These statistics have been collated from a variety of different sources, which have differing ways of categorising and describing ‘race’ and ethnicity. (For example, some sources differentiate between particular black ‘groups’ whilst others do not. Some sources may just use the term Asian, others may differentiate between different Asian groups or different religious groups.) Where we have used other organisations’ statistics, we have followed the categorisation/names used by them – which means that there may be inconsistencies in terminology within and between pages.
While all those researching race and discrimination issues will want to turn to the data, the statistics that we provide below, which are largely based on ethnicity, tend to generalise the BME experience without examining the interconnected nature of categories such as race, class and gender. The IRR’s statistics pages are aimed at directing our users to that data which indicates discrimination based in enduring institutionally racist (class-based and sexist) systems which reproduce inequality and disadvantage. To find complete breakdowns of data by all ethnic categories you can further consult the sources that we cite below.
HEALTH
Inequality in health between richer and poorer communities across the UK is marked. A study by the Nuffield Trust and the Health Foundation published in 2020 showed across a wide range of indicators that people who live in the most deprived areas in England have worse access to, experiences of, and outcomes in their healthcare. For example, in 2017/18 in the most deprived areas there were three times as many hospital admissions for conditions usually dealt with by primary care compared to the least deprived. Data published by the Office for National Statistics has shown that in England, the gap in life expectancy between the least and most deprived areas was 9.4 years for males and 7.4 years for females. These differences in health outcomes are related to the overlapping, interrelated effects of long-term inequality and poverty.
BME groups are disproportionately affected by these health inequalities. Census data has shown, for example, that people from ethnic minority groups are far more likely than white British people to live in the most deprived 10% of neighbourhoods in England. Pakistani and Bangladeshi people, for example, are over three times more likely than white British people to live in these deprived neighbourhoods, and Black African and Caribbean people were more than twice as likely to live in these areas.
The follow-up to The Marmot Review, published in 2020, underlined, amongst other things, the way that poor health outcomes are pronounced for BME people. The review highlighted recent work on mortality in the UK which has demonstrated the projected lower life expectancy among Pakistani and Bangladeshi people in particular. The review also noted that some groups, particularly individuals identifying as Gypsy or Irish Traveller, and to a lesser extent those identifying as Bangladeshi, Pakistani or Irish, stand out as having poor health across a range of indicators.
The Traveller Movement report Improving the Health of Gypsies and Travellers found in 2015 that Gypsies and Travellers have a life expectancy of over 10% less than the general population. Moreover, in 2016 a study found that two-thirds of Gypsies and Travellers reported their health as bad, very bad or poor.
Evidence has shown certain minority groups to be at greater risk of particular conditions. Bangladeshis and Pakistanis, for instance, have much higher rates of heart disease compared to their white British counterparts. Black African and African Caribbean people have higher rates of hypertension compared to other ethnic groups. Further, BME groups overall are six times more likely to develop diabetes compared to white British people.
Very little data exists on the health needs of migrants and asylum seekers. However, a 2018 study by Imperial College London and Doctors of the World UK, on behalf of the Equalities and Human Rights Commission, found that: there is much evidence that those who have been forcibly displaced are vulnerable to multiple health needs, but once in the UK often find it particularly challenging to get the care they need.
In the UK there are particular health risks for migrants and asylum seekers placed in immigration detention. The Shaw Review published in 2016 found that immigration detention particularly injures the mental health of a range of vulnerable populations. (One study of this effect in Canada reported that after just 18 days in a detention centre, nearly seventy-five per cent of their sample met the clinical criteria for depression, while sixty-seven per cent had symptoms of anxiety and thirty-three per cent PTSD.) In 2015, moreover, an NHS Health and Wellbeing Needs Assessment Programme report on the immigration detention estate in the UK noted that detainees were ‘highly stressed’ and exhibited raised prevalence of certain forms of disease and chronic ill health such as diabetes and tuberculosis.
ACCESS TO HEALTHCARE
Accessing healthcare for certain ethnic minority groups can be difficult. For example, Government statistics show that between 2011/12 and 2017/18, the ‘Any other’, ‘Black African’ and ‘Gypsy or Irish Traveller’ ethnic groups were consistently among the least likely to report success in getting an NHS dental appointment.
Moreover, Gypsies and Travellers particularly struggle to access services. The 2019 study Experiences of Gypsies and Travellers in primary care: GP surgeries found that amongst the participants almost half of those from Gypsy and Traveller communities reported difficulties in registering with a GP, over one third reported difficulties in getting an appointment and over one third reported that they found information from their GP difficult to understand.
For migrants and asylum seekers, accessing healthcare is also very difficult. A 2018 comprehensive review from Imperial College London and Doctors of the World UK found that there are clear barriers to accessing healthcare for people seeking and refused asylum both at systemic policy level and in implementation and practice. Another study by Doctors of the World UK in 2018 found that one fifth of attempts to register Doctors of the World patients (typically people experiencing homelessness, sex workers, migrants with insecure immigration status, asylum seekers, refugees and Roma communities) with GP practices were refused. Qualitative research has shown that NHS charges and “hostile environment” policy deters migrants from seeking care or attending screenings. This has been documented amongst migrants living with HIV, for example, despite the fact that HIV treatment is exempt from charging. Moreover, evidence has shown that during the COVID-19 pandemic, hostile environment policies and charges on healthcare has deterred migrants and asylum seekers from accessing needed healthcare. See our COVID-19 page for more details.
Doctors of the World UK showed in 2015 that the majority of pregnant migrant women who accessed its London drop-in clinic did not have a GP despite being in the UK for on average 4.6 years at the time of delivery. 38% had their first antenatal appointment in the first 12 weeks of pregnancy with the rest booking late and 34% accessing antenatal care at greater than 20 weeks gestation. Fifty per cent of women had 5 or less antenatal appointments (less than the minimum level of antenatal care) and fear of costs and communication problems were cited as barriers. This puts these women at increased risk of pregnancy-related complications.
EXPERIENCES OF HEALTHCARE
Once BME people manage to access the healthcare they need, their experiences of care can be poor.
Analysis of the 2017 GP Experience Survey has shown that on almost every index ethnic minority people reported less good experiences than White British people.[1] This experience is particularly marked for Bangladeshi, Pakistani and Chinese groups; for example the proportion of overall positive experiences was 77% for Bangladeshi, 75% for Pakistani and 72% for Chinese groups, while white British people’s experiences were 84% positive. The 2017 Race Disparity Audit also found that most Asian groups generally express lower levels of satisfaction and less positive experiences of NHS General Practice services than other ethnic groups.
Moreover, in 2019 the Care Quality Commission found that almost half of BME people with a previous mental health problem wanted to raise concerns about mental health services, compared to just 13% of non-BME people with a mental health problem. Also, 84% of BME people with a mental health problem wanted to raise concerns or make complaints about the standard of their care generally, in compared to 63% of non-BME people.
MENTAL HEALTH
Mental ill-health particularly affects BME groups. Government statistics show that Black / African / Caribbean / Black British people in particular have higher rates of mental illness and are therefore more likely to encounter mental health services. The 2017 Race Disparity Audit found that Black women are the group most likely to have experienced a common mental disorder such as anxiety or depression and that Black men are the group most likely to have experienced a psychotic disorder. Statistics show that Black men are ten times more likely than white men to experience such a disorder. A special issue of Race & Class, published in January 2021 points to the particular ways in which the mental health of BME people, migrants and refugees are affected by state policies.[2]
The Mental Health Foundation suggest that immigrants and asylum seekers are also more likely to experience poor mental health than the local population. One 2018 study, for example, found that non-European immigrant women, including young South Asian women, were a particularly high-risk group for suicide attempts.[3]
Government statistics published in March 2019 showed that Black people were more than four times as likely as white people to be detained under the Mental Health Act. Black Caribbean people had the highest rate of detention out of all ethnic groups. A January 2018 Care Quality Commission (CQC) report also showed that people from the ‘any other Black’ background are detained at over 10 times the rate of the white population group. Within this, NHS statistics reveal that Black, black British and ‘mixed race’ people are arrested under section 136 (forcibly removed from a public place to a ‘place of safety’) twice as often as white people and are put on Compulsory Treatment Orders eight times more frequently than white people.
These figures reflect the high levels of mental illness within BME groups, but also the ways in which BME people are racialised in the assessment and treatment of these illnesses.[4] Moreover, this affects the outcomes for BME people’s treatment. For example, statistics show that in 2018-19 the highest percentage of patients which showed an improvement following treatment was the white British group at 68% while the lowest was the Bangladeshi ethnic group at 61%.
A recent report by the NHS Race and Health Observatory (2022) into ethnic inequalities has analysed an array of evidence to show how ‘ethnic inequalities in access to, experiences of, and outcomes of healthcare are longstanding problems in the NHS, and are rooted in experiences of structural, institutional and interpersonal racism’
FOR MORE INFORMATION SEE:
Footnotes
[1] Byrne, Bridget et al, Ethnicity, Race and Inequality in the UK: State of the Nation. (Bristol, Policy Press, 2020).
[2] Race, mental health, state violence, Race & Class, 62/3, January 2021.
[3] Forte A., Trobia F., Gualtieri F. et al, ‘Suicide risk among immigrants and ethnic minorities: a literature overview’ International Journal of Environmental Research and Public Health. (15(7), 1438, 2018).
[4] Nazroo, J.Y. ‘Ethnic inequalities in severe mental disorders: where is the harm?’, Social Psychiatry and Psychiatric Epidemiology. (50(7): 1065– 7, 2015).