Race/ethnic inequalities in health: moving beyond confusion to focus on fundamental causes

Abstract

This commentary will focus on health inequalities in relation to race/ethnicity, and in doing so, it will connect with the health inequalities article by Case and Kraftman and the race and ethnic inequalities article by Mirza and Warwick, both in this collection. The central argument of this commentary is that to make sense of the (complex and often confusing) patterning of race/ethnic inequalities in health in the UK and to move towards developing policy to address these inequalities, we must adopt a theoretically informed approach that centres on the fundamental causes of race/ethnic inequalities—processes that flow from (structural, interpersonal and institutional) racism. To make this argument, first I critically review the data on race/ethnic inequalities in health and interpretations of these data. Second, I discuss the central role of social and economic inequalities in driving these inequalities. Third, I provide a more detailed discussion of how racism operates to shape social and economic inequalities and thereby to shape health outcomes. Fourth, I discuss the implications of this analysis for policy, particularly how this points to the need to address institutional racism and how this might be done. Finally, I briefly revisit the question of fundamental causes and the implications of this for considerations of other dimensions of inequality, such as those related to class and gender. 1