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

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

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 discrimination 3 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 behaviour 4 3. Williams et al., 2000; 4. Pickett & Pearl, 2001

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

7. Ethnic Density Effect As the proportion of an ethnic minority group increases, their health complications will decrease 5 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: 1.Social norms 2.Buffering effect against racism 3.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 * * * ** * Source: FNS data *p<.05, **p<.01, ***p<.001 Odds Ratio

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

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

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 26 th September 2008