Ethnic inequalities in child development and health: an examination and comparison across the United Kingdom, the United States, and New Zealand

Ethnic minority groups in the United Kingdom (UK), the United States (US) and New Zealand (NZ) have much poorer health and die younger than the white majority. The causes behind these inequalities in health are largely unexplained, although ethnic minority groups tend to be financially and materially poorer than white people, and this contributes to their worse health. Experiences of racism and discrimination have been found to also contribute to health differences between white people and ethnic minorities. Although broad similarities exist in the US, UK and NZ in terms of worse health among non-white ethnic groups relative to white people, health inequalities vary across ethnic minority groups both between and within countries and throughout the life course. Variations in ethnic inequalities in child health and development may arise due to differences in the countries of origin of the predominant minority groups, in reasons for migration, in cultural, economic and demographic profiles of the ethnic groups represented, and in civic and political cultures. The three countries that will be examined in this project are similar in terms of their documented ethnic inequalities, commitment to reducing said inequalities, and availability of health and social surveys, but also have stark differences, including in their healthcare and welfare systems, and very different ethnic minority populations, which vary, among other things, in terms of histories and reasons for migration and colonisation. Comparing the health of ethnic groups in these national settings will help us to better understand which factors lead to these different and avoidable health profiles, and will help inform policy makers about what are the key features that can be reduced, or promoted, in other to tackle preventable ethnic inequalities in health.

In the proposed project I will explore which factors influence the health and development of ethnic minority and white majority children during the early years of childhood, and lead to inequities in health as they grow up. I will analyse four datasets (one in the UK, one in the US and two in NZ), which provide detailed information on ethnic minority and white majority children's mental and physical health and development, as well as information about their families, schools, neighbourhoods and national context.

Key goals of this proposed project are to:
1. Examine the risk factors that contribute to generating ethnic health inequalities at the individual and family level, by assessing the contribution of a range of biological, psychosocial, economic and behavioural factors.

2. Examine factors that might explain ethnic inequalities in health at the neighbourhood level, including area deprivation, income inequality, social capital, and ethnic density.

3. Analyse structural differences between the UK, US and NZ as possible explanations for ethnic inequalities in child health and development, including migratory factors, socio-economic characteristics of the country of origin, social and public policies, structures for the delivery of healthcare, and historical and contemporary ethnic relations.

Findings of this study will be of benefit to several individuals, groups and organisations, and will provide a sound evidence base to inform decisions in public health to promote disease prevention approaches, including policies to tackle national and global ethnic inequalities in health. Study results will be directly relevant to policy development and practice, and will have a tangible impact on health by identifying modifiable risk factors that can prevent avoidable health inequities, aid in building healthy communities, and promote protective social factors for ethnic minority populations.

Beneficiaries of this project include: 1) Researchers in several disciplines and different national settings, since the pathways explored, and the methodology employed provide an expansion of the field of ethnic health inequalities specifically, and wider structural inequalities more broadly; 2) Policy makers in the UK, US and NZ, who can benefit from the results of the proposed project by expanding their understanding of the risk factors that lead to preventable ethnic health inequalities; and 3) Bodies such as the Equality and Human Rights Commission (EHRC) and the Department for Communities and Local Government (CLG), since results disseminated in this proposed project can provide further information for current debates on the impact of immigration and increase our understanding about the importance that the context of reception in which migrants arrive can have on the development of health inequalities.

Economic and societal impact of this research will be maximised by accessing a wide range of outlets to disseminate findings to study users. Non-academic beneficiaries will be engaged with the study via activities including a 1-day conference targeted at local and national policy makers, and third sector organisations; briefing notes submitted to community agencies and local organisations; and collaborations with the Ahmed Iqbal Ullah Education Trust.
Beneficiaries in the academic world will be directly reached through at least 5 publications in peer-reviewed academic journals in the fields of epidemiology and public health, medical sociology, and health geography. Papers will include a focus on methodological aspects of the study, as well as theoretical pieces and a focus on substantive empirical findings and implications for policy and practice. Findings will also be disseminated at national and international academic conferences such as the American Public Health Association, the BSA Medical Sociology conference, the World Congress of Epidemiology, the Annual Scientific Meeting of the Society for Longitudinal and Life Course Studies, and the Annual Scientific Meeting of the Society for Epidemiological Research.