Title: An ESRC/NIH Health Disparities Study of Discrimination & Disparities in Health & Health Service Use in the UK and US
Funder: Economic and Social Research Council

Abstract: There are an increasing number of reports from the US and the UK that show large differences in the quality of health among individuals from different ethnic and social class groups. These two countries share languages, comparable political systems and advanced economies, and are both multi-ethnic, multi-cultural societies with growing inequalities between racial/ethnic and economic groups. However, historical differences that generated these inequalities have had important and lasting implications upon contemporary society in each setting. Increasing inequalities in health has resulted in the need for an examination of why there are increasing differences in the level of health in both the US and the UK and what ongoing societal influences are contributing to these differences. To address this issue, this research has brought together US and UK researchers from various backgrounds to compare how similar and dissimilar processes of discrimination, unfair treatment across different areas of life, and social disadvantages may influence the quality of individual health. Conducting this study in both the US and UK will also allow us to examine how different social environments contribute to any identified health differences. Although previous research has found that discrimination has a strong negative impact on physical and mental health, discrimination attributed to socially disadvantaged statues other then ethnicity has not been explored in the UK. Further, there is little understanding about how discrimination contributes to differences in mental health, physical and social functioning, and health service use in the US and the UK. In this study, 800 adults were chosen from a larger group of adults participating in the Child Health and Development Disparities Study in the Easy Bay Area of California, USA. This group will be compared to 800 adults that are similar in age and race/ethnicity who are taking part in a research project that is currently evaluating the physical and mental health of 1200 households randomly selected from within three boroughs of South East London. From these two groups of adults, we will be comparing information between the US and the UK on the following: a) four key outcomes: functioning, mental health, general physical health, and health service access and use; b) their experiences of discrimination, how they cope with it, stressful circumstances, and related psychological and social experiences; c) individual social and economic status, as determined by one's own and parents' education level, occupation, reported wealth, migration history, and self-perceived social position in comparison to others; and d) the social environment in their neighbourhood, city, and nation. Overall, this study aims to use in-depth knowledge of social, economic and historical context from nation to neighbourhood to increase understanding of how ongoing discrimination experiences might explain differences in health and health service use in adult life. Since this approach incorporates the influences of history and social environments from both the US and the UK, this study also aims to increase the comparability of data on health and discrimination between the countries. This study will also improve the way we evaluate discrimination in the UK by adopting the more comprehensive approaches more commonly used in the US. Information collected from both countries will provide a novel and in-depth perspective of the social and historical influences on health and health care that are important for service users and practitioners, as well as policy-makers in both countries.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE