Ethnic inequalities in health: understanding the nexus between migration, deprivation change and social mobility

Ethnic inequalities in health, although widely observed, are not fully understood. Explanations for these inequalities are often overtaken by discussions of social inequalities in health or dismissed as the inevitable consequence of genetic and cultural differences determining health differences between ethnic groups. However, as society is becoming increasingly ethnically diverse, determining the nature of ethnic inequalities in health is ever more important, as is research evaluating whether and how health gradients are changing over time. This thesis addresses these gaps in knowledge, examining the nature of ethnic inequalities in health and evaluating whether theories of selective sorting can help explain changing health gradients in the overall population or by ethnic group in England. Selective sorting is the process whereby differently healthy groups are sorted into different area types or social classes through migration, deprivation change and social mobility. Given the contrasting socioeconomic, spatial and health experiences of different ethnic groups in England it is likely that selective sorting may operate differently for different ethnic groups. Using a variety of statistical methods, this thesis analyses data from the Health Surveys for England between 1998 and 2011, and the 1991, 2001 and 2011 Samples of Anonymised Records and ONS Longitudinal Study. This thesis notably finds that ethnic inequalities in health are better explained by socioeconomic and broad spatial difference than inherent features of different ethnic groups. However, an ethnic penalty may be operating which interacts with the already disadvantaged circumstances of certain ethnic groups further limiting their chances of good health. Transition between area types and social classes can contribute to widening health gradients for the overall population and by ethnic group. However, probability of transitioning varies between ethnic groups, with certain groups less likely to move away from areas becoming more deprived. This may further exacerbate existing health gradients