Comparing policies to tackle ethnic inequalities in health: #PHTwitJC 18

On Wednesday 19 September at 8.00 pm BST (UK time) we will be discussing this paper by Lorant and Bhopal (2010):

Lorant, V. and Bhopal, R. (2010). Comparing policies to tackle ethnic inequalities in health: Belgium 1, Scotland 4. European Journal of Public Health, 21, 2, 235-40. doi:10.1093/eurpub/ckq061 Journal link. Open access link

Brussels, Belgium


Glasgow, Scotland


All are welcome to join the discussion at the Twitter Hashtag #PHTwitJC. If you have not joined a Twitter chat before, please see the ‘about’ tab above for some tips.

The issue
Inequalities in health have become an increasing concern of governments and intergovernmental organisations such as the EU and WHO. By ethnic inequalities in health we mean disparities in health status and health outcomes between different ethnic groups in a society. The measurement of ethnicity and health has been fraught with difficulties, for example in the UK, data on ethnicity were not routinely collected and connected to medical records until relatively recently. While country of birth was identified on death certificates, allowing some comparison of mortality between groups, this captured migrant status rather than ethnicity per se. Self-categorisation into ethnic groups raises problems of perceived ‘fit’ and the matching of categories between data sets. These problems, and the differences in measurement between the two countries, are acknowledged in the paper.

Paper summary

The authors compared policies to tackle ethnic inequalities in health in Belgium and Scotland in terms of policy inputs (political / institutional awareness, commitment, strategy) and outcomes (self-reported health, morbidity and mortality for minority ethnic groups). They refer to Margaret Whitehead’s 2007 Typology of actions to tackle inequalities in health (paywall), which identifies the following framework for examining the ‘logic of health inequalities interventions’ (p. 474):


In order to assess policy, official documents were reviewed, and policy stakeholders in Scotland were interviewed by the Belgian first author. Account was taken of the institutional and legal contexts, in particular, the health care systems and citizenship principles in the two countries. Comparisons of health outcomes were achieved by accessing existing data, for example Census returns from 2001 and retrospective mortality studies covering 1991-96 (Belgium) and 1997-2003 (Scotland). /p>;

There are some difficulties with comparing the two countries including differences in the data sets available; in migration patterns; and political and cultural mores around settlement and citizenship. However, the analysis concludes that Scotland is the overall ‘winner’ as regards responding to ethnic inequalities in health. This is thanks mainly to its clear and comprehensive strategy for addressing the issue.

Questions for consideration during #PHTwitJC discussion
1. Were the aims of the study clear?
2. Was the selection of data for comparison clear and appropriate?
3. Were the methods of analysing and comparing clear and appropriate?
4. Are the authors’ conclusions justified by the findings presented?
5. What implications are there for policy on this issue?

Further reading
The ESRC Understanding Society project involves a major new UK survey with a ‘boosted’ ethnicity aspect, illuminating issues of diversity, migration and self-identification. Their most recent report includes some interesting data on ethnicity.

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