Ethnicity and Health Care Inequality

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Table of Contents

Introduction
Review of the Literature
Propositions
Expected Outcomes
Research Design
Limitations
Significance of the Study
References

Introduction

A growing body of literature has pointed out that race, ethnicity and gender are characterized by strong social dimensions which greatly implicate on the health of individuals. It has been discovered that the underlying mechanisms within these ethnicities have profound influence not just on the access to primary, secondary and tertiary health care but also policies and general practices that affect the groups.

Practices and beliefs by the ethnicities could be attributed to some of the greatest variability in diseases. Dindyal and Dindyal (2004) define an ethnicity as “a social group, which shares certain distinctive features, such as language, culture, physical appearance, religion, values and customs” (p. 1).

In the United Kingdom, the whole population is made up of 92% whites. This includes other whites who are significant but non British like the Irish. Asians and Asian Britons account for 4% of Britain population while blacks and black Britons account for a further 2%. Britons of mixed descent account for 1.5% of the whole population.

Although the percentages might look negligible, the total population represented by them could be extremely large. Considering that the government has, as its objective, the idea of ensuring that there is equity in health care access and provision, it is necessary that the underlying social mechanisms are understood in order to avoid some retrogressive practices that would lead to inequality. In order to come up with proper policies, it is important to ascertain whether ethnicity plays a role in inequality of health care access.

Review of the Literature

The Parliament Office of Science and Technology (2003) clearly argues that there is a great disparity of health and health care between ethnicities. In their report, it was identified that South Asians living in the United Kingdom had a 50% chance of suffering from heart attack and angina. On the other hand, men from the Caribbean origin in the United Kingdom run the highest risk of 50% of dying from stroke.

In their report, it was ascertained that blacks and minorities had comparatively small chances of dying from cancer as compared to the white majority. According to the report, immigrant women from Asia in the United Kingdom ran a comparatively lower risk of suffering from breast cancer as compared women born and brought up in the United Kingdom. The trend in lower cases of cancer in minority groups as compared to white Britons was attributed to less smoking.

The highest deaths that resulted from lung cancer were established to be from Scots and the Irish who are also found out to be great smokers. The lifestyle of women in the United Kingdom was also attributed to women’s death from breast cancer. Immigrant women had less chances of suffering from breast cancer because they take some time to adapt to Britain lifestyle. This was consistent with Wells and Evans (2003) and Ku and Waidmann (2003) findings.

Adamson (2009) argues that socio economic factors contribute to inequality of health and health care. He argues that the lower the position on the economic ladder an individual is, the higher the chances of poor health. Unfortunately, most of the ethnic minorities tend to have the lowest incomes in the United Kingdom.

This means that ethnic minorities are likely to suffer and die from diseases that they would easily control (Kuo 2001). In a study carried out on the immediacy of need for health care concerning chest pain and vignettes, it was found out that black respondents were very likely to seek for immediate health care seeking to get assistance for vignettes. On the other hand, the British whites were the most unlikely to seek for this help.

The result seemed consistent in several cases. This position is echoed by Lorant and Bhopal (2011) and Zimmermann, Wendy and Fix (1998) who also argue that socio economic disadvantage could lead to inability to get regular visits by the doctor. Furthermore, it would lead to inability to use the clinics regularly and the inability to purchase proper prescribed drugs. This therefore indicated that there is a clear disparity within ethnic groups. This assertion is also echoed by Fiscella, Franks, Doescher and Saver (2002)

Health insurance plays an important role in ensuring access to primary, secondary and tertiary health care. Inability or unwillingness to get insured would therefore lead to disparities in health and health care. Ku and Waidmann (2003) and Mai, Cummings McIntyre (2004) argue that most of the ethnic minorities account for the highest percentages of uninsured people in several countries. As argued above, socio economic factors contribute to inequality of health.

This is where insurance comes to question. With poverty and lack of money, it is clear that raising money for the expensive insurance could be a problem for most of the ethnic minorities. This also explains why less white Britons would die from diseases that are curable. They have enough money to seek for care from good providers. Similarly, Adamson (2003) and American Academy of Pediatrics (2000) support the same findings.

Discrimination and stereotyping are also factors that lead to inequality in health and healthcare. According to Lorant and Bhopal (2011), acts of discrimination and stereotyping could subject a group of people to a low social economic status. This can also be as a result of strongly held values that tend to demean and prejudice certain ethnicities.

Dealing with a case using a block approach as opposed to individuals leads to poor health for minorities. For instance, just believing that cancer is a disease for the Irish and Scots might lead to misdiagnosis. Every individual needs to be examined as an individual (Collins, Hall and Neuhaus 1999; Ku and Matani. 2001).

Power, Davis, Plant and Kjellstrom (2009) in their report on deprivation and ill health highlight a clear fact that people living in deprived environments are most likely to have poor health. Given that several studies have pointed out the fact that minority ethnicities tend to rank lowest on the economic ladder, it then suffices to argue that they account for the highest population living in dejected and overpopulated regions in the cities in the Britain.

Considering the arguments by Power et al (2009), “Living in deprived urban areas increases the risk of poor health outcomes even after controlling for individual characteristics” (p. 20), it suffices to argue that even when other factors are controlled, dilapidated housing and overcrowding in their own rights are able to lead to poor health. For instance, their study pointed out to the fact that men living in poverty stricken neighborhoods had a 6.8% lower life expectancy as compared to the average in the United Kingdom.

On the other hand, women from similar environs had 5% lower life expectance as compared to the overall rate of Britain. In contrast, men from high economy areas stand a high likelihood of living 4% more than the national average. Women in similar regions live run a likelihood of living 3% more than the average national life expectancy rate (Shaw, Smith & Dorling 2005; Popkin and Cove 2007).

Propositions

Given the purpose of this study, it is necessary to answer certain questions in order to ensure that one attains the objective. In order to succeed, one would have to understand several factors. Is there a clear relationship between ethnicities and health?

This question is necessary because consistent differences between ethnicities will ascertain whether there are significant effects of ethnicity on health and health outcomes of an individual. My proposition here is that ethnicity has certain social dimensions that affect greatly the health of individuals in Great Britain.

Given that there are substantial differences in health and health care between ethnicities, it is necessary to identify the underlying mechanisms and dimensions that lead to these differences. In this line, one question arises, what exactly are the social mechanisms within the minorities that lead to the identified disparity? This is a necessary question because by understanding the social dimensions, the causes of the differences will clearly be established. My proposition here is that factors like socio economic status, geographical location, deprivation of all kinds, ability to get an insurance and discrimination and stereotyping among others are factors that greatly contribute to differences in health and health outcomes.

There are some factors that would act to disadvantage some ethnicities. Their effects are hence great and could alter the results of a study. This leads to the question, if all the other factors are removed, can ethnicity as a single factor still exhibit similar results?

These factors that expect to be put constant here are education, government policies, et cetera. The proposition here is that even when other factors like education and some government policies are constant, some typical ethnicity social dimensions would still lead to disparities in health and health outcomes.

Finally, it is important to understand the role of government policies in health outcomes of individuals. This leads to the question, have government policies played any role in pushing the minorities further into misery as pertains to health? While this might not be a characteristic of health disparity from the ethnicities themselves, the effect on them is great. The hypothesis on this question is that certain government policies could assist to bridge the disparity or widen it further.

Expected Outcomes

As its hypothesis, this paper seeks to argue that ethnicities have varying levels of health and health care. Due to their characteristic outfit, certain ethnicities tend to have better health as compared to others. Whites in the United Kingdom tend to fair better in health issues as compared to ethnic minorities like the blacks and Asians.

The disparity is as a result of the ethnic group’s level on the economic status ladder, discrimination caused by stereotyping, natural habits of the ethnicity i.e. smoking and excessive drinking, geographical regions of settlement of these ethnicities, nationality status i.e. native or immigrant et cetera. There are some factors that can be removed from the equation. However, some factors are typical of most of the ethnicities. For instance, language as a barrier to communication cannot be removed from the equation.

It is clear that most immigrants are forced to struggle against the hurdles of communication in order to attain health. This means that removing other factors but maintaining the real characteristics of an ethnicity could still lead to the same results. Finally, it is clear that certain government policies push ethnicities further into poor health. For instance, failure of the government to address the issue of insurance and medical cover can lead to problems to minority ethnicities.

Research Design

The methodology of this research will entail the use of several ethnic groups as independent variables. There will be the whites of United Kingdom descent, the blacks from Britain, the Asians from Britain and the immigrants. In order to understand whether there is a relationship between ethnicities and health, different ethnicities will be analyzed based on a given area of health.

For instance, routine check ups would be the point of comparison. As a result, the ethnicities will be the variables to be manipulated. This will be labeled t₁= whites, t₂= Asians of British descent t₃= blacks of UK descent and t₄= immigrants. Other variables will include government policies. The non-constant variables will be tested under certain government policies and also after removal of those policies to see whether the results remain constant.

Indicators of health will be the number of times that a respondent has had to be hospitalized due to any serious illness. This will be a good start in determining disparities in health and health care. To determine this, the respondents will have to respond to the question, how many times have you visited the doctor as a result of serious illness in the last twelve months? The responses will be coded 0 = less than five times, 1 = >5<10, 2 = >10.

Another indicator of good health will be availability of health insurance. The measures of health insurance will be 1) having a private insurance, 2) depending on government programs and 3) having none at all. To identify whether a respondent has an insurance cover or not the responses will be coded as 0 = yes and 1 = No. For those who will have one, they will have to respond on the type of insurance that they have. The responses will be coded using 0 = private and 1 = government program.

To get data from this sample, the study will employ the use of interviews and questionnaires. Respondents will be asked to respond to a set of questions that would aim towards ensuring that the research purpose is arrived at. The interviews will be carried out from the respondents’ offices. In addition, some will be carried out on the phone and through emails.

In data analysis, the Multivariate analysis of variance (MANOVA) will be used. This system of data analysis is favorable for this study because it involves more than two dependent variables that are to be assessed against the various dependent variables.

This data analysis system is best fit for studies that are aimed at ascertaining whether alterations in the independent variables have significant changes to the dependent variables. It is also the most advisable method if the study intends to identify the relationship between the dependent variables and also the relationship among the independent variables.

Limitations

Like any other research, this one is also bound to have its limitations. The main limitation of this study will be ascertaining whether the identified factors and mechanisms within the ethnic groups were really the main causes of the disparity in health outcomes. For instance, a study carried earlier in Europe to identify whether socio economic status among minority ethnicities had effects on their health.

However, it was not clear because the effect of socio economic status was found to have no effect on inequality of health in Spain. In addition, different ethnic groups under similar socio economic status tend to exhibit differences in the level of disparity. Therefore, it will be difficult to separate ethnicity and some factors like socio economic status. The relationship between the three will be tricky to separate and analyze.

Significance of the Study

It is clear that every country in the world has been trying hard to ensure equality in health and health care. This is also a goal of the United Nations. By understanding the social mechanisms within an ethnicity and how these affect the health of an individual, it will be easy for the policy makers to come up with practical and functional policies that will assist the governments attain their goal of equal health for their citizens.

In this case, the United Kingdom will have the opportunity to develop good policies that will assist them ensure that every citizen in Britain has access to proper health.

References

Adamson, Joy. 2003. “Ethnicity, socio-economic position and gender—do they affect reported health—care seeking behavior?” Social Science & Medicine 57: 895.

American Academy of Pediatrics. 2000. “Race/Ethnicity, Gender, Socioeconomic Status Research Exploring Their Effects on Child Health: A Subject Review.” Pediatrics 106: 1349-1351.

Collins, Karen, Allison Hall, and Charlotte Neuhaus. 1999. U.S. Minority Health: A Chartbook, New York: Commonwealth Fund.

Dindyal, Shiva and Dindyal, Sanjay. 2004. “How Personal Factors Including Culture and Ethnicity, affect the Choices and Selection of Food we Make.” The Internet Journal of Third World Medicine 1: 1-5.

Fiscella, Kevin, Peter Franks, Mark Doescher, and Barry Saver. 2002. “Disparities in Health Care by Race, Ethnicity and Language among the Insured: Findings from a National Sample.” Medical Care 40(1): 52-9.

Ku, Leighton and Sheetal Matani. 2001. “Left Out: Immigrants’ Access to Health Care and Insurance.” Health Affairs 20(1): 247-56.

Ku, Leighton and Waidmann, Timothy. 2003. How Race/Ethnicity, Immigration Status and Language Affect Health Insurance Coverage, Access to Care and Quality of Care among the Low income Population. The Kaiser Commission on Medicaid and the uninsured. Web.

Kuo, Frances. 2001. “Coping with poverty: impacts of environment and attention in the inner city.” Environment and Behaviour 33: 5-34.

Lorant, Vincent and Bhopal, Raj. 2010. “Ethnicity, socio-economic status and health research: insights from and implications of Charles Tilly’s theory of Durable Inequality.” Journal of Epidemiol Community Health 7: 1-5.

Parliamentary Office of Science and technology. 2009. Strategic Review of Health Inequalities in England post-2010 Task Group 4. The Built Environment and Health Inequalities. Final Report 12 June 2009.

Popkin, Susan & Cove, Elizabeth. 2007. Safety is the most important thing. How HOPE VI Helped Families. Washington DC: Urban Institute.

Shaw, Mary, Davey Smith & Danny Dorling. 2005. “Health inequalities and New Labor: how the promises compare with real progress” Business Management Journal 330: 1016-1021.

Stafford, Mai, Steven Cummings & Sally Macintyre. 2004. Gender differences in the association between health and neighborhood environment.” Social Science & Medicine 60: 1681-1692.

Timperio, Anna, David Crawford, Amanda Telford & Jo Salmon. 2003. “Perceptions about the local neighbourhood and walking and cycling among children.” Preventative Medicine 38: 39-47.

Wells, Nancy and Gary Evans. 2003. Nearby Nature; A buffer of life stress among Rural Children. Environment and Behaviour 35(3): 311-330.

Zimmermann, Wendy. and Michael Fix. 1998. Declining Immigrant Applications for Medi-Cal and Welfare Benefits in Los Angeles County. Los Angeles: Urban Institute.

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