Social Science & Medicine, 60: 191-204.

Galobardes, B., Shaw, M., Lawlor, D.a., Lynch, J.W. & Davey Smith, G. (2006). "Indicators of socioeconomic position (part 2 )." J. Epidemiology Community Health, 60: 95-101.

Ginn, J., & Arber, S. (2000). "Ethnic inequality in later life: variation in financial circumstances by gender and ethnic group." Education and Aging, 15 (1): 65-83.

Graham, H. (2005). “Intellectual disabilities and socioeconomic inequalities in health: an overview of research.” Journal of Applied Research in Intellectual Disabilities, 18: 101-111

Grundy, E., & Holt, G. (2001). "The socioeconomic status of older adults. how should we measure it in studies of health inequalities?" Journal of Epidemiology and Community Health, 55 (12): 895-904.

Macintyre, S. (1997). "The Black Report and beyond what are the issues?" Social Science & Medicine, 44 (6): 723-745.

Nazroo, J. Y. (2003). “The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism”. American Journal of Public Health, 93 (2): 277-284.

Nazroo, J. Y., & Williams, D.R. (2005). ‘The social determination of ethnic/racial inequalities in health’, in Marmot, M. and Wilkinson, R.G. (ed.) The Social Determinants of Health, Oxford: University Press.

Nazroo, J.Y. (2006). ‘Ethnicity and Old age’, in Vincent, J.A., Phillipson, C. and Downs, M. (ed.) The Futures of Old Age. UK: Sage

Office for National Statistic (ONS) (2001) Focus on older people & ethnic minorities. Available at: http://www.statistics.gov.uk/focuson/ethnicity

Power, C., Matthews, S., & Manor, O. (1998). “Inequalities in self-rated health: explanations from different stages of life”. The Lancet, 351: 1009-1013.

Read, J.G., & Gorman, B.K. (2006). “Gender inequalities in US adult health: The interplay of race and ethnicity”. Social Science & Medicine, 62 (12): 1045-1065.

Townsend, P., & Davidson, N. (1988). Inequalities in health: The Black Report. Harmonsworth: Penguin.

V?gerö, D., & Illsley, R. (1995). “Explaining health inequalities: Beyond Black and Barker.” European Sociological Review, 11 (3): 219-40.