Rory Williams

Ethnic inequalities in health: a review of UK epidemiological evidence

Studies ethnic health differentials in Great Britain. Contribution of socioeconomic factors to ethnic inequalities in health; Approaches to understand differentials in health status between ethnic groups.

Psychological distress among British South Asians: the contribution of stressful situations and subcultural differences in the West of Scotland Twenty-07 Study

BACKGROUND This paper seeks to explain an excess of psychological distress previously found among groups of British South Asians (with ancestry from the Indian subcontinent) living in Glasgow, compared with the general population. The excess was found on a psychosomatic measure and a measure of self-assessed distress but not on a clinically validated measure (the General Health Questionnaire or GHQ). The paper investigates whether South Asians are subject to stressful situations to which the GHQ is less sensitive than the other two measures. METHODS Random samples of 159 South Asians aged 30-40, mean age 35, and 319 from the general population, all aged 35, were interviewed in Glasgow, using the 12-item General Health Questionnaire (GHQ-12), a psychosomatic symptom scale (PSS) and a self-assessment of distress. Subcultural groupings were differentiated by South Asian origin, English fluency, religion, and gender. Stressful situations assessed were experience of assault, stress/dissatisfaction with work, overcrowding, low standard of living, absence of family and absence of confidants. RESULTS The GHQ-12 was less sensitive to certain stressful situations than the other two measures. The PSS and/or self-assessed distress were more sensitive to low standard of living, self-rated stress in work around the house and possibly experience of assault. In a combined analysis, the relation between distress on the PSS or self-assessed measure and subcultural groupings became nonsignificant, while the relation between distress and key stressful situations remained significant. CONCLUSIONS The greater distress of women, Muslims and limited English speakers is largely explained by the stressful situations they experience. The GHQ-12 under-estimates distress related to situations experienced particularly by ethnic minorities and by women.

Ethnic differences in anthropometric and lifestyle measures related to coronary heart disease risk between South Asian, Italian and general population British women living in the West of Scotland

AIMS: To compare anthropometric measurements and to define their behavioural associations in migrant and British-born South Asians (who have increased cardiovascular risk) or Italians (who have reduced cardiovascular risk), and in the general population of British women living in the west of Scotland.STUDY DESIGN: Cross-sectional survey of women aged 20–42 y, selected mainly from birth registration data, which included 63 migrant South Asians, 56 British-born South Asians, 39 migrant Italians, 51 British-born Italians, and 50 subjects representative of the general population of women, all resident in the west of Scotland.MEASUREMENTS: Height, weight, body mass index (BMI), and waist and hip circumferences.RESULTS: With age adjustment, migrant South Asians (0.88) had greater waist-to-hip ratio than British-born South Asians (0.84; P<0.05), while there was no difference between migrant (0.81) and British-born (0.79) Italian groups. Both migrant (P<0.001) and British-born South Asian (P<0.05) groups had higher waist-to-hip ratio and were about 3 cm shorter than Italian groups and the general population. Neither weight nor BMI were different between ethnic groups. Waist and hip circumferences were not different between migrant and British-born ethnic minority groups. Migrant South Asians (86.8 cm) had significantly (P<0.05) larger waist circumference than the general population (78.6 cm). British-born Italian women (103.0 cm) had larger hip circumference than the general population of women (96.4 cm), while other groups had similar hip circumferences. Additional adjustments for physical activity, smoking, alcohol consumption and parity reduced the differences in anthropometric measurements: only waist-to-hip ratio of migrant South Asians remained significantly (P<0.01) higher than that of the general population women.CONCLUSIONS: The adverse anthropometric indicators of cardiovascular risk in migrant South Asian women are substantially explained by their lifestyle factors and parity. British-born South Asian women are more similar to the general population women. Anthropometric differences between migrant or British-born Italians and the general population women are small.

Sampling Asian minorities to assess health and welfare.

STUDY OBJECTIVE--The aims were (1) to sample a specified subgroup of the Asian minority; (2) to give proper representation to those outside the areas of concentration; and (3) to evaluate the costs and benefits of the method. DESIGN--Glasgow postcodes with varying concentrations of Asians were sampled, and 173 Asians aged 30-40 were interviewed after household screening of 1439 Asian names identified on the electoral roll or valuation roll. Areas with few Asians, and households with two or more members aged 30-40, were undersampled, and then reweighted. MEASUREMENTS AND MAIN RESULTS--Nurse measures of blood pressure, lung function, and body mass were taken, and selected interview measures of health and social background are reported. Substantial differences in blood pressure, reported health, and social background were revealed between Asians in areas of concentration and those in areas of dispersion. Loss in effective sample size due to undersampling and reweighting was 4-5% in the case of the area sampling, 13% in the case of the household sampling. Losses of potential sample members through under registration were probably less than 6%. CONCLUSIONS--The present sampling method targets subgroups successfully, and improves on sampling in areas of concentration, in that it enables dispersed members of the minority, who differ in crucial indices of health and social position, to be represented. The costs of the method are acceptable.

Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population.

OBJECTIVE--To compare common health experiences of a South Asian (predominantly Punjabi) population with that of the general population, according to sex, and to related patterns of health in the fourth decade of life to the pattern of hospital admission and mortality documented in the published reports. DESIGN AND SETTING--A cross sectional survey with interviews and physical measures was undertaken in a two stage stratified random cluster sample in the city of Glasgow. SAMPLE--This comprised 159 South Asians aged 30-40 years, mean age 35 (73.6% of those invited) and 319 subjects from the general population, all aged 35 years. MEASUREMENTS AND MAIN RESULTS--Body structure, lung function, pulse and blood pressure, history of physical and mental health, results of standardised questionnaires on mental health, angina and respiratory health, recent and past symptoms, history of accidents, and sickness behaviour were determined. South Asians were shorter, broader, and more overweight (women); they had lower values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), a faster pulse, and higher diastolic pressure (men). Fewer South Asians had had accidents or digestive symptoms (men); more had psychosomatic and high total symptoms (women); fewer wore glasses, had lost teeth, or had long standing illness (men) (all p < 0.01). Women had a lower FEV1/FVC ratio (p < 0.05). CONCLUSIONS--South Asians were consistently disadvantaged only in terms of anthropometric measures. Otherwise, the many differences were balanced, with disadvantage being concentrated only among South Asian women. The health gap between sexes in South Asians seems higher than in the general population. The findings show patterns of health in the fourth decade of life which are consistent with patterns of hospital admission and mortality documented in the published reports.

Irish descent, religion and food consumption in the west of Scotland☆

Mortality and morbidity of people of Irish descent in Britain is high, including from cardiovascular causes potentially linked with diet. The west of Scotland has long had a pattern of Irish migration, where migrants were poorer than the host population, and their different religious background gave rise to prolonged discrimination. This paper uses data collected in 1987/88 from the west of Scotland Twenty-07 study to test whether dietary differences due to poverty or to other factors have persisted among the descendents of these migrants. Being born of Catholic parents was the index of Irish descent used, these respondents consumed less of a factor represented by fruit, yoghurt and vegetables, and more of one represented by snacks and processed foods than the rest of the sample. The picture for those reporting current Catholic affiliation in adulthood was similar. Differences are largely associated with social class and mediated not by low income but by educational disadvantage. The findings suggest the continuation of a diet affected by limited opportunities for social mobility, and thus by obstacles to sustained educational advancement, among the descendants of Irish migrants even after several generations.

Is Religion or Culture the Key Feature in Changes in Substance Use after Leaving School? Young Punjabis and a Comparison Group in Glasgow

Aims. To establish levels of use of tobacco, alcohol and illegal drugs among 18–20 year old men and women of Asian (Punjabi) and non-Asian origin compared with levels four years earlier and consider the role of religion and culture in abstinent behaviour. Design. Structured self-complete questionnaire used with 94% of pupils with South Asian names recorded by the Greater Glasgow education department in 1991 and a proportionate random sample of pupils in the same years who did not have South Asian names. Followed up in 1996 in an interviewer-led structured questionnaire in their own homes. Setting. Greater Glasgow, largest city in the west of Scotland. Participants. Eight hundred and twenty-four overwhelmingly British-born 14–15 year olds in 1992, 492 followed up aged 18–20 years in 1996. Measurements. Self-report measures of ever having tried alcohol, tobacco and drugs and the quantities consumed at age 14–15 and 18–20. Indication of reasons for abstinence from substance use at age 18–20. Findings. Asians were much more abstinent from all these substances at both ages (p < 0.001), except for smoking at 18–20. However, religiously specific patterns of abstinence were particularly strong for alcohol (Muslim odds ratio 7- to 9-fold lower at 14–15, 16- to 25-fold lower at 18–20) and smoking (Sikh/Hindu odds ratio 10-fold lower than Muslims, 20-fold than Christians at 18–20), though there is a shared Asian tendency for women to observe these patterns more than men at 18–20. Conclusions. At age 14–15 abstinence was high in the largely British-born generation of Asians mainly for cultural reasons common to religious groups. Four years later culturally determined abstinence has atrophied, and abstinence reflects the specific influence of ascetic religious traditions, though some cultural influence remains in that women are more affected. Intergenerational changes are similar. The erosion of constraints on smoking presents a threat to health.

Family Hospitality and Ethnic Tradition Among South Asian, Italian and General Population Women in the West of Scotland

South Asians have a high risk of heart disease in Britain and Italians low, and there are corresponding differences in total energy and total fat intake. The present paper explores how far obligatory patterns of food intake exist in either group and are reflected in conventions of hospitality. Both groups are from peasant-based economies, where, despite the common pattern of low fat intake, food occupies a high proportion of family income, and is correspondingly important as a part of gift exchange in marriage, and as a bearer of collective meanings. Open-ended questions on meals suitable for family hospitality were asked of South Asian women (63 born abroad, 56 in Britain), and Italian women (39 abroad, 51 in Britain) together with 50 women from the general population, all aged 20–40 and resident in the West of Scotland urban area. The traditional family meal of the Glasgow general population corresponds to the cooked dinner described in South Wales, and suggests a pan-British cultural symbol. However traditional family hospitality meals play a more important part in the life of migrant South Asians and Italians than they do in the majority culture, and British-born South Asians maintain this pattern more than British-born Italians. This pattern of hospitality, in an economy where energy-dense foods are readily available, may result in high energy intake and increased coronary risk. However realisation of these implications, and increased weight consciousness, can lead to restoration of the traditional cardioprotective diet.

Social class and health: The puzzling counter-example of British South Asians

British South Asians (with ancestry from the Indian subcontinent) provided a puzzling exception to the British class gradient in mortality during the 1970s. On the assumption that class gradients in health are produced mainly by gradients in standard of living, this might be due to a break in the relation of class to standard of living (change in class structure), or by a break in the relation of standard of living to patterns of health behaviour and health risk (change in class lifestyles). Data on these characteristics are available from the West of Scotland Twenty-07 Study, where 159 South Asians aged 30-40 (mean age 35) were sampled alongside 319 of the general population in Glasgow. As regards changes in class structure, results indicate that the underclass thesis, which suggests that ethnic minorities are forced into less eligible jobs or into a separate labour market or into unemployment, resulting in a standard of living below that of the general population, still holds good for British South Asians in categories from social class III non-manual downwards. It does not hold good for owners of small businesses, where Sikhs and Hindus in particular have a standard of living equivalent to general population counterparts. However, prosperity is not predictable from levels of education in the subcontinent and from this and other signs it appears that a wholesale redistribution of class chances is occurring among British South Asians, disrupting inter-and intra-generational continuities in the relation between class and standard of living. There is little sign of change in class lifestyles, i.e. in the relation between standard of living and health behaviour or health risk. As yet, though, the new distribution of standard of living is affecting patterns of health behaviour and health risk more strongly than symptom experience or chronic illness, suggesting that a class gradient in health will re-emerge.

Potential barriers to prevention of cancers and to early cancer detection among Irish people living in Britain: a qualitative study

Objectives. To identify and explore explanatory models of cancer among Irish and white British people living in Britain. Methods. Ethnographic in-depth interviews and focus groups were conducted in London, Manchester and Glasgow, with a total of 58 (n = 58) Irish and 57 (n = 57) white British participants. The study samples were broadly similar in socio-demographic characteristics. Results. We explored explanatory models (lay beliefs) used by the Irish and white British to understand their cancer-related beliefs and behaviours. Among both groups there was confusion about causation, poor knowledge of signs and symptoms, and a general pessimism about cancer prevention and treatments. The narratives of the Irish were, however, qualitatively different from those of the white British. Historical, cultural, social and economic circumstances, both in the UK and in the past in Ireland, appeared to influence views of cancer and health-seeking behaviours. Recollections of negative family experiences of cancers linked to ‘stigma’ and ‘secrecy’, poor outcomes and medical practices in rural Ireland, particularly among the older Irish, influenced Irish understanding of cancers and help-seeking behaviours. The second generation also appeared to retain some beliefs that were common amongst the first generation migrants. The context of migration was also felt by the Irish group to have exposed them to living and working environments that made them susceptible to cancers. Conclusion. The Irish frame of reference was firmly embedded in a specific historical, social and economic context which may contribute to cultural constraints on discussions about cancers and to the lack of engagement with preventative behaviours and health care services.