Intergenerational continuities of ethnic inequalities in general health in England

Background: Previous research strongly suggests that ethnic minority groups are more likely to suffer a poorer health profile compared with the overall population, although it is not clear whether these inequalities persist over generations. This study aimed to establish the degree to which ethnic inequalities in health are transmitted from the first to the second generation, and to determine the extent to which intergenerational changes in socioeconomic status and health behaviours might explain any variation that exists. Methods: Data from the 1999 and 2004 Health Surveys for England assessed the prevalence of fair/poor general health across first (n=4492) and second (n=5729) generations of six ethnic minority populations. A white population was selected as reference (n=18 407). The risk of fair/poor general health was estimated by applying logistic regression models and stepwise inclusion of demographic, socioeconomic and behavioural variables. Generational movement relative to the white baseline was assessed for all ethnic groups adjusted for age and sex. Results: No significant differences in levels of reported fair/poor general health were observed between generations. After adjusting for improved socioeconomic position, the second generation became more likely to report worse health, whereas adjusting for differences in health behaviours had no effect. The Bangladeshi population showed significant intergenerational improvement in general health relative to the white reference, showing a reduction in the odds ratio (95% CI) from 2.75 (2.14 to 3.56) for the first generation to 1.58 (1.17 to 2.13) in the second generation. Conclusion: Ethnic minorities in England report consistent rates of fair/poor general health across generations, despite the health benefits resulting from upward social mobility. These health inequalities are unaffected by changes in health behaviours. Understanding these intergenerational pathways will have important public health policy implications as the migrant population not only ages, but also reproduces.