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The Impact of Ethnic Density on Health Outcomes: Insights from the UPTAP Study

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28 diapositives · 407 Views · Sep 14, 2014

This workshop presentation by Laia Bécares, James Nazroo, and Mai Stafford discusses how ethnic density influences health outcomes, presenting evidence from the Health Survey for England and the Fourth National Survey on Ethnic Minorities. Ethnic minorities residing in high-density areas tend to report better health and lower experiences of racism, which positively impacts mental health and alcohol consumption. The presentation highlights the complex relationship between ethnic density, socio-economic factors, and health behaviors, calling for further research to explore these pathways and implications for community health.

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  1. The effect of ethnic density on health Laia Bécares, James Nazroo & Mai Stafford UPTAP/BURISA Workshop 26th September 2008

  2. Odds of reporting fair or poor health compared with White English Controlled for age and gender Source: Health Survey for England 2004

  3. Health Inequalities • Socio-economic inequalities • Migration effects • Culture – lifestyle • Genetic differences • Access to and quality of healthcare • Racial harassment and discrimination

  4. Racial Discrimination in the UK • Interpersonal or institutional • 25% of ethnic minority people fearful of racial harassment • 20% of ethnic minority people report being refused a job for racial reasons • 3/4 of them say it has happened more than once • 20% of ethnic minority people believe that most employers would refuse somebody a job for racial reasons Fourth National Survey on Ethnic Minorities, Moodod et al., 1997

  5. Area deprivation and Health • Segregation - social manifestation of individual prejudices and institutional discrimination3 • Caribbean, Pakistani, Bangladeshi, and to some extent Indian people, more likely to reside in disadvantaged wards • Neighbourhood effects associated with risk of all-cause mortality, infant and child health, chronic disease among adults, and health behaviour4 3. Williams et al., 2000; 4. Pickett & Pearl, 2001

  6. Area Deprivation – 1999 & 2004 HSE Sample Characteristics – Area Deprivation

  7. Ethnic Density Effect • As the proportion of an ethnic minority group increases, their health complications will decrease5 • Associated with better mental health, better pregnancy outcomes, reduced mortality and morbidity • Results not consistent – methodological and measurement limitations 5. Faris & Dunham, 1939; Halpern & Nazroo, 2000

  8. Pathways between Ethnic Density & Health • UPTAP project hypothesises that ethnic density impacts on health through: • Social norms • Buffering effect against racism • Increased political mobility

  9. 1. Social Norms Model Decreased likelihood that an ethnic minority person will experience racial harassment through: Informal social control Low tolerance against discrimination

  10. 2. Buffering Effect Model • Social support protects from potentially pathogenic influence of stressful events such as discrimination • Hypothesised to act through 2 ways: • change in appraisal process of stressful event • recognition and discussion of event with others

  11. 3. Increased Political Mobility Model Stronger sense of community and belongingness produces and is fuelled by increased political mobility Better services for the community

  12. Data • 1999 & 2004 Health Survey for England • Fourth National Survey of Ethnic Minorities (1993-1994) • 2005 & 2007 Home Office Citizenship Survey (forthcoming)

  13. Ethnic Density • From UK Census • At ward & MSOA level • Individual ethnic group density • Overall ethnic minority density • Continuous • Categorical

  14. Ethnic Density and Racism

  15. Experiences of racism by a 10% increase in own ethnic density * * Odds Ratio * ** * ** ** ** ** Source: FNS data *p<.05, **p<.01, ***p<.001

  16. Experiences of racism by a 10% increase in overall ethnic minority density Odds Ratio * ** ** ** Source: FNS data *p<.05, **p<.01, ***p<.001

  17. Ethnic Density and Mental Health

  18. Reports of psychotic symptomatology by a 10% increase in own ethnic density *** *** ** ** Odds Ratio * * * * * * * * Source: FNS data *p<.05, **p<.01, ***p<.001

  19. Reports of psychotic symptomatology by a 10% increase in overall ethnic minority density Odds Ratio * * * ** * * * * Source: FNS data *p<.05, **p<.01, ***p<.001

  20. Ethnic Density and Physical Health

  21. Reports of fair, poor or very poor health by a 10% increase in own ethnic density * Odds Ratio Source: FNS data *p<.05, **p<.01, ***p<.001

  22. Reports of fair, poor or very poor health by a 10% increase in overall ethnic minority density ** ** ** ** ** Odds Ratio Source: FNS data *p<.05, **p<.01, ***p<.001

  23. Ethnic Density and Alcohol Use

  24. Odds of reporting current drinking by a 10% increase in own ethnic density *** *** *p<.05, **p<.01, ***p<.001 Adjusted for age, gender, SES, area deprivation, and generation

  25. Odds of reporting current drinking by a 10% increase in overall ethnic density ** ** *p<.05, **p<.01, ***p<.001 Adjusted for age, gender, SES, area deprivation, and generation

  26. Conclusions • Ethnic minorities who live in areas of greater ethnic density experience less racism • Ethnic density protective of mental health and current alcohol consumption • Ethnic density performs differently across ethnic groups and health outcomes • Still to come: political participation, social networks and sense of community

  27. Implications • Protective benefits of ethnic density found but picture still inconclusive – further research • Understanding pathways behind ethnic density can help us better understand healthy communities • Additional evidence for the detrimental impact of racism on health

  28. The effect of ethnic density on health Laia Bécares, James Nazroo & Mai Stafford UPTAP/BURISA Workshop 26th September 2008