Ethnicity, socioeconomic status and health inequality among children
Ethnicity, socioeconomic status and health inequality among children
Theme 3: Inequalities
There is enormous policy interest in health inequalities – both physical and mental health, and both socioeconomic and ethnic inequalities. Research has focused mainly on adult health outcomes – including our previous work in EEPRU2. That work established that the relative contributions of ethnicity and socioeconomic disadvantage are complex and depend on which aspect of health is considered.
The previous work on adults needs to be extended in two ways:
Further investigation of ethnicity effects to consider language, time since immigration, etc.
Distinguish the effects of family-specific and neighbourhood-specific deprivation
Children need to be brought into the inequality picture. Children are especially important, particularly because:
Health behaviours (diet, exercise, risky behaviours, etc) are the basis for chronic health conditions that may persist through much of the adult lifecourse (https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach/)
In relation to children’s mental health, there is evidence of substantial unmet need – particularly post-covid19 (https://www.childrenscommissioner.gov.uk/blog/news/damage-to-childrens-mental-health-caused-by-covid-crisis-could-last-for-years-without-a-large-scale-increase-for-childrens-mental-health-services/)
The statistical associations between ethnicity and socioeconomic characteristics on one hand, and health on the other are complex. Further consideration needs to be given to specific policy messages from this complex picture.
For the adult population:
Further investigation of ethnicity effects to consider language, time since immigration, etc.
Distinguish the effects of family-specific and neighbourhood-specific deprivation
For children:
Estimate the differences in health-related outcomes among children between social groups defined by ethnicity and socioeconomic status.
Calculate quantitative measures of the relative influence of ethnicity and socioeconomic factors on children’s health and behaviour
Develop a statistical model for predicting the distributional character of early adult health outcomes from indicators of health and behaviour measured earlier during childhood
Develop an outline methodology for simulating the lifecourse consequences of the estimated inequalities during childhood. Full implementation of the methodology would be reserved for a successor project
Steve Pudney, Monica Hernandez, Jean Hamilton, Allan Wailoo
Steve Pudney steve.pudney@sheffield.ac.uk
Background:
Why are some groups healthier than others, or are less affected by certain diseases? This research aims to delve into these health inequalities, covering both physical and mental health, comparing different ethnic groups. Importantly, we want to find out whether any differences we might observe between different ethnic groups is explained by differences in things like their income or educational background, rather than ethnicity directly. This is important because, whilst government makes the reduction of health inequalities a very high priority, designing policies to achieve this requires us to understand the reasons for any differences.
We have done some work on this issue in adults already. The new work extends the analysis. We're looking at how the area they live in, and their family's situation, play a role. For immigrant groups, we want to know how factors like language and how long they’ve lived in Britain affect their health.
Aims and Objectives:
Measure health differences among children and adults based on ethnicity and socioeconomic status.
Examine how ethnicity is influenced by factors like language and time since immigration.
Differentiate the impact of deprivation at the family and neighbourhood levels.
Methods:
Importantly, the proposed study will also extend the analysis to consider children. We’ll examine whether their ethnicity and their parents’ income, education, etc affect their health. We’ll measure children’s health in different ways including both mental and physical health, and also health behaviour (e.g. attitudes to smoking, drinking, drug abuse). We want to predict what the lifelong consequences may be of these health inequalities in early life. To do this, we're using a large research survey (called “Understanding Society") that follows the same individuals and families over many years, asking questions about different parts of their lives like health, jobs, income, education and housing. Because it collects information from the same people over time, it helps researchers like us see how things change. The study involves a lot of people from different backgrounds, so we can understand what life is like for many different types of individuals and families.
A significant limitation is that there is no link between the data in the Understanding Society survey and official records of deaths. Because of this, the survey misses some cases of ill-health leading to death. We’ll try to understand how the results of our research might be affected by this.
Policy relevance & dissemination:
DHSC and related bodies, particularly the Office for Health Inequalities and Disparities, make policy where the reduction of health inequalities is either a key aim or must, at least, be considered. This work will provide information to help shape those policies.
The study is looking at the roles of ethnicity and socioeconomic status (SES) in shaping health inequalities among children, adolescents, and adults in the UK. It aims to assess their relative importance in explaining these inequalities and guide targeted health interventions.
The analysis is based on 13 waves of the UK Household Longitudinal Survey (2009-2022), which collects self-reported health data across different age groups. The study employs random effects models to assess health inequalities and their links to SES and ethnicity.
1. Socioeconomic Disadvantage is the Strongest Predictor of Poor Health
SES consistently affects health negatively across all age groups.
Individuals from lower SES backgrounds are more likely to experience chronic illness, mental health issues, and poor health behaviours.
Health inequalities due to SES continue into adulthood, even after adjusting for early-life health conditions.
2. Ethnicity Has a Mixed Impact on Health
Ethnic minorities show health advantages in some areas, such as lower rates of mental health issues and cardiovascular diseases
However, some disadvantages are evident, particularly:
Lower exercise levels among adolescent girls from ethnic minorities.
Higher diabetes rates among South Asian adults.
Ethnicity alone is less predictive of poor health than SES, except for specific conditions.
3. Health Inequalities in Children and Adolescents
Mental health indicators suggest better outcomes for ethnic minorities compared to White children.
Exercise levels are significantly lower for South Asian girls, raising concerns about long-term health risks.
Adolescent risk behaviors (smoking, alcohol use) are lower in ethnic minority groups than in the White majority.
SES-focused interventions (e.g., targeting poverty and neighbourhood deprivation) could reduce health inequalities across ethnic groups.
Health policies should be tailored by considering specific disease risks, age, and gender.
Addressing barriers like language difficulties could improve healthcare access for ethnic minorities.
While ethnicity does influence health outcomes, socioeconomic disadvantage is the dominant factor driving health inequalities in the UK. Effective policies should prioritise reducing SES-related inequalities while considering targeted interventions for specific ethnic groups.