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New data from the Office for National Statistics reveals that white Britons have higher mortality rates compared to any other ethnic group. This finding is surprising, considering the disproportionate impact of Covid on ethnic minorities and the detrimental effects of racism on health outcomes.
Understanding mortality inequalities is crucial for developing effective health and economic policies. However, gathering the necessary data can be challenging. The UK does not record ethnicity on death certificates, so statisticians had to link self-reported ethnicity from census data to death records using NHS numbers. This comprehensive analysis covered nearly 92% of England’s usual resident population.
While the results are not perfect due to various factors impacting the successful linking of records for ethnic minorities, it provides us with a comprehensive and up-to-date profile of ethnic differences in mortality, according to Veena Raleigh, an epidemiologist and senior fellow at the think-tank The King’s Fund.
“We should act based on this data,” Raleigh emphasizes. “Policy interventions and services should be evidence-based and tailored to address the specific issues affecting each community.”
When adjusted for age differences in the population, mortality rates for white Britons were found to be 50% higher between March 2021 and January 2023 compared to the group with the lowest rates, Chinese people.
The lower mortality rates among ethnic minorities can be attributed in part to a higher proportion of migrants in these groups. Migrants tend to be healthier than the overall population, as shown by academic research conducted in various developed countries, including the UK and US. This phenomenon, known as the “healthy migrant effect,” is influenced by self-selection, where healthier and better-educated individuals are more likely to migrate. Additionally, lifestyle choices play a role. The Commission on Race and Ethnic Disparities has found that white Britons have higher rates of smoking and excessive drinking, both of which are significant risk factors for common diseases like cancer.
However, as migrants assimilate, they often adopt unhealthy behaviors, leading to adverse health consequences. Previous research from the ONS has shown that migrants who arrived in the UK after 1991 had lower death rates than both UK natives and migrants who arrived before 1991, except for the Pakistani community.
It is important to note thatthis data from the ONS is considered “experimental” but is consistent with existing research. Mortality rates for diabetes and cardiovascular diseases like hypertension are known to be higher among South Asian and Black communities, while lung cancer has a higher mortality rate among white Britons.
Raleigh emphasizes the importance of not treating ethnic minorities as a homogenous group. Even among South Asian groups in England, there are notable differences in death rates for specific diseases. For example, Bangladeshis have a death rate for diabetes almost twice as high as that of Indians.
Understanding the complex relationship between ethnicity and health is increasingly important as demographics continue to shift. In 2021, one in four people in England and Wales belonged to an ethnic group other than white British, compared to one in eight in 2001.
Deprivation and geography are additional key determinants of health that must be considered alongside ethnicity. ONS data shows that death rates are almost twice as high among the most deprived 10% of the population compared to the least deprived 10%. While the worst health outcomes are observed in the poorest areas, different conditions and communities need to be targeted in each location.
For example, Blackpool and Manchester have high age-standardized death rates. Both areas are located in the North West and have high levels of deprivation, but their demographics differ significantly. Manchester has a much higher non-white population, with Pakistanis accounting for over 10% of the residents, according to the 2021 census. This is reflected in health outcomes, with coronary heart disease having the highest death rate in Manchester, while pneumonia is the leading cause of death in Blackpool, which is associated with poverty.
Despite the strong correlation between deprivation and health, some minority groups such as Pakistanis and Bangladeshis have better health outcomes compared to their white peers, despite being more financially vulnerable on average. Experts suggest that this may be due to differences in lifestyle and stronger support networks within their families and communities. However, further research is needed to fully understand the complex factors contributing to health inequalities.
Raleigh emphasizes the urgent need to address the growing disease burden across all ethnic groups. By reducing the demand for healthcare, we can make the population healthier, put the NHS and the economy on a more sustainable footing, and improve individual and community health.
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