Read: Health inequality for older people from ethnic minority groups is evidence of accumulated disadvantage
It’s a sad fact of life that every week seems to bring yet more evidence of health inequality in the UK, whether that’s related to life expectancy rates, neonatal health or maternal deaths.
A common theme across all the research is the negative impact on those from ethnic minority backgrounds. How that affects the older demographic in that group is less well understood. However, a new study by the University of Sussex and the University of Manchester, which looked at UK social survey data for the 20 years between 1993 and 2017, has highlighted that there are stark and significant ethnic inequalities which tend to be even greater in older ages.
The research found that the health of those from Pakistani and Bangladeshi backgrounds is equivalent to that of White people who are at least 20 years older. It also showed that inequality becomes apparent as early as 30 and then continues to widen with age. Rates of poor health among men and women from black Caribbean backgrounds were found to be equivalent to those of White British around 10 years older.
Twenty-two per cent of people who identified as ‘White British’ in their 80s report poor health, the same proportion as for women from Pakistani backgrounds in their 50s. Similar findings were highlighted for people from Bangladeshi backgrounds where poor health of women in their 40s is equivalent to that of White British women in their 70s.
People from Pakistani backgrounds were also twice as likely to report poor health than people who identify as ‘White’. The odds were 1.64 times higher for those from Bangladeshi backgrounds and 1.5 times higher for those from the Black Caribbean group than for White British people.
In these communities, there tends to be a higher prevalence of health conditions such as cancer, obesity and chronic obstructive pulmonary disease as well as hypertension, Type 2 diabetes and sickle cell disease. Some of the factors behind this shocking picture are already familiar. Poor health is often a result of - and exacerbated by – poverty which increases the likelihood of infection and mortality. Other factors which affect life chances include low-paid employment and unemployment, poor housing conditions and social isolation.
There are also less well-defined elements at work which are harder to assess, including conscious and unconscious racism and discrimination. We know these can be key drivers of ethnic inequalities in health, with a clear impact on physical and mental health and wellbeing outcomes. People from different ethnic backgrounds are often treated differently based just on their ethnicity, without reference to their economic or social status and, as a result, the treatment is often detrimental to individuals in these groups, especially when measured in terms of equality of opportunity and employment.
Statistics show that the more marginalised a group is, and the fewer economic or social opportunities it has, the more inward facing it is likely to become, with even less chance of breaking the cycle of inequality. That was highlighted during the pandemic when those of an ethnic minority background experienced worse outcomes, with a higher risk of hospitalisation and death. The factors behind that – lower economic resilience, more precarious employment conditions, fewer employment rights and less opportunity to work from home – need to be addressed urgently if we are to reduce the inequality that starts to accumulate early on in life.
The establishment by the Government of a new body, the Office for Health Improvement and Disparities, to tackle health inequalities across the country is a step in the right direction. But we need a longer-term approach, drawing on the experience and knowledge that often already exists in these communities, to better understand the persistence of inequality over time. More robust data collection and monitoring specifically on older ethnic minority groups would also support a more comprehensive strategy to help prevent poorer outcomes in later life.
An increasing population of older people from ethnic minority backgrounds will be a key demographic feature in Britain over the next few decades. A better understanding of the accumulation of disadvantage and the impact that this has on health outcomes for older people from ethnic minority groups is therefore an economic and social imperative, and one that needs to be addressed effectively – and soon - if we are to level up the country.
By Rt Hon Anne Milton