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Ethnic inequalities in health outcomes

Dr Asma Khan discusses ethnic inequalities in health outcomes.
© Cardiff University, Asma Khan

There are stark disparities in physical and mental health outcomes among ethnic groups in Britain; health data on differences between religious groups is not as readily available.

This article begins with a brief discussion of the difficulties this can pose in identifying the mental health needs of Muslims, and how these might be reconciled. After this, some key facts on physical health inequalities are presented as examples of health inequalities among ethnic groups. Some links are then made between physical and mental health. Finally, some key facts around ethnic disparities in experiences of mental health are presented.

As you read this article, bear in mind that ethnicity is part of the intersectional experience of Muslims in Britain and other minority contexts. Therefore, Muslims who belong to a visible ethnic minority group experience ethnic difference in addition to, or in interaction with, their religious identities and other social identities (e.g., gender or social class).

Ethnicity as a proxy for religious belonging in health data

In Britain, national and regional data on health outcomes and experiences are most often collected on the basis of ethnicity rather than religion. This data reveals disparities in health outcomes between different ethnic groups. Visible ethnic minority groups are significantly more likely to have poor health outcomes than White groups (Lymperopoulou and Finney 2017). The majority of Muslims belong to visible ethnic minority groups.

Comprehensive and good-quality data is essential to identify the specific needs of minority communities and to create strategies for addressing inequalities. Health data on ethnicity is imperfect in coverage and quality; these limitations present barriers to understanding health issues among minority groups (Kapadia, Zhang et al 2022; Raleigh and Holmes 2021). In their recent report on health inequalities, the NHS Race Health Observatory recommend enforcement of statutory guidelines on inclusion of national ethnic monitoring data in all NHS mental health clinical data that allows robust analysis of where lie inequalities are, and for which ethnic groups (Kapadia, Zhang et al 2022)

Given the limitations of the data that is available, identifying inequalities in relation to religious groups is challenging. It is, however, possible to draw some conclusions in relation to Muslim experiences of health based on this data, by taking religiously homogenous ethnic groups, such as Pakistani and Bangladeshi, as a proxy for the Muslim group. This becomes less straightforward when the broader ethnic category of ‘South Asian’ is used to encompass Indian, Pakistani, and Bangladeshi groups- the Indian group are relatively advantaged across socio-economic and health outcomes in relation to the other two.

As a minimum, the uniform use of specific ethnic categories would allow research and analysis using ethnicity as a proxy for religion in some cases. This approach does now however adequately encompass religiously diverse ethnic groups such as Indian or Black African. Given the increasing ethnic diversity among British Muslims, the inclusion of a standard question on religion, in addition to ethnicity, would be most helpful to develop a robust evidence-base around Muslim mental health.

Key facts on health inequalities among ethnic groups

Ethnic minority communities experience a higher burden of some physical health conditions that are potentially preventable. Some examples:

  • Pakistani and Bangladeshi groups are more likely than White British to report limiting long-term illness and poor health
  • compared with the white group, the rate of women dying in the UK in 2016–18 during or up to one year after pregnancy is more than four times higher in the Black group, and almost double in the Asian group
  • childhood obesity rates are higher among Black and Asian children
  • South Asian children have lower levels of physical fitness than children in white European and Black groups, and physical activity levels are low among children from Bangladeshi and Pakistani groups
  • there is higher incidence, prevalence and mortality from heart disease and stroke incidence in South Asian groups compared with the white group.

Raleigh and Holmes 2021

The relationship between mental and physical health

Mental health and physical health are closely related., they are both determinants and consequences of each other and are underpinned by wider social factors, for example:

  • eating healthy food, particularly fruit and vegetables, can positively affect mental as well as physical health
  • physical activity can positively affect stress, self-esteem, anxiety, dementia, and depression and is recommended in the treatment of depression
  • rates of obesity are higher among people with a mental health condition
  • high rates of mental health conditions among people with long-term physical health problems
  • reduced life expectancy among people with the most severe mental health conditions is largely attributable to poor physical health
  • men with severe mental health conditions die 20 years earlier, and women die 15 years earlier, than the general population.

PHE 2019

Ethnic minorities and mental health

Ethnic minorities have distinct experiences of mental health care in comparison to the majority White population. They are more likely to:

  • be diagnosed with a mental health problem
  • seek help in a crisis situation and in A&E
  • be admitted to hospital with a mental health problem
  • experience a poor outcome from treatment
  • disengage from mainstream mental health services
  • be disproportionately seen in the ‘hard end’ of services (for example, at the point of arrest) and are more likely to receive harsher or more coercive treatments, particularly in the case of people from black African and Caribbean backgrounds
  • struggle to access services in ways meaningful to them.

PHE 2019

In the next step, we take a closer the socio-economic circumstances of Muslims in Britain and begin to consider how these might impact on their experiences of mental health problems.

© Cardiff University, Asma Khan
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