.

HEALTH INEQUALITIES ASSOCIATED WITH LONG TERM

CONDITIONS EXPERIENCED BY AFRICAN AND CARIBBEAN PEOPLE

LIVING IN BIRMINGHAM, LEWISHAM AND THE UK – A RAPID

SYSTEMATIC REVIEW

By (Student’s Name)

The Name of the Class (Course)

Professor (Tutor)

The Name of the School (University)

The City and State where it is located

The Date
. 2

HEALTH INEQUALITIES ASSOCIATED WITH LONG TERM

CONDITIONS EXPERIENCED BY AFRICAN AND CARIBBEAN PEOPLE

LIVING IN BIRMINGHAM, LEWISHAM AND THE UK – A RAPID

SYSTEMATIC REVIEW

Structural inequalities as a factor leading to health inequality

According to studies, health-related disparities disproportionately affect Black African

and Caribbean populations in the United Kingdom. This is made worse by disparities in housing,

employment, and education. There are systematic discrepancies in groups’ ability to achieve

optimal health due to health inequalities, which leads to unfair and avoidable health inequities

(Collyer & Smith, 2020). All of these aspects of social identity and locality, such as race and

ethnicity, gender, work, and financial level, as well as disability and immigration status, “shape”

unequal access to health care. Structural inequalities relate to the issues like racism, sexism,

ableism, xenophobia, and homophobia that contribute to the salient of certain identities in terms

of fair distribution of health opportunities and outcomes (Corris et al., 2020). Policies that

increase inequality at all levels are major contributors to structural injustice (from the

corporation to the neighborhood to the county, state, and nation). Socio-economic-

environmental-cultural factors compound structed gaps to create health inequalities by

exacerbating existing ones. A person’s general well-being is influenced by a variety of factors,

including having access to clean water, nutritious food, and enough shelter. A person’s social

network, education, career, and locality all have a role in their overall well-being.

Even before individuals are born, societal inequalities have an effect on them. However,

there are no biological differences between infants born to African and Caribbean mothers who

die before their second birthday and those born to white women. Even when socio-economic
. 3

factors are taken into consideration, this remains true (Barnett et al., 2020). Though the evidence

is still being gathered, some feel that the persisting differences in birth outcomes might be linked

to the chronic stress that comes from being treated unfairly in society (Christian, 2012). IQ

ratings have little bearing on how well students manage their time in elementary school or how

well they succeed in terms of academics (Pathirana & Jackson, 2018). ACEs, chronic stress, and

trauma have distinct effects on racial and socio-economic groups’ learning and academic

performance. Environmental exposures like lead may contribute to inequalities in intelligence

quotient (IQ), and systemic imbalances exist there as well. One of the biggest determinants of

life expectancy is a person’s ability to complete high school, which varies greatly by race and

ethnicity. Other key predictors of life expectancy include their occupation, income, and personal

and intergenerational wealth (Corris et al., 2020). People of different races, genders, and physical

abilities face uneven opportunities because of implicit and explicit prejudice. This leads to

inequities in the hiring process. Inequality in house ownership, small company growth, and the

creation of other assets is expanding as a consequence of lending regulations (Thomson et al.,

2018). Inequitable structures limit the ability of some groups to participate in politics. They have

their opinions heard, including the right to vote, which is a cornerstone of our system of

representative government. (Thomson et al., 2018). There are several examples of unconscious

prejudice leading to discriminatory health care service offers and delivery and lowering the

efficacy of treatment (Thomson et al., 2018). Social inequities present obstacles to people’s

ability to reach their full health potential. A wide range of elements influences a community’s

health.
. 4

Social gradient as a factor in health inequality

In public health research, the health social gradient is considered to be one of the most

reliable discoveries. Data implies that there are long-term and cross-national discrepancies in

healthcare access and outcomes (Mackenbach, 2012). Health disparities affect people of all ages

and socio-economic backgrounds, but those with lower education, employment, or money have

shorter lives and are more likely to be unwell. According to official figures, life expectancy

differences of 5-10 years and a disability-free life expectancy disparity of 10-20 years,

respectively, remain among European nations (Wilkinson & Pickett, 2019). Numerous studies

show that health disparities are widening and becoming more common in Europe and the United

States (Vandenheede, 2014; Singh & Siahpush, 2016). Scientists are examining a variety of

datasets, procedures, and research designs to discover what is causing the discrepancies. As a

result, the subject is more important than it has ever been.

According to Kröger and his colleagues, there were two competing hypotheses in this

study. When a person’s health varies in reaction to their social standing, it is called health

selection. People who are physically fit have an advantage over those who are not, yet being

physically unfit limits one’s options and keeps one in low-status employment for a lengthy

period. According to the social causality hypothesis, having a better socio-economic status is

associated with greater health (Kröger et al., 2015). There is a social gradient in overall health

because of differences in resources, support, knowledge, behavior, and other socio-economic

variables.

Indirect selection is often cited as the explanation for the link between health and socio-

economic status. Third-component traits such as education, according to this theory, have an

impact on overall health and socio-economic status. Researchers found that health selection and
. 5

social causation work together to create health disparities throughout space and time. According

to the study, health selection vs. social causation has a different relative value. There is enough

information to support both positions, regardless of whether health or socio-economic level is

used as an indicator. Salary, employment, and promotion are all factors that seem to be crucial in

explaining health inequities in the labor market as a whole. However, the role of social causation

seems to be more relevant than ever when it comes to health disparities explained by more

specific variations in status, such as educational attainment, participation in occupational groups,

or family income (Patel et al., 2020; Holding et al., 2021). This fact should not be overlooked

since most educational research focuses on social and economic issues (Khanolkar et al., 2021).

In contrast to financial or professional success, educational accomplishment, for example, is

typically ephemeral and cannot be further impacted by one’s physical condition. Early adulthood

and adolescence have less volatility in health than middle age and old age, which is a good

development.

As a result of the impact health has on productivity and absences due to sickness,

employers prefer healthy workers and reject those sickly. Thus, the connection between health

selection and labor market indices may be explained (Mishra et al., 2021). According to the study

results, additional reasons should be investigated in addition to the two diametrically opposed

theories already being considered. There have been several studies demonstrating distinct

personality traits in people who are well-educated and financially successful. Consequently, there

is a chance that the connection between socio-economic position and health will be partially

reestablished.
. 6

Role of structural inequities in establishing health inequality

This is related to a social group’s systematic disadvantage in contrast with other groups

with whom they share space and is deeply embedded in society’s fabric, as previously mentioned

(Collyer & Smith, 2020). Policy, law, government, and society contribute to structural

inequalities, including race, ethnicity, gender, sexual orientation, and class (Collyer & Smith,

2020). Uneven interactions with social determinants of health lead to systemic disadvantages,

which, in turn, affect health outcomes.

Disparities related to race are by far the most ingrained and toughest to eliminate, given

that they are also predicated on socio-economic background and other variables (Green, 2020).

Racial characteristics substantially affect the construction of socio-economic disparities (Kröger

et al., 2015); hence, dealing alone with socio-economic problems is unlikely to reduce these

inequalities.

A socioecological framework uses the word racism as a blanket term to refer to several

diverse processes occurring at the intrapersonal and interpersonal levels and institutional and

systemic levels2. Racism may be found at many different socioecological levels, and listing them

all would take a very long time. For example, a stereotyped threat is a process that occurs inside

the individual. To reinforce negative stereotypes about a person’s race, ethnicity, gender, or

cultural background is a risky business (Wilkinson & Pickett, 2019). A common symptom of

stereotype threat is self-doubt, which makes it more likely to perform below expectations, such

as on a test. Implicit biases impact interpersonal relationships by influencing attitudes and

behavior unconsciously (Wilkinson & Pickett, 2019). For example, the normalization of stop-

and-frisk techniques against African and Caribbean populations by the Birmingham City Police

Department indicates how often ethnic profiling happens (Wilkinson & Pickett, 2019).
. 7

As a final note, systemic processes affect the community or higher levels (such as policy)

in a more complex way than a simple one-off effect. For example, neighborhood segregation

may be caused by landlords, tenants, buyers, and sellers (Collyer & Smith, 2020). Segregation

was formed, facilitated, and legitimized historically by economic and housing agencies’ laws and

procedures (including discriminatory financial policies and housing discrimination), enforced by

the court and institutionalized by cultural or religious institutions (Vandenheede, 2014). As a

result of interaction and accumulation, segregation has been and continues to be a phenomenon

that cannot be attributed solely to one person or organization. Segregation in housing is still a

major factor in health disparities across races today (Collyer & Smith, 2020).

As a result of social context and uneven power relations between races and ethnicities,

racism is not a trait of minority groups (Singh & Siahpush, 2016). Consider, for example, the

placement of environmental hazards close or within reach of marginalized communities. Because

it increases the danger of exposure for members of a minority population, putting a hazard in the

majority community also reduces the risk for others (Patel et al., 2020). If both sides see this,

they can work together on a solution that avoids the problem in the first place, one that is

beneficial to neither party.

Apart from the African and Caribbean populations, other races may be vulnerable to

racist manifestations separate from what African and Caribbean peoples have to deal with

(Pathirana & Jackson, 2018). People of Asian, Hispanic, Arab, and Muslim descent are deemed

non-citizens of the United Kingdom, denying them the same rights and advantages as other UK

citizens (Pathirana & Jackson, 2018). Members of these groups may face threats or even physical

violence as a result of this. Studies have shown that African and Caribbean surnames in the UK

are associated with increased ethnic microaggressions (i.e., apparently harmless types of
. 8

“everyday racism”) and lower birth outcomes, compared to other ethnic groups in the UK (Singh

& Siahpush, 2016).

Studies linking race to health disparities are piling up at an alarming rate. Racial

discrimination has been linked to various adverse health effects, including mental illness,

cardiovascular disease, and congenital disabilities (Mishra et al., 2021). To some degree, the

disease determines which racial processes are essential, and to a lesser amount, the population

does. Much of the current study focuses on discrimination, defined as discrepancies in treatment

based on race by another individual or institution in specific circumstances. Those studies on

segregation make up the vast majority of the research done. Additionally, there have been

findings indicating gender differences in certain people’s perceptions of and responses to racism

(Mishra et al., 2021).

Resolving health inequality issues

Whether stated officially or otherwise, the preponderance of local government actions is

concerned with factors that affect people’s well-being. Health-improving efforts such as home

rehabilitation, poverty reduction, and the introduction of green space management may all have a

significant positive impact on the population. Depending on how they are designed and

implemented, many additional areas of local government activity may be helpful to health or

even damaging to health. This is significant because such policies and initiatives often affect

different ethnic groups differently and provide different benefits. As a result, it is vital to

consider ethnic diversity and inequality when coming up with and implementing policies like

these (Corris et al., 2020). People of different ethnicities may benefit differently from active

transportation programs, which means that initiatives to promote it should consider factors such

as residential patterns, commuting distance, the physical and social terrain of the area, and
. 9

available transportation options. By using urban design to guide community development, local

governments may be more proactive and innovative. More ethnic groups participating in the

process means more unified and culturally competent settings will be created (Corris et al.,

2020). In this process, familiarity with the African and Caribbean communities (especially in

terms of ethnic residence and employment patterns), rigorous Equality Impact Assessments

(EIA), specific attention to racism and an underestimate of exclusionary factors, and learning

from progressive communities may all help.

Actions to combat racism and ethnic discrimination must be given particular attention

because of the huge direct and indirect effects on the health of minority ethnic groups of racism

and ethnic discrimination. This commission undertook a study on eliminating prejudice,

including media campaigns and diversity training, which included increasing contact between

people of diverse ethnic groups. It found compelling evidence from working with children and

via schools that prejudices against different groups arise at different periods of life. However,

that prejudice may still be modified early on. A growing body of evidence suggests that

treatments based on multicultural curricula are more successful when people from different

groups work together (Mackenbach, 2012). However, the review found a scarcity of high-quality

research in the United Kingdom on the effectiveness of different treatments. Even if there are

various ways for reducing prejudice and boosting good relations, there is a propensity to assume

that they are useful merely because they have been implemented (Mackenbach, 2012). There is

currently inadequate data to support the effectiveness of interventions (Pathirana & Jackson,

2018), but integrating public health within local governments offers a conducive environment for

coordinated local responses, which need to be properly examined to continue increasing the

evidence base.
. 10

Conclusion

Institutional, cultural, and policy disadvantages have contributed to historical and present

health disparities among the African and Caribbean communities in the United Kingdom. The

African and Caribbean population of Birmingham makes about 8% of the country’s total. Black

Africans and Caribbean-born residents of Lewisham make up the majority of the city’s BAME

population. According to a national study, inequalities in housing, work, and education are major

health predictors in the Black African and Caribbean populations. Health inequalities are

disparities in health that are unjust and preventable, both within and between populations and

social groupings. Social determinants of health include structures, regulations, and practices such

as segregation, redlining, foreclosure, and unconscious bias, to name a few. Equality in health is

impossible until we all have equal access to healthy environments at every stage of our lives —

from conception to death. These circumstances affect our chances for good health and our

thoughts, feelings, and behaviors, all of which have an impact on our overall well-being,

including our mental health. According to the findings of this systematic review, those who live

in the most impoverished parts of our country endure the greatest health disparities in health care

access, use, and outcomes. The effects of socio-economic and other health difficulties have been

formed by imbalances in education, money, wealth distribution, the job market, health care

systems, services, housing, and the physical environment.

References

Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2020). Epidemiology

of multimorbidity and implications for health care, research, and medical education: a

cross-sectional study. The Lancet, 380(9836), 37–43. https://doi.org/10.1016/s0140-

6736(12)60240-2

Christian, L. M. (2012). Psychoneuroimmunology in pregnancy: Immune pathways linking stress

with maternal health, adverse birth outcomes, and fetal development. Neuroscience &

Biobehavioral Reviews, 36(1), 350–361. https://doi.org/10.1016/j.neubiorev.2011.07.005

Collyer, T. A., & Smith, K. E. (2020). An Atlas of Health Inequalities and Health Disparities

Research: “How is this all getting done in silos, and why?” Social Science & Medicine,

113330. https://doi.org/10.1016/j.socscimed.2020.113330

Corris, V., Dormer, E., Brown, A., Whitty, P., Collingwood, P., Bambra, C., & Newton, J. L.

(2020). Health inequalities are worsening in the North East of England. British Medical

Bulletin, 134(1), 63–72. https://doi.org/10.1093/bmb/ldaa008

Green, P. (2020). Risks to children and young people during covid-19 pandemic. BMJ, m1669.

https://doi.org/10.1136/bmj.m1669

Holding, E., Fairbrother, H., Griffin, N., Wistow, J., Powell, K., & Summerbell, C. (2021).

Exploring the local policy context for reducing health inequalities in children and young

people: an in depth qualitative case study of one local authority in the North of England,

UK. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10782-0

Jenkinson, T., & Ramadorai, T. (2013). Does One Size Fit All? The Consequences of Switching

Markets with Different Regulatory Standards. European Health Management, n/a-n/a.

https://doi.org/10.1111/j.1468-036x.2013.12021.x
. 12

Khanolkar, A. R., Chaturvedi, N., Kuan, V., Davis, D., Hughes, A., Richards, M., Bann, D., &

Patalay, P. (2021). Socioeconomic inequalities in prevalence and development of

multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National

Survey of Health and Development in the UK. PLOS Medicine, 18(9), e1003775.

https://doi.org/10.1371/journal.pmed.1003775

Kröger, H., Pakpahan, E., & Hoffmann, R. (2015). What causes health inequality? A systematic

review on the relative importance of social causation and health selection. The European

Journal of Public Health, 25(6), 951–960. https://doi.org/10.1093/eurpub/ckv111

Mackenbach, J. P. (2012). The persistence of health inequalities in modern welfare states: The

explanation of a paradox. Social Science & Medicine, 75(4), 761–769.

https://doi.org/10.1016/j.socscimed.2012.02.031

Mishra, V., Seyedzenouzi, G., Almohtadi, A., Chowdhury, T., Khashkhusha, A., Axiaq, A., Wong,

W. Y. E., & Harky, A. (2021). Health Inequalities During COVID-19 and Their Effects on

Morbidity and Mortality. Journal of Healthcare Leadership, Volume 13, 19–26.

https://doi.org/10.2147/jhl.s270175

Patel, J. A., Nielsen, F. B. H., Badiani, A. A., Assi, S., Unadkat, V. A., Patel, B., Ravindrane, R.,

& Wardle, H. (2020). Poverty, inequality and COVID-19: the forgotten vulnerable.

Public Health, 183, 110–111. https://doi.org/10.1016/j.puhe.2020.05.006

Pathirana, T. I., & Jackson, C. A. (2018). Socioeconomic status and multimorbidity: a systematic

review and meta-analysis. Australian and New Zealand Journal of Public Health, 42(2),

186–194. https://doi.org/10.1111/1753-6405.12762

Singh, G. K., & Siahpush, M. (2016). Widening socioeconomic inequalities in Uk life

expectancy, 1980–2000. International Journal of Epidemiology, 35(4), 969–979.

https://doi.org/10.1093/ije/dyl083

Sum, G., Salisbury, C., Koh, G. C.-H., Atun, R., Oldenburg, B., McPake, B., Vellakkal, S., &

Lee, J. T. (2019). Implications of multimorbidity patterns on health care utilisation and

quality of life in middle-income countries: cross-sectional analysis. Journal of Global

Health, 9(2). https://doi.org/10.7189/jogh.09.020413

Thomson, K., Hillier-Brown, F., Todd, A., McNamara, C., Huijts, T., & Bambra, C. (2018). The

effects of public health policies on health inequalities in high-income countries: an

umbrella review. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5677-1

Tweed, E. J., Popham, F., Thomson, H., & Katikireddi, S. V. (2021). Including “inclusion

health”? A discourse analysis of health inequalities policy reviews. Critical Public

Health, 1–13. https://doi.org/10.1080/09581596.2021.1929847

Vandenheede, H. (2014). Trends in inequalities in premature mortality: a study of 3.2 million

deaths in 13 European countries. Journal of Epidemiology and Community Health, 69(3),

205–206. https://doi.org/10.1136/jech-2014-204450

Wilkinson, R., & Pickett, K. E. (2019). Health inequalities: England in profile. The Lancet,

367(9517), 1126–1128. https://doi.org/10.1016/s0140-6736(06)68489-4