Challenging policy debates on ethnic inequalities in health
At The University of Manchester a significant programme of work on ethnic inequalities in health – including original research on socioeconomic inequalities, racism and discrimination, health service provision and segregation – has challenged and shifted dominant policy understandings of the factors that underlie ethnic inequalities in health.
Our research has been applied in a governmental context, including: the 2008 Department of Health ‘Expert Panel on Inequalities in Health’; the 2010 ‘Strategic Review of Health Inequalities post-2010’ (the Marmot Review); and the 2008 Health Select Committee inquiry into ‘Inequalities in Health’.
It has also been used in research, lobbying and campaigning by a number of NGOs, including: the Equality and Human Rights Commission, the Afiya Trust, the Council for Ethnic Minority Voluntary Organisations, Race for Health and the Race Equality Foundation.
Our research has questioned orthodox assumptions regarding the basis for ethnic health inequalities. It has been used to challenge official reviews, and hold public bodies to account, compelling them to consider the central role of social and economic inequality and discrimination. The research has informed policy debate via several routes:
Prof Nazroo has been invited to submit written and oral evidence within a number of reviews. In particular, he was a member of the ‘Strategic Review of Health Inequalities post-2010’. In these reviews, he summarised evidence from his research, steering debate away from the identification of ethnic minority groups as subject to unique ‘essentialised’ explanations. Similarly, his research fed into the Department of Health ‘equality analysis’ for the 2011 Health and Social Care Bill, noting that health service factors are unlikely to be a crucial determinant.
Research-based evidence fed into the Equality and Human Rights Commission review of population health (date) and is widely cited in reports by a range of comparable governmental organisations and public bodies – including Government Office for Science, World Health Organisation, OECD, European Union, Public Health Agency of Canada, and the Wellesley Institute (Canada).
Messages have been taken directly from the research, and used in campaigning and lobbying work around alternative policy approaches to race equality, and the role and scope of health NGOs. The work has been employed to challenge government thinking, by the Race Equality Foundation, the Afiya Trust and Race for Health. Nazroo has also written summary reports, presented research at meetings and has been involved in assisting NGOs to set their terms of reference. For example, research was cited by the Afiya Trust in support of its overall strategy for addressing health inequalities faced by ‘racialised’ groups, and within its response to the 2010 public health white paper ‘Healthy Lives Healthy People’.
Research findings have been utilised indirectly, with Nazroo quoted extensively in policy literature. Key examples include the Race Equality Foundation and Race for Health, in their responses to the Marmot Review, and citations by the Race Equality Foundation and the Council for Ethnic Minority Voluntary Organisations.
Ethnic differences in health are typically assumed to relate to some essential characteristic of ‘ethnicity’, such as differences in culturally informed behaviours or genetically determined risks. Our research shifts the focus away from these factors and also away from supposed failings in the provision of health services – clearly demonstrating that these are not the main issue – reasserting the importance of social and economic inequalities as the primary drivers of health inequalities (including experiences of racism and discrimination), and identifying that these are not simply driven by segregation. The research has been developed in four distinct ways.
Generating and bolstering an evidence base on the importance of social and economic inequalities in driving ethnic inequalities in health. This is achieved by replicating findings across settings, using more recent data in the UK, examining differences in the circumstances of nominally similar groups in different locations (for example, Caribbean people in the US and the UK) and extending the work into international settings (notably the US and New Zealand).
Considering the significance of discrimination in health care settings, showing that within nationalised health services (for example, the NHS) there are minimal ethnic inequalities in access to care or the outcomes of care received, in contrast to marked inequalities in insurance based systems (such as the US).
Developing earlier findings regarding the protective effects of residential ethnic concentration for ethnic minority people. Examining underlying mechanisms to show the relationship between residential concentration and reduced exposure to racism, stronger social ties and protective health behaviours, countering claims that such concentration can be described as segregation and is inevitably harmful.