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White Britons die at higher rates than any other ethnic group, according to new data from the Office for National Statistics. This finding comes despite the disproportionate impact of Covid on ethnic minorities and the negative effect that racism has on health outcomes.
Understanding inequalities in mortality — defined as the number of deaths per 100,000 people if followed for a year — is crucial for designing effective health and economic policies. But assembling the required data is complicated. The UK does not record ethnicity on death certificates, so to produce these new estimates statisticians linked self-reported ethnicity from the latest census data to death records using NHS numbers, capturing just under 92 per cent of England’s usual resident population.
The results are not perfect. For various reasons, records for ethnic minorities are less likely to be linked successfully, but Veena Raleigh, epidemiologist and senior fellow at think-tank The King’s Fund, says it is “as comprehensive, up to date and representative” a profile of ethnic differences in mortality as we are likely to get.
“We should be acting on this data,” she adds. “It’s really important that policy interventions and services are evidence-based and tailored to reflect the specific issues affecting each community.”
The data shows that mortality rates for white Britons, when adjusted for age differences in the population, were 50 per cent higher between March 2021 and January 2023 than for the group with the lowest rates, Chinese people.
One of the key reasons for lower death rates for ethnic minorities is that a larger share are migrants, who tend to be healthier than the population as a whole. Academic research has found this to be the case in a range of developed countries, including the UK and US.
The so-called “healthy migrant effect” is believed to be driven by self selection — for instance, better educated people are likely to be both better off and more likely to migrate — and lifestyle choices. According to the Commission on Race and Ethnic Disparities, white Britons are more likely than most other ethnic groups to smoke and to drink to excess, which are big risk factors for common killers like cancer.
However, as migrants assimilate, many adopt these unhealthy behaviours, with adverse health consequences. Previous ONS research has found that, between 2012 and 2014, migrants who had arrived in the UK from 1991 onwards had lower death rates in England and Wales than both UK natives and those migrants who arrived before 1991. This was true for all ethnic groups except Pakistanis.
The latest release marks the first time this data has been produced and it is still classed as “experimental” by the ONS. But while it is subject to more uncertainty than other national statistics, the findings are consistent with existing research. Mortality rates from diabetes and cardiovascular diseases like hypertension are known to be higher for South Asian and Black people, while common cancers like lung cancer kill white Britons at a higher rate.
Raleigh says it is important not to treat ethnic minorities “as if they are one homogenous group”. Even among the South Asian groups living in England there are notable differences, with death rates for diabetes almost twice as high among Bangladeshis as Indians, for example.
Understanding the complex relationship between ethnicity and health is increasingly important given the shift in demographics. In 2021, one in four people in England and Wales belonged to an ethnic group other than white British, compared to just one in eight in 2001.
Deprivation and geography are also key determinants of health that need to be considered alongside ethnicity.
Death rates among the most deprived 10 per cent of the population are almost twice as high as in the least deprived 10 per cent, according to the ONS data. But while the worst health outcomes are in the poorest parts of the country, different conditions and communities need to be targeted in each place.
For example, Blackpool and Manchester have some of the highest age-standardised death rates in the country. Both are in the North West and have high levels of deprivation, but very different demographics. The share of the population that is non-white is eight times higher in Manchester, with Pakistanis accounting for more than one in every ten people, according to the 2021 census.
This is reflected in health outcomes. For Mancunians, coronary heart disease, which disproportionately affects South Asians, has the highest death rate of all diseases. Pneumonia, a disease linked to poverty, is the biggest killer in Blackpool.
Despite the strong link between deprivation and health, some minority groups like Pakistanis and Bangladeshis have better outcomes than their white peers despite being on average more financially vulnerable. Experts suggest this may be explained by differences in lifestyle and more supportive family and community networks, but more work needs to be done to understand the complex interplay of factors behind health inequalities.
Raleigh says that there is an urgent need to address the large and growing disease burden across all ethnic groups.
“The growing mountain of [the] long-term sick is having a huge negative effect on population health and the economy. The NHS is firefighting long waiting lists but what we also need to focus on is reducing the demand for healthcare,” she says.
“That will put the NHS and the economy on a more sustainable footing and above all it will make individuals and communities healthier.”