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Bcares, LaiaMay 2007

THE EFFECT OF ETHNIC DENSITY ON HEALTH

Abstract

Studies in the United Kingdom show a consistent inequality between the health of ethnic

minorities and that of White people, with differences reported on health outcomes such as overall

self-reported health, limiting long-standing illness, heart disease, and hypertension, among others.

Further, it has been shown that ethnic minorities are over-represented in deprived and segregated

areas, which have been correlated with high mortality rates, infectious diseases and teenage

childbearing. However, albeit ethnic density is generally thought of in terms of the negative impacts

of segregation, it can also be considered in terms of social networks and supportive communities,

mitigating socioeconomic effects and the detrimental impact of racism on the health of ethnic

minority people. Several studies in both the UK and the US have studied the protective properties of

ethnic density on the health of ethnic minorities, but existent evidence is unreliable due to statistical

and measurement problems, leaving the question of whether ethnic density is protective on the

health of ethnic minorities unanswered.

The proposed study consists of an investigation of the hypothesised protective effects that

ethnic density has on the health of its ethnic minority residents. It aims to improve current

knowledge and methodological gaps by using a novel multilevel approach that will analyse data

from three large nationally representative surveys: the 1999 and 2003 Health Survey for England,

the 2003 and 2005 Home Office Citizenship Survey, and the Fourth National Survey of Ethnic

Minorities, all of which will be linked to the 2001 UK Census.

Introduction

Although the transformation of Great Britain into the multi-ethnic society of today began in the

1550s with the arrival of a small number of Africans as Britain became involved in the slave trade,

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notable migration to Great Britain didnt start until the early nineteenth century, with an influx and

efflux of Irish people who came to either settle permanently, or worked temporarily and eventually

returned back to Ireland. The latter part of the nineteenth century greeted an initial wave of Eastern

European Jews, who migrated to Britain escaping poverty or persecution, with a second wave

migrating during World War II. Ethnic minority populations in the UK increased significantly during

the second half of the 20th century as a result of high rates of immigration in the 1950s and 1960s.

It was during that time that people from the West Indies were recruited to fill low paying jobs in

urban areas, which were of low appeal to local residents. Around that same time the peak of Indian

migration occurred, with people from the Indian subcontinent settling in Britain for educational and

economic purposes. About a decade later, Britain welcomed Ugandan refugees from the Idi Admins

government, and in the 1980s open entrance to the United Kingdom started to close, with a change

in immigration laws limiting the numbers of people allowed to migrate1. Despite the commonality of

arriving to the same host country, ethnic minority groups residing in the UK differ greatly by their

reasons for immigration, settlement patterns, and age structure, among other factors which inevitably

affect their health and socioeconomic status.

Health Inequalities among Ethnic Groups

Although the collection of ethnic data in the United Kingdom began in the late 1970s, the

1991 Census was the first to classify the British population by ethnic group1. The 1991 Census

reported that approximately 5.5% of people residing in the UK (over 3 million) were from an ethnic

minority background. By the 2001 census, the percentage of ethnic minorities had grown to 7.9%, an

increase of 53% from 19911. As of the latest census, Indians were the largest UK ethnic minority

group (22.7%), followed by Pakistanis (16.1%), individuals of mixed ethnic backgrounds (14.6%),

black Caribbeans (12.2%), black Africans (10.5%), and Bangladeshis (6.1%). Inequalities in health

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among ethnic groups in the United Kingdom have been extensively documented, with studies on

health disparities showing a consistent discrepancy between the health of Bangladeshi, Pakistani and

Caribbean people compared to that of White and Chinese people2-6. Analyses on the Fourth National

Survey on Ethnic Minorities indicate that Caribbeans are more likely than Whites to describe their

health as fair, poor or very poor, and that Pakistani and Bangladeshi people, who fare worse than all

other ethnic groups, are 50% more likely than White people to report fair, poor, or very poor health5.

Similar patterns of health disparities have been observed in other health outcomes, including long-

standing illness limiting ability to work, heart disease, and hypertension, where ethnic minorities

report higher rates of disease than those reported by White people. In some cases, as in diabetes

amongst Pakistani and Bangladeshi people, rates of ill health are over five times that of Whites5.

Possible explanations of health disparities have fallen on socio-economic inequalities among ethnic

groups, and analyses on socio-economic position and health have demonstrated a steady relationship

among ethnic groups7. However, despite sound and replicated studies on ethnic inequalities in

health2-4;6;7, a core problem on the quality of data remains. Studies often use broad categories of

ethnicity (lumping together South Asians, for example), or crude levels of socioeconomic data,

which do not reflect actual income gradients between ethnic groups. Moreover, the majority of

studies are cross-sectional and collect socioeconomic data on current position, rather than across the

life course6. Despite these flaws, important socio-economic effects have been found. However, after

accounting for socio-economic status large differences remain among ethnic groups, providing

evidence for the possibility that socio-economic factors are not the sole explanation behind ethnic

disparities in health5. The impact of socioeconomic disadvantages experienced by ethnic minorities

must be studied within a wider framework, encompassing their migrant history and disadvantaged

place in society. More importantly, the explanation of ethnic inequalities in health must take into

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consideration health-shaping daily experiences of ethnic minorities in the UK, such as events of

racial harassment and discrimination experienced by ethnic minority groups6. Furthermore, the

number of epidemiological studies collecting data on experiences of racial harassment and

discrimination remains fairly limited6.

Racial Discrimination and Health

Racism or racial discrimination has been examined by recent studies as a possible cause of the

health gap among ethnic minority groups, reporting correlations between interpersonal ethnic

discrimination and higher levels of stress, anxiety, and high blood pressure, among other health

outcomes

8-12

. Racial discrimination can be enacted through two different, although not mutually

exclusive paths: interpersonally and/or institutionally. Interpersonal discrimination refers to

discriminatory interactions between individuals13; institutionalised discrimination, on the other hand,

is embodied in discriminatory policies embedded in organizational13, and can discern itself as

inherited disadvantage, such as racial residential segregation. The existence of interpersonal

discrimination in the UK has been clearly established in several studies. For example, in an analysis

of the Fourth National Survey on Ethnic Minorities, Karlsen and Nazroo13 found that in the year

previous to the survey, 3% of the respondents believed that they or their property had been

physically attacked for reasons to do with their ethnicity; 12% reported experiencing racially

motivated verbal abuse; and 64% believed that some British employers would refuse someone a job

on the grounds of race, colour, religion, or cultural background13.

Discrimination has been suggested to impact on mental health by leading to affective reactions

such as sadness, through shaping an individuals appraisal of the world14, by reinforcing secondary

status and impacting on ones self esteem15, and by internalising negative stereotypes16. Despite this

information, the exact pathways by which racism and discrimination impact on health have not been

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clearly defined yet; nonetheless, several studies have linked experiences of discrimination to poor

health. For example, Karlsen and Nazroo found that respondents who reported experiences of verbal

abuse were approximately 50% more likely than those who did not report such events to describe

their health as fair or poor, and those who reported being physically attacked or having their property

vandalized were over 100% more likely than those who did not to report fair or poor health13.

Although the direct association between interpersonal discrimination and health has been

established8-13, the ways in which the processes and mechanisms of institutional discrimination, such

as racial residential segregation, impact on health are not yet fully understood, and in the UK there is

currently a dearth of research examining the relationship between racial segregation and health

outcomes.

Racial Residential Segregation

Residential segregation has been defined as the spatial differentiation and distribution of

majority and minority ethnic groups across a metropolitan area and its neighbourhoods17;18, and has

been referred to as a social manifestation of individual prejudices and institutional discrimination,

and as one of the mechanisms by which racism operates17;19-21. Processes shaping residential

segregation include distrust and fear caused by generalised racism and the experience of continuous

discrimination of exclusion along ethnic lines22. In the UK, studies have suggested that racism is a

major factor affecting the residential choices and housing tenure adopted by early migrants, as

private landlords and public housing allocation have restricted ethnic minority groups to areas of

low-quality housing23.

Segregation has been stated to concentrate poverty, dilapidation, and social problems in ethnic

minority neighbourhoods24;25, resulting in under-funded and ineffective institutions in these

communities25. Wards with high proportions of ethnic minorities have been shown to be more

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densely populated, with more social housing, lower proportion of households with cars and central

heating, and lower proportions of unemployment and individuals in professional and managerial

occupations26.

Pathways linking segregation to health

Residential segregation can impact on health either directly, if the mere fact of living in a

deprived neighbourhood is deleterious to health, or indirectly, through a broad range of pathogenic

residential conditions, such as the availability and accessibility of health services, lack of healthy

foods or recreational facilities, environmental pollution, access to transportation, normative attitudes

towards health, and social support

17;27-30

. A review by Picket and Pearl

28

found negative

neighbourhood effects to be associated with an increased risk of all-cause mortality31-38; infant and

child health39-41; chronic disease among adults32;37;42-48; and health behaviour42;45;46;49-51.

Despite comprising a minority of the overall UK population, ethnic minority groups are over-

represented in specific geographic areas, accounting for a majority of the neighbourhood resident

population; over thirty percent of the total ethnic minority population live in neighbourhoods where

minorities account for over 50% of the residents52. For example, albeit only accounting for 0.55% of

the general UK population, Bangladeshis constitute more than a third of the residents of the London

borough of Tower Hamlets52. In addition, the ethnic minority population is not evenly distributed

among all wards. An indication of the degree of ethnic concentration in the UK is that 31.2% of the

total ethnic minority population live in wards where minorities account for over 50% of the

population, and that the top 10% of wards by ethnic minority density contain around 64% of all

minority residents52. Within greater London, which contains 45% of the ethnic minority population,

and only 10.3% of the overall population5, several residential areas have been associated with

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specific ethnic groups, so that, for example, Ugandans, Ghanaians and Nigerians are usually

clustered in south London, and most Somalis reside in east London53.

Existing neighbourhood studies show that Caribbean, Pakistani, Bangladeshi, and to some

extent Indian people are more likely than White people to reside in disadvantaged wards54, which, as

previously mentioned, are characterised by poor social and material infrastructure, including low

quality and quantity of leisure facilities, transport, housing, physical environment, food shopping

opportunities, and primary and secondary health services27. Moreover, living in a deprived

neighbourhood has been associated with an increased risk of poor-rated physical and mental

health

27;55

, and given that ethnic minorities have been found to reside in deprived areas, it is possible

that they are being disproportionately affected by detrimental area effects on health. However,

despite the evidence on the deleterious effect that residential segregation has on socioeconomic

standing and health, areas with high levels of ethnic concentrations have been hypothesized to

provide its residents with an information network highly valuable in social interactions and

economic activities, such as expenditures and employment opportunities56. In the case of new

migrants, living in areas with high concentrations of co-ethnics provides them with location-specific

human capital acquired by neighbourhood residents (longer term migrants or natives of the same

origin), including information obtained directly and indirectly through established networks56.

Further, regional and national associations fostering social networks are closely linked with the

clustered settlement process53. For example, ethnic minority people have been found to perceive the

amenities in their neighbourhood in a more favourable manner than White people, even after

accounting for area deprivation54, possibly reflecting their investment in the facilities, either

commercial or civic, established for their communities57. Furthermore, it is has been hypothesized

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that the concentration of ethnic minorities in a particular geographical area, or ethnic density,

might provide its residents with protective effects on health, through the ethnic density effect.

Ethnic Density

Researchers in several disciplines have investigated the properties of the ethnic density effect

on different outcomes, including education, health, and economic mobility54;58-64.

Hypotheses of the ethnic density effect in health research have been coined stipulating that as

the size of an ethnic minority group increases, their health complications will decrease60;65. It has

been stated that ethnic density may aid in the development of positive roles64, and it may facilitate

increased political mobilisation and material opportunities, as well as encourage healthy behaviour

54

.

Moreover, theoretical frameworks behind the ethnic density effect articulate that positive health

outcomes are attributed to the protective and buffering effects that enhanced social cohesion, mutual

social support and a stronger sense of community and belongingness provide from the direct or

indirect consequences of discrimination and racial harassment1;53;64;65.

Hypothesised pathways for the relationship between ethnic density and health

Social capital, a key domain of social cohesion66, defined as the features of social life such as

networks, norms and trust, that enable participants to act together more effectively to pursue shared

objectives67, has been linked to several health outcomes and measures of well-being68, and has been

argued to generate positive social outcomes69. Social capital has been described to be either bonding

(inward looking) or bridging (outward looking); thus, whereas bridging social capital includes

people across diverse social divisions, bonding social capital is centred on relationships and

networks of trust and reciprocity that reinforce bonds and connections within groups70. Ethnicity has

been referred to as a form or source of social capital because ethnic group membership is often a

basis for networks of social relations71, and because social capital obtained through resources found

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in ethnic minority networks is considered the leading factor in improving the chances of upward

educational mobility among ethnic minorities72, and a source of economic and moral support for

second generations73. Besides the well-established pathway of social support, which has been

associated with a decrease in morbidity and mortality74-77, this study hypothesises that social capital

will impact on the health of ethnic minorities through two individual, although not mutually

exclusive pathways that will counterbalance or reduce the harmful effects of racism. These

mechanisms, encompassed within ethnic density effect, are described below:

1) Buffering effect: The buffering model posits that social support "buffers (protects) persons

from the potentially pathogenic influence of stressful events

75

, such as racial harassment and

discrimination. The buffering properties found in the ethnic density effect are expected to counteract

the detrimental effects of racism through two different, yet not mutually exclusive mechanisms: a) a

change in the appraisal process of a stressful event such as interpersonal racial harassment, and b)

the recognition and discussion of experienced discrimination with other ethnic minority people. The

first mechanism, a change in the appraisal process, is based on the premise that racial harassment is

usually perceived and internalised by ethnic minority people as evidence of their own flaws and

subordinate status9, rather than as an act perpetrated from a discriminatory and prejudicial stance.

However, it is hypothesised that living among co-ethnics and other ethnic minority people will

bestow upon the person subjected to interpersonal racial harassment a different perspective, based on

the likelihood that the discriminatory event experienced it is not due to an internalized individual

flaw, but rather to an isolated assault by aberrant perpetrator. It is hypothesised that this outlook will

be the consequence of greater involvement and participation in the community, found in areas of

high ethnic density. Community involvement, or civic participation, has been shown to be lower in

ethnic- or income-heterogenic areas78;79, thus it is likely that areas of high ethnic density will be

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characterised by higher rates of community involvement, including participation in political parties,

trade unions, PTA, neighbourhood associations, and informal social contact with neighbours among

others. It is then expected that participation in the community will generate positive role models64, a

stronger sense of community and belongingness1 and enhanced social cohesion64, which are

hypothesised to provide ethnic minorities with the notion that an interpersonal racist event

experienced is the oddity of one individual, not a normative behaviour and a consequence of being

an ethnic minority. This cognitive process, in turn, is hypothesised to decrease self-stigmatisation

and stress, which have been related to overall health and mental health31;80;81.

The second mechanism, the recognition and discussion of experienced discrimination with

other ethnic minority people, emerges from the indication that an individuals social support and

social networks, such as those found in neighbourhoods and residential communities, may permit an

ethnic minority individual to recognize and discuss experiences of racism with others, which may

mediate the association between racism and health82. Further, studies have shown that among people

who report having experienced discrimination, those who do something about it, such as reporting

the event or talking about it, have better health outcomes than those who do not9.

2) Social norms: The existence of social norms, a characteristic of social capital83, is

hypothesised to decrease the likelihood that an ethnic minority person living in an ethnically dense

neighbourhood will experience racial harassment. Through the enforcement of informal social

control exerted over deviant behaviour84 and low tolerance against discrimination, it is expected that

racist harassment and discriminatory events will be less frequent in ethnically dense

neighbourhoods.

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In conjunction with its buffering effects, the existence of social norms carries out the

hypothesised protective effects of ethnic density against the detrimental impact of racism, illustrated

in Figure 1.

Figure 1. Hypothesised protective mechanisms of the ethnic density effect (model adapted fromCohen and Wills, 1985)

Racial harassment or interpersonal

discriminatory event(s)

Appraisal process

Event(s) perceived as stressful.Internalised oppression.

Event(s) perceived as oddity ofindividual, not as evidence of own flaws

Emotionally linked physiological response

Buffering effect

Reduced incidence

Enforcement of social norms andlow tolerance against racism

Buffering effect

Discussion ofevents with peers

Community involvementleading to: Positive role

models, sense of

belonging, increasedsocial cohesion

Health outcome

Existent studies on the relationship between ethnic density and health

Studies that have examined the effects of ethnic density on health have yielded mixed results;

whereas several analyses have been able to demonstrate the protective effect of ethnic density63;65;85-

92, others have not54;93-95. This discrepancy in the findings can be attributed to the fact that studies

have used different health outcomes, different definitions of ethnic groups, different levels of

geographical measurement, and most importantly, weak methodological approaches. It is also

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possible that other variables in the relationship between ethnicity, neighbourhood and health are

overshadowing the effect of ethnic density, masking its protective effect on health. For example,

Karlsen and colleagues54 refer to the interplay between socio-economic status and health, indicating

that the concentration of ethnic minorities in socio-economically deprived neighbourhoods might

disguise the protective effects of ethnic density through the negative health impact of living in

deprived areas.

Studies supporting and contradicting ethnic density are characterised by methodological and

measurement limitations, making the results unreliable. Such limitations include:

1.The collection of ethnic data as an observer-assigned characteristic

63

.

2. The combination of ethnic groups into one non-white group or several largeheterogeneous ethnic groups, such as the classification of South Asians for

Bangladeshis, Pakistanis and Indians63;85-87;89;91-95.

3. The measurement of ethnic density as either own-group residential concentration oroverall minority concentration, failing to test whether the ethnic density effect is

group-specific or the result of living among other ethnic minorities, regardless of

specific ethnic group. Moreover, several studies have been inconsistent in the definition

of ethnicity, measuring ethnic group specifically (e.g., black) but defining ethnic

density as general minority concentration (e.g., non-white)85-87;91-95.

4. The use of statistical analyses that do not account for the nested nature of the data,hindering the identification of independent effects of the individual and the area on

health, and not allowing for the clustering of individuals within areas63;87;89;91;93-95.

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5. The use of data collected in few and similar areas in close proximity (e.g., boroughs insouth east London), which does not allow for generalisation of the effects of ethnic

density to other areas and/or ethnic groups63;86;87;89-91;93;94.

6. The failure to test and control for confounders and mediators in the relationshipbetween ethnic density and health, concealing possible effects of ethnic density, and

failing to provide insight into pathways linking the ethnic density effect to health

outcomes63;85;87;89-97.

7. The use of rigid categories of ethnic density, making difficult the detection of an ethnicdensity effect, a possible threshold, and/or testing the linearity of the association

between ethnic density and health54;85;91.

8. The use of different measures of ethnic density (i.e., percentage minority people vs.segregation indices), limiting the possibility of comparing results across studies87.

Therefore, in order to correct limitations from previous research and accurately measure the

impact of the ethnic density effect on health, future studies must be designed appropriately, ensuring

the use of: a) a self-assigned ethnicity variable, divided into ethnic groups as specific as possible; b)

a measure of ethnic density categorised as both specific-ethnicity density for each ethnic group and

overall ethnic minority density, measured through different methodology (e.g., percentage ethnic

minority people, Index of Dissimilarity, and Index of Isolation) and recoded as both a continuous

and categorical variable; c) individual-level markers of social participation and social networks,

socioeconomic status, experiences of discrimination and racism, health and wellbeing, as well as

area geomarkers of deprivation; d) multilevel methodology that allows for the clustering of

individuals within census areas; and e) precise and clearly defined area measures that will be able to

capture local group concentrations with accuracy88;98.

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The use of the analytical and measurement considerations described above are expected to

warrant a stronger confidence in the results found for the association between ethnic density and

health. These improvements, however, will not provide a clear explanation regarding the pathways

linking exposure and outcome variables, underlying the need to test for the hypothesised mediator

variables and explanatory pathways explaining the association. Figure 2 represents this studys

hypothesised relationships between residential segregation, ethnic density and health. Residential

segregation, a social manifestation of individual and institutionalised discrimination17, has been

shown to impact negatively on health through the different area and individual-level variables listed

inside boxes 1 and 2 (red-coloured), including area deprivation, social isolation from political and

economic power, poor social norms and inferior social services. While residential segregation has

been shown to be deleterious to health, its ethnic density attribute has also been hypothesised to

provide some protective effects to ethnic minority residents, buffering the detrimental impact of

residential segregation through the social support variables enumerated in box number 3 (light

orange), which include enhanced social cohesion, mutual social support, and stronger sense of

community, among others. More specifically, it is hypothesised that ethnic density is protective of

the harmful effects of discriminatory insults on health through two different, although not mutually

exclusive, processes (described in detail in figure 1): 1) a buffering effect produced by a change in

the appraisal process of a discriminatory event and the possibility of discussing the event with peers,

and 2) a reduced incidence of racial harassment due to enforced social norms and low tolerance for

racism.

In summary, this study hypothesises that the health of ethnic minorities living in ethnically

dense areas will be better than that of their counterparts residing in areas of less ethnic concentration,

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due to ethnic densitys protective effects of enhanced social networks and buffered experiences of

discrimination. More specifically, the study hypothesises that:

I. The health of ethnic minority people residing in areas with high ethnic density will bebetter than the health of ethnic minority people residing in less ethnically dense areas

after controlling for area deprivation and individual socio-economic and demographic

characteristics.

II. The relationship between ethnic density and health will follow a non-linear path wherethe buffering effects of ethnic density will significantly impact on ethnic minorities

health after a certain percentage of co-ethnics living in an area.

III. Ethnic minority people living in areas of high ethnic density will have greater communityinvolvement than their counterparts living in areas of low ethnic density.

IV. Reported experiences of racism will be fewer in areas with higher concentrations ofethnic minority people as compared to areas of less ethnic density.

V. The impact of discrimination will be less among ethnic minority people living in areas ofhigh ethnic density as compared to their counterparts living areas of less ethnic density.

These hypotheses will be tested by asking the following research questions:

1. Is there an association between ethnic density and health?2. What is the strength of the relationship between ethnic density and health after

controlling for the following factors?

a. Neighbourhood deprivationb. Genderc. Aged. Individual socioeconomic position

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e. English language fluencyf. Immigrant generation (1st generation vs. British born, and migration cohort)g. Religionh. Household compositioni. Neighbourhood clustering (ethnic minority neighbourhoods right next to each

other as compared to ethnic neighbourhoods surrendered by non-ethnic

neighbourhoods).

3. What are the mechanisms by which ethnic density impacts on health? Is there anassociation between:

a. Ethnic density and increased community involvementb. Increased community involvement and healthc. Ethnic density and experienced discrimination

4. Amongst individuals reporting experiences of racism and discrimination, does ethnicdensity moderate the effect of racism and discrimination on health?

5. Is there a certain proportion of ethnic density that is beneficial for health and a thresholdin which ethnic density becomes detrimental?

6. Is there a difference in the ethnic density effect in:a. White residents in ethnic minority neighbourhoodsb. Ethnic minority residents from the same ethnic background as the majority of

ethnic minority residents populating the neighbourhood (e.g. Bangladeshi

people in a neighbourhood with high Bangladeshi concentration)?

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c. Ethnic minority residents from a different ethnic background than thatpopulating the neighbourhood (e.g. Black Caribbean people in a Bangladeshi

neighbourhood)?

In order to conduct these research questions, this study will analyse data from three large

national surveys (the 2003 and 2005 Home Office Citizenship Survey, the 1999 and 2004 Health

Survey for England, and the Fourth National Survey on Ethnic Minorities); the variables contained

in these five datasets will ensure that the different hypotheses and research questions can be

adequately tested. This study will build on previous literature and improve the current gaps in the

methodology by using detailed and precise ethnic groups, two definitions (specific and general to

ethnic minority status) and two values of ethnic density (continuous and categorical) to test for a

threshold effect and the linearity of the relationship. Moreover, in order to test the hypothesised

pathways linking ethnic density to health, the study will include variables on individual-level

markers of social participation and social networks, socioeconomic status, and experiences of

discrimination and racism, employing multilevel methodology to allow for the clustering of

individuals within geographical areas.

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Reference List

(1) Bhugra D, Becker M. Migration, cultural bereavement and cultural identity. WorldPsychiatry 2005; 4(1):18-24.

(2) Davey Smith G, Chaturvedi N, Harding S, Nazroo JY, Williams R. Ethnic inequalities inhealth: a review of the UK epidemiological evidence. Critical Public Health 2000; 10(4):375-408.

(3) Erens B, Primatesta P, Prior G. health Survey for England 1999: The Health of MinorityEthnic Groups. London: The Stationary Office; 2001.

(4) Nazroo JY. The Health of Britain's Ethnic Minorites: Findings From a National Survey.London: Policy Studies Institute; 1997.

(5) Nazroo JY. Ethnicity, Class and Health. London: Policy Studies Institute; 2001.

(6) Nazroo JY. Patterns of and explanations for ethnic inequalities in health. In: Mason D, editor.Explaining ethnic differences in health. Bristol: Policy Press; 2003. 87-103.

(7) Nazroo JY. South Asian people and heart disease: an assessment of the importance ofsocioeconomic position. Ethnicity and Disease 2001; 11(3):401-411.

(8) Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Socialscience & medicine 1990; 30:1273-1281.

(9) Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of youngblack and white adults. American journal of public health 1996; 86(10):1370-1378.

(10) Williams D, Yu Y, Jackson J, Anderson N. Racial differences in physical and mental health:socioeconomic status, stress, and discrimination. Journal of Health Psychology 1997; 2:335-351.

(11) Williams D. Race, SES, and health: the added effects of racism and discrimination. Annals ofthe New York Academy of Science 1999; 896:173-188.

(12) Williams D, Neighbors H. Racism, discrimination and hypertension: evidence and neededresearch. Ethnicity and Disease 2001; 11:800-816.

(13) Karlsen S, Nazroo JY. Relation between racial discrimination, social class, and health amongethnic minority groups. American-Journal-of-Public-Health 2002; 92:624-631.

(14) Harrell S. A multidimensional conceptualization of racism-related stress: implications for thewell-being of people of color. American Journal of Orthopsychiatry 2000; 70:42-57.

(15) DuBois D, Burk-Braxton C, Swenson L, Tevendale H, Hardesty J. Race and genderinfluences on adjustment in early adolescence. Child Development 2002; 73:1573-1592.

18

7/28/2019 Ba Cares

19/26


(16) Williams D, Williams-Morris R. Racism and mental health: the African Americanexperience. Ethnicity and Health 2000; 5:243-268.

(17) Acevedo GD. Residential segregation and the epidemiology of infectious diseases. SocialScience & Medicine, 51, 1143-1161 2000; 51:1143-1161.

(18) Acevedo GD, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residentialsegregation and health research: A multilevel approach. American-Journal-of-Public-Health2003; 93:215-221.

(19) Collins CA, Williams DR. Segregation and mortality: the deadly effects of racism?Sociological forum 1999; 14:495-523.

(20) Grady SC. Racial disparities in low birthweight and the contribution of residentialsegregation: a multilevel analysis. Social Science and Medicine 2006; 21:[ahead of pub].

(21) Pettigrew T, Meertens RW. Subtle and blatant prejudice in Western Europe. European

Journal of Social Psychology 1995; 25:57-77.

(22) Amin A. Ethnicity and the mulitcultural city: living with diversity. Environment andPlanning A 2002; 34:959-980.

(23) Peach C, Byron M. Council house sales, residualisation and Afro Caribbean tenants. Journalof Social Policy 1994; 23(3):363-383.

(24) Farley R, Frey W. Changes in the segregation of whites from blacks during the 1980s: smallsteps toward a more integrated society. American Sociological Review 2007; 59(1):23-45.

(25) Massey DS, Denton NA. American apartheid: Segregation and the making of the underclass.Cambridge, Mass.: Harvard University Press; 1993.

(26) Clark K, Drinkwater S. Enclaves, neighbourhood effects and employment outcomes: ethnicminorities in England and Wales. Journal of Population Economics 2002; 15:5-29.

(27) Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A. Neighbourhood environmentand its association with self rated health: evidence from Scotland and England. Journal ofEpidemiology and Community Health 2004; 59:207-213.

(28) Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context andhealth outcomes: a critical review. Journal of Epidemiology and Community Health 2001;

55:111-122.

(29) Polednak AP. Segregation, poverty and mortality in urban African-Americans. New York:Oxford University Press; 1997.

(30) Williams D, Collins CA. Racial residential segregation: A fundamental cause of racialdisparities in health. Public Health Reports 2001; 116:404-416.

19

7/28/2019 Ba Cares

20/26


(31) Anderson N, Myers H, Pickering T, Jackson J. Hypertension in blacks: psychological andbiological perspectives. Journal of Hypertension 1989; 7:161-172.

(32) Davey Smith G, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-baseddeprivation, cardiovascular disease risk factors, and mortality: the Renfrew and PaisleyStudy. Journal of Epidemiology and Community Health 1998; 52(6):399-405.

(33) Haan M, Kaplan GA, Camacho T. Poverty and health: prospective evidence from theAlameda County Study. American Journal of Epidemiology 1987; 125:989-998.

(34) Kaplan GA. People and places: contrasting perspectives on the association between socialclass and health. International Journal of Health Services 1996; 26:507-519.

(35) LeClere FB, Rogers RG, Peters KD. Ethnicity and mortality in the United States: individualand community correlates. Social forces 1997; 76:169-198.

(36) LeClere FB, Rogers RG, Peters KD. Neighbourhood social context and racial differences in

women's heart disease mortality. Journal of Health and Social Behavior 1998; 39:91-107.

(37) Slogget A, Joshi H. Higher mortality in deprived areas: community or personaldisadvantage? British Medical Journal 1994; 309:1470-1474.

(38) Waitzman N, Smith K. Phantom of the area: poverty-area residence and mortality in theUnited States. American-Journal-of-Public-Health 1998; 88:973-976.

(39) Morgan M, Chinn S. ACORN group, social class, and child health. American Journal ofEpidemiology 1983; 37:196-203.

(40) O'Campo P, Xue X, Wang M-C, Caughy M. Neighborhood risk factors for low birthweigh inBaltimore: a multilevel analysis. American-Journal-of-Public-Health 1997; 87:1113-1118.

(41) Roberts E. Neighborhood social environments and the distribution of low birthweight inChicago. American-Journal-of-Public-Health 1997; 87:597-603.

(42) Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E et al.Neighborhood environment and coronary heart disease. American Journal of Epidemiology1997; 146(1):48-63.

(43) Humphreys K, Carr-Hill R. Area variations in health outcomes: artefact or ecology.International Journal of Epidemiology 2007; 20(1):251-258.

(44) Jones K, Duncan C. Individuals and their ecologies: Analyzing the geography of chronicillness within a multilevel modeling framework. Health and Place 1995; 1(1):27-40.

(45) Krieger N. Overcoming the absence of socioeconomic data in medical records. American-Journal-of-Public-Health 1992; 82:703-710.

20

7/28/2019 Ba Cares

21/26


(46) Reijneveld SA. The impact of individual and area characteristics on urban socioeconomicdifferences in health and smoking. International Journal of Epidemiology 1998; 27:33-40.

(47) Robert S. Community-level socioeconomic status effects on adults health. Journal of Healthand Social Behavior 1998; 39:18-37.

(48) Shouls S, Congdon P, Curtis S. Modelling inequality in reported long-term illness in the UK:combining individual and area characteristics. Journal of Epidemiology and CommunityHealth 1996; 50:366-376.

(49) Curry S, Wagner E, Cheadle A, Diehr P, Koepsell T, Psaty B et al. Assessment ofcommunity-level influences on individual's attitudes about cigarette smoking, alcohol use,and consumption of dietary fat. American journal of preventive medicine 1993; 9:78-84.

(50) Kleinschmidt I, Hills M, Elliott P. Smoking behaviour can be predicted by neighbourhooddeprivation measures. J ournal of Epidemiology and Community Health 1995; 49(suppl2):S72-S77.

(51) O'Campo P, Gielen A, Faden R, Xue N, Kass N, Wang M-C. Violence by male partnersagainst women during the childbearing years: a contextual analysis. American-Journal-of-Public-Health 1995; 85:1092-1097.

(52) Clark K, Drinkwater S. Ethnic minority segregation preferences: Evidence from the UK.2004.Ref Type: Report

(53) Daley P. Black Africans in Great Britain: spatial concentration and segregation. UrbanStudies 1998; 35(10):1703-1724.

(54) Karlsen S, Nazroo JY, Stephenson R. Ethnicity, environment and health: putting ethnicinequalities in health in their place. Social science & medicine 2002; 55:1647-1661.

(55) Stafford M, Marmot M. Neighbourhood deprivation and health: does it affect us all equally?International Journal of Epidemiology 2002; 32:357-366.

(56) Chiswick BR, Miller PW. Do enclaves matter in immigrant adjustment? City andCommunity 2005; 4(1):5-35.

(57) Nazroo JY, Williams DR. The social determination of ethnic/racial inequalities in health. In:Marmot M, Wilkinson RG, editors. Social determinants of health. Oxford: Oxford University

Press; 2005. 238-263.

(58) Bhugra D, Leff J , Mallet R, Der G, Corridan B, Rudge S. Incidence and outcome ofschizophrenia in whites, AfricanCaribbeans and Asians in London. Psychological Medicine1997; 27:791-798.

(59) Bhugra D, Jones P. Migration and mental illness. Advances in Psychiatric Treatment 2001;7:216-223.

21

7/28/2019 Ba Cares

22/26


(60) Faris R, Dunham W. Mental disorders in urban areas: An ecological study of schizophreniaand other psychoses. Chicago, IL: University of Chicago Press; 1939.

(61) Lackland Sam D. Predicting life satisfaction among adolescents from immigrant families inNorway. Ethnicity and Health 1998; 3(1/2):5-18.

(62) Mintz NL, Schwartz DT. Urban ecology and psychosis. International Journal of SocialPsychiatry 1964; 10:101-118.

(63) Neeleman J, Wessely S. Ethnic minority suicide: a small area geographical study in southLondon. Psychological Medicine 1999; 29:429-436.

(64) Smaje C. Ethnic residential concentration and health: evidence for a positive effect? Policyand Politics 1995; 23(5):251-269.

(65) Halpern D., Nazroo JY. The ethnic density effect: results from a national community surveyof England and Wales. International Journal of Social Psychiatry 2000; 46(1):34-46.

(66) Forrest R, Kearns A. Social cohesion, social capital and the neighbourhood. Urban Studies2001; 38:2125-2143.

(67) Putnam R. Tuning in, tuning out: the strange disappearance of social capital in America. PS:Political Science and Politics 1995; 28:664-683.

(68) Kawachi I, Kim D, Coutts A, Subramanian SV. Reconciling the three accounts of socialcapital. International Journal of Epidemiology 2004; 33:682-690.

(69) Putnam R. The prosperous community: social capital and public life.http://wwwprospectorg/print/V4/13/putnam-r html [ 1993

(70) Putnam R. Bowling alone - the collapse and revival of American community. New York:Simon & Schuster; 2000.

(71) Bankston C, Zhou M. Social capital as a process: The meanings and problems of a theoreticalmetaphor. Sociological Inquiry 2002; 3:285-317.

(72) Modood T. Capitals, ethnic identity and educational qualifications. Cultural Trends 2004;13(2):87-105.

(73) Portes A, Zhou M. The new second generation: segmented assimilation and its variants. The

Annals of the Academy of Political and Social Science 1993; 530:74-96.

(74) Berkman LF, Glass T, Brissette I, Seeman T. From social integration to health: Durkheim inthe new millennium. Social-Science-and-Medicine 200; 51:843-857.

(75) Cohen S, Wills TA. Stress, social support, adn the buffering hypothesis. PsychologicalBulletin 1985; 98:310-357.

22
http://www/http://www/

7/28/2019 Ba Cares

23/26


(76) Dalgard O, Lund-Haheim L. Psychosocial risk factors and mortality: a prospective study withspecial focus on social support, social participation, and locus of control in Norway. Journalof Epidemiology and Community Health 1998; 52:476-481.

(77) Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiologyand prognosis of coronary heart disease. Systematic review of prospective cohort studies.British Medical Journal 1999; 318:1460-1467.

(78) Alesina A, Ferrara EL. Participation in heterogeneous communities. Quarterly Journal ofEconomics 2007; 115(3):847-904.

(79) Costa D, Khan M. Civic engagement and community heterogeneity. Perspectives on Politics2003; 1:103-111.

(80) Chakraborty A, McKenzie K. Does racial discrimination cause mental illness? BritishJournal of Psychiatry 2002; 180:475-477.

(81) Williams D. Black-white differences in blood pressure: the role of social factors. Ethnicityand Disease 1992; 2:126-141.

(82) Karlsen S, Nazroo JY. Agency and structure: the impact of ethnic identity and racism on thehealth of ethnic minority people. Sociology of Health and Illness 2002; 24(1):1-20.

(83) Coleman J. Social capital in the creation of human capital. American Journal of Sociology1988; 94:S95-S120.

(84) Sampson RJ, Raudenbush SW, Earls F. Neighbourhoods and violent crime: a multilevelstudy of collective efficacy. Science- 1997; 277(5328):918-924.

(85) Boydell J , van Os J, McKenzie K, Allardyce J, Goel R, McCreadie R et al. Incidence ofschizophrenia in ethnic minorities in London: ecological study into interactions withenvironment. British Medical Journal 2001; 323:1-4.

(86) Fagg J, Curtis S, Stansfeld S, Congdon P. Psychological distress among adolescents, and itsrelationship to individual, family and area characteristics in East London. Social-Science-and-Medicine 2006; 63:636-648.

(87) Fang J. Residential segregation and mortality in New York City. Social-Science-and-Medicine 1998; 47(4):469-476.

(88) Franzini L, Spears W. Contributions of social context to inequalities in years of life lost toheart disease in Texas, USA. Social-Science-and-Medicine 2003; 57:1847-1861.

(89) Neeleman J, Wilson-Jones C, Wessely S. Ethnic density and deliberate self harm; a smallarea study in south east London. Journal of Epidemiology and Community Health 2001;55(2):85-90.

23

7/28/2019 Ba Cares

24/26


24

(90) Pickett KE, Collins JW, Masi CM, Wilkinson RG. The effects of racial density and incomeincongruity on pregnancy outcomes. Social-Science-and-Medicine 2005; 60:2229-2238.

(91) Rabkin JG. Ethnic density and psychiatric hospitalization: hazards of minority status.American Journal of Psychiatry 1979; 136:1562-1566.

(92) Wickrama K, Noh S, Bryant C. Racial differences in adolescent distress: differential effectsof the family and community for black and whites. Journal of Community Psychology 2005;33(3):261-282.

(93) McNally R, Alston R, Cairns D, Eden O, Kelsey A, Birch J. Geographical and ecologicalanalyses of childhood acute leukaemias and lymphomas in north-west England. BritishJournal of Haematology 2003; 123:60-65.

(94) McNally R, Alston R, Cairns D, Eden O, Kelsey A, Birch J. Geographical and ecologicalanalyses of childhood Wilms' tumours and soft-tissue sarcomas in North West England.European Journal of Cancer 2003; 39:1586-1593.

(95) McNally R, Alston R, Eden O, Kelsey A, Birch J. Further clues concerning the aetiology ofchildhood central nervous system tumours. European Journal of Cancer 2004; 40:2766-2772.

(96) Franklin J. Looking at beyond the Third Way. www anthropolis de/franklin htm [ 2001

(97) Mellor JM, Milyo JD. Individual health status and racial minority concentration in US statesand counties. American journal of public health 2004; 94:1043-1048.

(98) Halpern D. Minorities and mental health. Social-Science-and-Medicine 1993; 36:597-607.

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1

- Poor quality of primary health care servicesanddiscriminatorypractices among service providers- Poor Collective Resourcessuch as services and job opportunities

- Increased crime and victimisation

- Poor Housing Conditions(dampness, overcrowding, etc)- Economic De rivation concentrated overt and unem lo ment

2

- Lack of social integration thorough limited contact with successfulmembers of the white or ethnic minority community leading to isolationfrom economic power

- Poor Social Normsregarding work ethic, devalued academic success,de-stigmatisation of imprisonment and unemployment

3

- Enhanced social cohesion- Mutual social support- Stronger sense of community and belongingness

- Development of positive roles- Increased political mobilisation and employmentopportunities- Encouragement towards healthy behaviour- Lower exposure to racial harassment and discrimination- Recognition and discussion of experienced discriminationwith co-ethnicsR

esidentialSegregation

Area-Level Consequences of Residential Segregation

Individual-Level Consequences of Residential Segregation

EthnicD

ensity

Racism

Buffering Effects of Ethnic Density

igure 2. Hypothesised Pathways between Residential Segregation, Ethnic Density and Health

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