GENETIC, CULTURAL OR SOCIOECONOMIC VULNERABILITY - EXPLAINING ETHNIC INEQUALITIES IN HEALTH

Most work on ethnic inequalities in health in the UK has focused on ge netic and cultural difference, ignoring issues relating to class disad vantage. However, more recent work, and that conducted in the US, sugg ests that material disadvantage might be crucial. Nevertheless, the wi der sociological literature illustrates that ethnicity and 'race' cann ot simply be reduced to class. This paper uses data from the Fourth Na tional Survey of Ethnic Minorities to examine three alternative approa ches to ethnic inequalities in health. Epidemiological approaches are driven by empirical findings and make little explicit acknowledgement of theoretical understandings of ethnicity, but they carry the assumpt ion that ethnicity provides a natural and fixed division between popul ation groups. Consequently, explanations for differences tend to be re duced to ahistoric and de-contextualised genetic and cultural factors. Structural approaches generally focus on material explanations for in equalities, but there are important methodological difficulties in ass essing these. We also need to consider other elements of the structura l disadvantage faced by ethnic minority groups, such as their experien ces of racism or concentration in particular geographical locations. A pproaches that focus on ethnic identity emphasise the importance of gr oup affiliation and culture, while acknowledging the contingent and co ntextual nature of ethnicity. However, despite the promise carried by identity based approaches, there has been little empirical work undert aken. These varying approaches illustrate how important ethnic inequal ities in health might be to a wider understanding of mechanisms produc ing inequalities in health. However, a concern with mechanisms in heal th inequalities research can lead to a focus on technical intervention s along causal pathways, with the roots of health inequalities, wider social inequalities, being ignored.