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Editorials

Neglect of older ethnic minority people in UK research and policy

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m212 (Published 11 February 2020) Cite this as: BMJ 2020;368:m212

Read all of the articles in our special issue on Racism in Medicine

  1. Laia Bécares, senior lecturer in applied social sciences1,
  2. Dharmi Kapadia, Q-step lecturer in sociology2,
  3. James Nazroo, professor of sociology2
  1. 1School of Education and Social Work, University of Sussex, Falmer, UK
  2. 2School of Social Sciences, University of Manchester, Manchester, UK
  1. Correspondence to: L Bécares l.becares{at}sussex.ac.uk

Exclusion from population studies is a form of institutional racism

Older people from ethnic minorities are one of the most disadvantaged and excluded groups in society.1234 This is reflected in international studies, which show increased rates of poor mental and physical illness among ethnic minority ageing populations compared with the ethnic majority population.45678

The UK has not collected any survey data specifically on older ethnic minority populations, but data from 2004, the last year when the Health Survey for England oversampled ethnic minority people (over 15 years ago), found that the proportion of people aged 61-70 reporting fair or bad health was 34% for white English people but 86% for Bangladeshi people, 69% for Pakistani people, 63% for Indian people, and 67% for black Caribbean people. These data show that the health of white English people aged 61-70 is equivalent to that for Caribbean people in their late 40s or early 50s, Indian people in their early 40s, Pakistani people in their late 30s, and Bangladeshi people in their late 20s or early 30s.9

These alarming ethnic inequalities are currently undermonitored and poorly understood because of the lack of data and research in this area. Policy efforts to reduce inequalities, improve population health, and plan for the provision of health and social care are therefore not adequately informed by evidence.

A lifetime of disadvantage

Although there is great heterogeneity across and within ethnic minority groups in countries of origin, reasons for migration, and personal characteristics, most older people who migrated to the UK when young entered low skilled and low paid manual work. They have endured a lifetime of disadvantage and deprivation driven by experiences of structural, institutional, and interpersonal racism and discrimination.210

As they approach later life, the complex interplay of social and economic disadvantages accumulated across their life negatively affects a range of outcomes. An understanding of the pathways leading to ethnic inequalities in older age requires research on these complex processes and how they link different life experiences to health and social outcomes in later life. This nuanced understanding would allow us to develop responses to these inequalities.

For the general, mainly white, British population we have several data sources to facilitate our understanding of later life outcomes. However, such data are not available for older ethnic minority people. This lack of representation in population level studies that monitor health and social circumstances is indicative of systematic discrimination and institutional racism.

The three UK national longitudinal birth cohort studies with samples suitable to study the ageing processes (the National Survey of Health and Development, National Child Development Study, and 1970 British Cohort Study) have negligible numbers of ethnic minority respondents. The UK’s largest survey of ageing, the English Longitudinal Study of Ageing (ELSA), which has been running since 2002, included only just over 300 people from ethnic minorities out of a total of 7265 at its most recent data release (wave 8),11 and of these just under 150 were aged 65 or older.

The largest UK household panel study, the UK Household Longitudinal Study,12 included 570 non-white ethnic minority participants aged 65 or older in the most recently released wave of data (2017-18; total sample size aged ≥65 was 6470). Although the sample is larger than that in ELSA, it is not big enough to conduct robust analyses examining the circumstances of older people within specific ethnic minority groups (for example, there were only 32 Bangladeshi participants aged 65 or older); it is also not possible to determine period and cohort differences within ethnic minority groups or the underlying mechanisms behind ethnic health inequalities in later life. And, importantly, the topics covered by the UK Household Longitudinal Study are not focused on issues related to later life.

In order to document and understand ethnic health inequalities in later life, and identify drivers of healthy ageing for ethnic minority people, studies must include suitable sampling designs with representative and sufficiently large samples of ethnic minority groups. Surveys must include questions on ethnicity, identity, and key determinants, such as experiences of racism and discrimination.

Socially unjust

Although we endorse the attempts being made to close data gaps in studies such as ELSA, UK agencies need to commit substantial funding to adequately address this problem. The exclusion of older ethnic minority people from population based studies is a form of institutional racism and leads to a worrying and socially unjust dearth of knowledge about the health and social conditions of an already disadvantaged part of the UK population.

The need for data is now critical. But visibility alone will not lead to the disappearance of ethnic inequalities, which have persisted despite indisputable evidence. Evidence must be used to develop and implement national policies that improve the health of ethnic minority people to ensure an equitable society for all.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

References

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