Introduction

The Acheson Report (Acheson, 1998) included a chapter on ‘Ethnicity’, an important dimension of inequalities in health in the UK. The chapter acknowledged the difficulties in defining ethnicity and considered evidence on health inequalities from different definitions of ethnicity. Apart from documenting the patterns of morbidity and mortality among the major ethnic groups living in Britain, the report noted differences in socioeconomic status between ethnic groups. Unemployment, poverty and poor housing conditions among Pakistani and Bangladeshi households were highlighted as potentially contributing to their poorer health in general. However, there remains considerable debate about specific factors that underlie both ethnic differences in health and differences in health within ethnic groups.

The inquiry made recommendations in two general areas: first, general policies targeted at disadvantaged socioeconomic groups in which minority ethnic groups are disproportionately represented; and second, policies specifically targeted at ameliorating health service access for minority ethnic groups. As minority ethnic communities typically contain a higher proportion of households with children, living in disadvantaged socioeconomic conditions, these communities should benefit from general policies targeted at mothers, children and families and those related to education, employment, poverty and housing. The inquiry argued that separate policies for minority ethnic groups risked marginalising minority ethnic issues, with the implication that the health problems in minority ethnic groups are different from those in the ethnic majority, with different causes and different solutions. Any such implication would run counter to the evidence that suggests that the similarities between ethnic groups in the causes of health inequalities are greater than the differences (Bhopal, 1997).

On the other hand, the inquiry also acknowledged that failure to consider minority ethnic issues risked increasing ethnic inequalities by unintentionally favouring policies that benefited the ethnic majority. So the inquiry also made recommendations specific to ethnic minorities. These were:

• • the further development of services that are sensitive to the needs of minority ethnic people and that promote greater awareness of their health risks; and

• • the specific consideration of minority ethnic groups in needs assessment, resource allocation, healthcare planning and provision.

In addition, as data on the health of minority ethnic groups are particularly hard to collect and are based on inappropriate definitions of ethnicity, the inquiry's general recommendation to improve the capacity to monitor inequalities in health and their determinants is especially valid for ethnic minorities.