George Davey Smith, Katherine Charsley, Helen Lambert, Sheila Paul. Understanding Health Inequalities,

Abstract

Observed differences in both health status and health service use across ethnic groups have been variously attributed to cultural, socio-economic and genetic differences, as well as to the impact of individual and institutional racism. The roles of health-related selection at the point of migration and of possible artefacts in the process of data collection have also been examined (Smaje 1995). The contribution of differences in socio-economic circumstances to health differentials between ethnic groups has been an area of particular-and often polemical-concern. Research into ethnicity and health often utilizes inappropriately crude and simplistic cultural variables, sometimes neglecting issues of social deprivation entirely (Sheldon and Parker 1992; Ahmad 1996). Alternatively, some authors who are concerned with socio-economic differences have interpreted their data as showing that differentials in mortality between ethnic groups are essentially due to income or class inequalities (Navarro 1990), while other studies suggest that this explanation is at best partial (Cooper 1993). Health research in this area has also tended to treat the construct of'eth-nicity'itself as unproblematic, taking certain ethnic categories (for example'Indian'or'Asian'in Britain) for granted, and presuming that the'ethnic groups' so termed are essentially and unproblematically different from the majority ethnic population in a concrete and unchanging manner (see Chapter 3; Senior and Bhopal 1994; Ahmad 1999; Fenton and Charsley 2000). In fact, many of the factors which, taken together, compose and constitute