Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom

Background Racism has been linked with poor health in studies in the United States. Little is known about prospective associations between racial discrimination and health outcomes in the United Kingdom (UK). Methods Data were from 4883 ethnic minority (i.e. non-white) participants in the UK Household Longitudinal Study. Perceived discrimination in the last 12 months on the basis of ethnicity or nationality was reported in 2009/10. Psychological distress, mental functioning, life satisfaction, self-rated health, physical functioning and reports of limiting longstanding illness were assessed in 2009/10 and 2011/12. Linear and logistic regression analyses adjusted for age, sex, income, education and ethnicity. Prospective analyses also adjusted for baseline status on the outcome being evaluated. Results Racial discrimination was reported by 998 (20.4%) of the sample. Cross-sectionally, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.49; 2.13) and fair/poor self-rated health (OR = 1.50; 95% CI 1.24; 1.82) than those who did not report racial discrimination. Racial discrimination was associated with greater psychological distress (B = 1.11, 95% CI 0.88; 1.34), poorer mental functioning (B = − 3.61; 95% CI -4.29; − 2.93), poorer physical functioning (B = − 0.86; 95% CI -1.50; − 0.27), and lower life satisfaction (B = − 0.40, 95% CI -0.52; − 0.27). Prospectively, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (OR = 1.31, 95% CI 1.01; 1.69) and fair/poor self-rated health (OR = 1.30; 95% CI 1.00; 1.69), than those who did not report racial discrimination. Racial discrimination was associated increased psychological distress (B = 0.52, 95% CI 0.20; 0.85) and poorer mental functioning (B = − 1.77; 95% CI -2.70; − 0.83) over two-year follow-up, adjusting for baseline scores. Conclusions UK adults belonging to ethnic minority groups who perceive racial discrimination experience poorer mental and physical health than those who do not. These results highlight the need for effective interventions to combat racial discrimination in order to reduce inequalities in health.

Effect of pro-social behaviour and conduct problems on the relationship between limiting longstanding illness and negative emotional symptoms in children

Purpose The purpose of this paper is to explore direct and moderating effects of pro-social behaviour and conduct problems on the link between limiting longstanding illness (LL-I) and negative emotional symptoms in children. Design/methodology/approach The Welsh Health Survey variables: LL-I, emotional symptoms, conduct problems, pro-social behaviour, gender, age and socio-economic status were entered into regression models to assess the relationships outlined above. Cross-sectional data from several years were combined. Findings In the cohort of 627 children aged 4–12 years who had LL-I, 601 (95.9 per cent) had complete data for analysis. Children with LL-I scored a mean of 1.8 points higher on negative emotional symptoms than children without LL-I, with LL-I accounting for 6 per cent of the variance in emotional symptoms in a regression model. In children with LL-I, highly pro-social children had lower levels of negative emotional symptoms compared to those with low pro-social levels (1.1 points on emotional symptoms scale, 95% CI=0.55–1.70; p<0.001). In children with LL-I, high levels of conduct problems were associated with increased negative emotional symptoms compared to those with low levels of conduct disorder (2.1 points on emotional symptoms scale, 95% CI=1.3–2.5; p<0.001). Research limitations/implications Potential improvements include a longitudinal design, and use of multi-informant Strengths and Difficulties Questionnaire scores. Practical implications Assessment of children with LL-I could usefully include pro-social behaviours. Social implications National policy could consider the value of promoting pro-social responses. Originality/value Emotional symptoms in children with LL-I are associated with pro-social behaviour and conduct problems, primarily as a direct effect. Pro-social interventions could promote emotional wellbeing in children with LL-I.

Social Inequalities in “Sickness”: Does Welfare State Regime Type Make a Difference? A Multilevel Analysis of Men and Women in 26 European Countries

In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies by education within different welfare contexts. This research has used either a limited number of countries or quantitative welfare state measures in studies of many countries. In this study, the authors expand on this knowledge by investigating whether a regime approach to the welfare state produces consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude that the Scandinavian welfare regime is more able than other regimes to protect against non-employment in the face of illness, especially for individuals with low educational level.