Children, ethnicity and long-term illness Paper presented to Childhoods 2005: Oslo, June

2005

Lucinda PlattUniversity of Essexlplatt@essex.ac.uk

BackgroundThe research presented here is part of a project (joint with colleagues at the University of Sheffield and the London School of Hygiene and Social Action for Health) on long-term illness and poverty and how the relationship between the two -- and the strategies in dealing with them -- vary by ethnic group.This project engages in a complex area that is receiving increasing research and policy attention in relation to such issues as caring, extra costs of disability, the relationship between sickness and work, the role of social security benefits and the interface between work and benefits, and the impact of long-term illness on other household members. However, many gaps still remain, and some current research could benefit from further development and this project hopes to explore a number of the gaps and contribute to evidence base and understanding of patterning of illness across households, specifically contributing to our understanding of how it varies by ethnic group.

Background: the research project (1)Details of the research project:

Limiting illness and poverty: breaking the vicious cycle, January 2005-June 2006Funded by the Joseph Rowntree Foundation

Research teamSarah Salway, University of Sheffield (project

leader)Punita Chowbey, University of Sheffield Kaveri Harriss, London School of Hygiene and

Tropical Medicine Lucinda Platt, University of EssexElizabeth Bayliss, Social Action for Health

Background: the research project (2)Specific contribution of the project:

Exploring ethnic group differences in rates of illness, coping with illness and in the relationship between illness and various indicators of poverty (including worklessness)

Looking at and within households, considering the whole unit and the interplay between different household members.

Focusing on social relationships and social participation among those with long-term illness and those with caring responsibilities and other members of their households

Looking at use of benefits by those with long-term illnesses

Using the livelihoods approach to examine coping strategies, and how people use their strengths

Framework of the projectApproach:Predominantly qualitative project (focused on ethnographic work in the East End of London) supplemented by quantitative exploration of some of the issues (including what is being presented in this paper), but integrated approach.Focusing on four main groups: Ghanaians, Punjabi Pakistanis, Bangladeshis and White English.

What do we know?1. We know that those who are long-term sick and

disabled are more likely to be poor than those not, largely through economic inactivity, but also through lower wages and higher risks of unemployment.

2. We know that there is a relationship between poverty and ill-health that appears to work both ways if examined over time: those who are at the lower end of the social class scale are more likely to get sick, but sickness itself also brings increased poverty.

3. We also know that certain minority ethnic groups are much more likely to be unemployed and economically active than others and rates of long-term illness one of the main causes of economic activity vary enormously between groups.

Ethnicity and health

0.0 1.0 2.0 3.0 4.0

General population

Irish

Indian

Pakistani

Bangladeshi

Black Caribbean

Chinese

Men

Women

Source: Health Survey for England, 1999, Department of Health, in Focus on Ethnicity: http://www.statistics.gov.uk/downloads/theme_social/social_focus_in_brief/ethnicity/ethnicity.pdf

Low income and ethnicity

0

20

40

60

80

White Indian Pakistani/ Bangladeshi

BlackCaribbean

Black NonCaribbean

Other

Before housing costs

After housing costsNotes:1. Low income household is defined as having less than 60 per cent of the median disposable income.

Source: Households Below Average Income, Family Resources Survey, 2000/01, Department for Work and Pensions, in Focus on Ethnicity: http://www.statistics.gov.uk/downloads/theme_social/social_focus_in_brief/ethnicity/ethnicity.pdf

Economic Activity by ethnic group and sex

0 10 20 30 40 50 60 70 80 90

White

Mixed

Indian

Pakistani

Bangladeshi

Other Asian

Black Caribbean

Black African

Other Black

Chinese

Other

All ethnic groups

Female

Male

Source: Annual Local Area Labour Force Survey, 2001/02, Office for National Statistics

in Focus on Ethnicity: http://www.statistics.gov.uk/downloads/theme_social/social_focus_in_brief/ethnicity/ethnicity.pdf

What don’t we know?1. It is hard to disentangle the causal

relationship between long-term illness and economic inactivity, particularly for those at the more deprived end of the class spectrum

2. We don’t know much about whether the relationship between worklessness and ill health varies from ethnic group to ethnic group and the chances of being in particular types of job

What don’t we know? (2)3. We don’t know much about how much

coping strategies for dealing with ill-health and the associated financial strain vary much – and in particular whether they vary between groups

4. We don’t know much about the impact of ill-health on other members of the household and how this varies by ethnic group.

This last area is the focus of today’s paper

Today’s paperOne of a number of quantitative analyses

using different data and exploring social participation, relationship between ethncity, illness and the chances of being employed, also earnings, this paper focuses on what the impact of long-term illness is on children, so far as we can determine it from a large-scale cross-sectional survey of the British population.

FocusIt focuses on two main areas:Measurement issues:

should we be looking at households with children or with children by the characteristics of children? Given the differences in fertility across ethnic groups, we might hypothesise that the story of the impact on children will look different either way – but does it?

what are the possible impacts on children (and ethnic group differences). Can think of these in terms of financial (number of earners around), and caring (potential burden of having an long-term ill adult in the household, especially if no other adults available for care.

Policy contextChild poverty pledge

Changes to incapacity benefit and policy focus on inactivity through ill-health

Differential employment rates of ethnic groups and target to reduce the employment gap

DataThe household file of the Labour Force

Survey, a nationally representative sample survey that is carried out quarterly with a semi- (short) panel structure. About 58, 000 households are covered at each quarter. Questions focus on labour market and other related issues (e.g. education), but there are some general demographic questions as well. The household file, which enables analysis of households rather than individuals, is produced for just the Spring and Autumn quarters each year.

Data cont.This analysis pools (to increase numbers from

minority ethnic groups) quarters from 2002-2004 (6 data extracts altogether). Due to the semi-panel structure of the survey there is some overlap between households, however, in future statistical analyses the standard errors will be adjusted for these.

Acknowledgement:I am grateful to ONS for use of the data and to the UK Data Archive for making them available. Neither ONS or the UK Data Archive, however, bear and responsibility for the analysis or interpretation offered here.Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland

Data ReferencesOffice for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly

Labour Force Survey Household Dataset, September - November, 2004 [computer file]. Colchester, Essex: UK Data Archive [distributor], February 2005. SN: 5097.

Office for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly Labour Force Survey Household Dataset, March - May, 2004 [computer file]. Colchester, Essex: UK Data Archive [distributor], August 2004. SN: 5000.

Office for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly Labour Force Survey Household Dataset, September - November, 2003 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], June 2005. SN: 4820.

Office for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly Labour Force Survey Household Dataset, March - May, 2003 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], June 2005. SN: 4714.

Office for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly Labour Force Survey Household Dataset, September - November, 2002 [computer file]. 2nd Edition. Colchester, Essex: UK Data Archive [distributor], August 2004. SN: 4625.

Office for National Statistics. Socio-Economic Statistics and Analysis Group, Quarterly Labour Force Survey Household Dataset, March - May, 2002 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], August 2004. SN: 4575.

Sample numbers by ethnic group

Households with children

Children in households

White British 77 478 135 863

Pakistani 1 433 3 290

Bangladeshi 622 1 521

Black African 1 255 2 580

All (including other ethnic groups)

93 200 165 694

Some definitionsQuestions on illness:

Do you have any health problems or disabilities that you expect will last for more than a year?If yes: Do these health problems or disabilities, when taken singly or together, substantially limit your ability to carry out normal day to day activities? If you are receiving medication or treatment, please consider what the situation would be without the medication or treatment.

NB some standard questions (e.g. census) ask about long-standing illness that limits work or daily activity but as this question allows partialling out of the work-limiting element that is not included in the current definition in order to make more sense of analysis of employment patterns of those with long-term illness

Ethnic group Focus on this paper on just certain ethnic group, defined according to self-identification in relation to a compound question as used in 2001 census. Household ethnicity is defined on the basis of the household reference person, however the impact of alternative ways of defining household ethnicity will be explored in the next stage.

ChildFor simplicity have only considered children aged 0-15.

Results: rates of long-term illness

% with long-standing illness

% with longstanding illness that restricts daily activity

All households 52 36Households with 1 or more working age adults

44 30

Households with 1 or more working age adults and 1 or more children

35 23

Ethnic groups and age profiles

0% 20% 40% 60% 80% 100%

White

Mixed

Indian

Pakistani

Bangladeshi

Other Asian

Black Caribbean

Black African

Other Black

Chinese

Other

Under 16

16-64

65 and over

Notes:Sample size too small for a reliable estimate of the Other Black group aged 65 and over.

Source: Annual Local Area Labour force Survey, 2001/02, Office for National Statistics

in Focus on Ethnicity: http://www.statistics.gov.uk/downloads/theme_social/social_focus_in_brief/ethnicity/ethnicity.pdf

And by ethnicityAll

households with

longstanding

illness

Households with

children and

longstanding illness

All households

with restrictive

illness

Households with

restrictive illness with

children

White British

54 35 36 22

Pakistani 54 51 44 42

Bangladeshi

53 51 43 41

Black African

29 24 19 17

Households with children and illness of working age adults

Where any adult has long-term

illness

Where a working

age adult has a long-

term illness

Where any adult has a restrictive

illness

Where any working

age adult has a

restrictive illness

White British

35 35 22 22

Pakistani 51 46 41 38Bangladeshi

51 46 41 35

Black African

24 24 17 16

Measurement issues: households with children or children in households?

Rate by type of hh

(restrictive long term

illness)

Shares of hhs

(children in hhs) by hh

type

Composition of hhs

with children

with restricted long-term

ill

Composition of

children in households

with restricted long-term

ill

All hhs with children

23% 100 (100)% 100% (23% hhs w

children)

100% (23% of children)

Hhs with 1 child

25% 44 (24)% 47% 27%

Hhs with 2 children

20% 40 (45)% 36% 40%

Hhs with 3 children

23% 12 (21)% 13% 21%

Hhs with 4 or more children

27% 4 (10)% 5% 12%

And by ethnic group: white British

Rate by type of hh

(restrictive long term

illness)

Shares of hhs

(children in hhs) by

hh type

Composition of hhs

with children

with restricted long-term

ill

Composition of

children in households

with restricted long-term

ill

All hhs with children

22 100 100 100

Hhs with 1 child

25 44 (25) 48 28

Hhs with 2 children

20 41 (47) 36 42

Hhs with 3 children

22 12 (20) 12 20

Hhs with 4 or more children

26 3 (8) 4 10

PakistaniRate by

type of hh (restrictive

long term illness)

Shares of hhs

(children in hhs) by

hh type

Composition of hhs

with children

with restricted long-term

ill

Composition of

children in households

with restricted long-term

ill

All hhs with children

42 100 100 100

Hhs with 1 child

50 30 (13) 36 16

Hhs with 2 children

36 31 (27) 27 24

Hhs with 3 children

37 25 (32) 22 29

Hhs with 4 or more children

45 14 (28) 15 31

BangladeshiRate by

type of hh (restrictive

long term illness)

Shares of hhs

(children in hhs) by

hh type

Composition of hhs

with children

with restricted long-term

ill

Composition of

children in households

with restricted long-term

ill

All hhs with children

41 100 100 100

Hhs with 1 child

46 26 (11) 30 12

Hhs with 2 children

39 32 (26) 31 25

Hhs with 3 children

30 23 (28) 17 21

Hhs with 4 or more children

48 19 (35) 22 42

Black AfricanRate by

type of hh (restrictive

long term illness)

Shares of hhs

(children in hhs) by

hh type

Composition of hhs

with children

with restricted long-term

ill

Composition of

children in households

with restricted long-term

ill

All hhs with children

17 100 100 100

Hhs with 1 child

18 38 (18) 41 19

Hhs with 2 children

14 34 (34) 28 27

Hhs with 3 children

18 18 (26) 19 27

Hhs with 4 or more children

17 10 (22) 12 27

Distributions by family type Defining family type to take account of economic status

and potential caring burden:

1 = one working age adult, not ill and in employment2 = one working age adult, ill, and in employment3 = one working age adult, ill, and not in employment4 = more than one working age adult, no working age illness,

and at least one adult in employment5 = more than one working age adult, at least one ill

(unemployed), and all well in employment 6 = more than one working age adult, at least one ill

(employed), and all well in employment7 = more than one working age adult, at least one ill, and at

least one well working age adult not in employment 8 = other combinations

Also created for restrictive illness

Overall distributions of hh typesfor all hhs and hhs with children

All hhs (using all long-term

ill)

Hhs with children

(using all long-term

ill)

All hhs (using

restrictive illness)

Hhs with children

(using restrictive

illness)

1 16 8 19 92 5 2 3 13 7 4 6 34 37 49 46 605 5 5 5 46 13 14 7 77 6 8 5 68 10 11 10 11

And by ethnic group: just those hhs with children for restrictive illnessType White

BritishPakistani Banglade

shiBlack

African

1 9 2 1 11

2 1 0 0 1

3 3 2 2 4

4 60 49 47 42

5 4 7 6 2

6 8 2 1 3

7 5 25 26 6

8 10 13 17 31

And also looking at numbers of children in such householdsType White

BritishPakistani Banglade

shiBlack

African

1 8 2 1 10

2 1 0 0 1

3 3 2 2 5

4 61 49 47 40

5 4 7 7 2

6 7 2 1 3

7 5 24 27 6

8 11 15 17 34

Conclusions It is important to take account of who is affected by illness within

households in addition to the sick person themselves. Despite the fact that illness is associated with age and this greater

among those above working age, approaching a quarter of children live in a household containing someone with a restrictive long-term illness and over a third live in a household with an adult with a long-standing illness.

Over 40% of Bangladeshi and Pakistani households with children have someone with a restrictive long-term illness, but the rate for Black African households with children is as low as 16%

Overall households with few and households with many children have higher rates of long-term illness. This means that using households or children as the unit of analysis makes little difference to the picture. However, by ethnic group there are some striking differences, as rates interact with prevalence of households of different sizes. Thus 30% of children in white British households with an adult with a restricting long-term illness come from families with 3 or more children but 60% of Pakistani and Bangladeshi children do, and over 50% of Black African children do.

It is worth considering a range of aspects of family type when investigating the impact of long-term illness on other household members. Financial impacts and caring responsibilities may operate differently and different groups may be at different risks of them

Next steps To look at the role of disability and other benefits in

households with long-standing illness and containing children, and examine differences by ethnic group

To consider alternative ways of constructing typologies of household structure to pick up on the intersection of employment and illness in more refined ways (including introducing the gender of the adults concerned)

To utilise further questions on attitudes to work in understanding configurations of households

To look at patterns separating out pre-school and school-age children; and investigate by child’s ethnic group rather than that of the household reference person

To identify clear questions to follow up in the in-depth qualitative phase of the research