Ethnic density effects on physical health

Some research studies of health among ethnic minority groups have shown that people may have better health if they live in areas with high concentrations of people from the same ethnic group. This has been called a group density effect. It has been suggested that this effect may be linked to the stress and social stigma of belonging to a low status group and the ways in which discrimination and prejudice worsen or ease this stress. One reason why this is such an important area to study is that it allows us to distinguish between the effects of better material conditions usually enjoyed by ethnic minority groups who live outside minority areas, and the effects of psychological or social factors.

This research project is from a team of social epidemiologists, medical sociologists and demographers, and will examine ethnic group density effects on physical health. Most previous studies have been of mental health and so this project aims to look at the effect in relation to several different health outcomes, in several different ethnic groups, in two countries.

The results of this research will need to be communicated to non-academic and public users with care and sensitivity, given the possibility as they might be misinterpreted as favouring residential segregation rather than illustrating the effects of social stigma and the benefits that would come from reducing discrimination and prejudice in society. Results will be communicated as non-technical reports to relevant non-academic institutions that have an interest in social policy related to ethnic minorities. In the UK, these include the Commission for Racial Equality, the Social Exclusion Unit and the Neighbourhood Renewal Unit. In the USA, non-academic users at the federal level include the Office of Minority Health at the Department of Health and Human Services Administration and the Office of Minority Health at the Centers for Disease Control and Dissemination.

Health professionals and health service organizations with an interest or remit in cultural competence within health care will also be interested in findings generated by this research programme. Such organizations include: the National Center for Cultural Competence and the Cross-Cultural Health Care Program in the USA, and in the UK: the Black Practitoners and Learners Network of the National Institute of Adult Continuing Education and the Transcultural Nursing and HealthCare Association supported by the Foundation of Nursing Studies.

There is some evidence that the health of members of low status ethnic minorities is less good if they live in areas where they are in more of a minority. If this reflects the stress of exposure to the stigmatisation associated with minority status, then it may serve as a model for, and opportunity to explore, wider processes of social comparison which may be important in social inequalities in health. This is a proposal to conduct a systematic programme of secondary data analysis on the effects of ethnic density on physical health. Members of minorities living within their own communities seem to be partly protected from the effects of stigmatisation. First observed for mental health and now reported in a few studies of physical health, this phenomenon is potentially important not only because it may be a testament to the experience of all stigmatized minorities, including the poor, but also because it enables us to distinguish between the effects of better material conditions usually enjoyed by people living in majority areas, and the psychosocial effects of discrimination. The proposed series of secondary data analyses involving quantitative, multilevel methods aims to: establish the saliency of ethnic density effects for physical health; identify the ?tipping point? at which ethnic density becomes protective for health; and establish the size of areas in which any effect is clearest. The use of extant publicly-available datasets offers a timely and cost-effective opportunity to address an important dimension of the social determinants of health.