Genetic, cultural or socio-economic vulnerability? Explaining ethnic inequalities in health

Most work on ethnic inequalities in health in the UK has focused on genetic and cultural difference, ignoring issues relating to class disadvantage. However, more recent work, and that conducted in the US, suggests that material disadvantage might be crucial. Nevertheless, the wider sociological literature illustrates that ethnicity and 'race' cannot simply be reduced to class. This paper uses data from the Fourth National Survey of Ethnic Minorities to examine three alternative approaches to ethnic inequalities in health. Epidemiological approaches are driven by empirical findings and make little explicit acknowledgement of theoretical understandings of ethnicity, but they carry the assumption that ethnicity provides a natural and fixed division between population groups. Consequently, explanations for differences tend to be reduced to ahistoric and de-contextualised genetic and cultural factors. Structural approaches generally focus on material explanations for inequalities, but there are important methodological difficulties in assessing these. We also need to consider other elements of the structural disadvantage faced by ethnic minority groups, such as their experiences of racism or concentration in particular geographical locations. Approaches that focus on ethnic identity emphasise the importance of group affiliation and culture, while acknowledging the contingent and contextual nature of ethnicity. However, despite the promise carried by identity based approaches, there has been little empirical work undertaken. These varying approaches illustrate how important ethnic inequalities in health might be to a wider understanding of mechanisms producing inequalities in health. However, a concern with mechanisms in health inequalities research can lead to a focus on technical interventions along causal pathways, with the roots of health inequalities, wider social inequalities, being ignored.