Ethnic minorities: introduction

Ethnicity refers to a common group identity based on language, culture, religion or other social characteristics. This means that people define their own ethnicity, that everyone (and not just those in minorities) has an ethnicity and that a person's ethnic identity may change over time. More information on defining ethnicity and race is available.

Williams et al (2019) provide an overview of the evidence linking structural racism, cultural racism and individual-level racism to mental and physical health outcomes. They recommend that future research focuses on interventions to reduce and prevent racism, as well as mitigating against its impact on health.

In the 2021 census, non-White minority ethnic groups in England and Wales were estimated to account for 18.3% of the population, up from 14.1% in 2011 (ONS). Results for the 2022 Census in Scotland have not yet been published. However it is likely that the share of ethnic minority population has also increased in Scotland, from 4% in 2011. The non-White population aged 16+ in Scotland increased from 3.1% in 2011-12 to 5.4% in 2022-23 (Annual Population Survey).       

The largest single ethnic minority group in Scotland are those of Pakistani origin followed by those of White Irish origin. There may also be local concentrations of specific groups such as asylum seekers or migrant workers.  More details of the ethnic composition of the Scottish population and Analysis of Equality results from the 2011 Census are available from the 2011 Scottish census.

Allik et al. (2019) analysed rates of ill-health and inequalities in ill-health by ethnicity using 2011 Scottish Census data. The White Scottish population had the worst health and highest inequalities compared to other ethnic groups, while White Polish and Chinese people had the best health and lowest inequalities. Within non-White ethnic minorities, the Pakistani population has poor health, especially at aged 45 and above.

Country of birth has been used as a guide to ethnic group, though it gives only an approximate indication. For example, Fischbacher et al (2007) (see Key references) analysed mortality by country of birth for people living in Scotland between 1997 and 2003. They found that men and women born in Pakistan had similar overall mortality to the Scottish-born population.

Schofield et al., (2019) found that non-whites born in the UK/Ireland had significantly higher mortality risk than Whites born in the UK for both Scotland and Glasgow, with a 77% and 310% higher risk respectively. It must be noted that these result should be interpreted with caution as the sample size of non-Whites in Scotland born in the UK that was include in this study was small. In contrast to this, those who are classed as non-White but are born outside of the UK/Ireland tend to have better health and a lower risk of mortality (Walsh et al., 2018). It has been suggested that this may be due to the healthy migrant effect (Walsh et al., 2018).

A 2018 review of the ethnicity and health literature highlights ethnic difference in some of the leading causes of death. For example, the majority of ethnic minority groups in Scotland tend to have lower rates of Cancer than the White Scottish population. A number of ethnic minority groups had a similar risk of stroke. Compared to the white-Scottish average, the risk of heart disease was found to be higher for men and women of Pakistani origin and lower for Chinese men and women (Walsh et al, 2018).

Data on live births in Scotland by country of birth of the mother can be produced by National Records Scotland. This may give more recent information than that based on the census but may not reflect the ethnicity of minority ethnic persons whose mothers were born in the UK.

Analyses of disease risk among ethnic minorities need to distinguish between relative and absolute differences. In the figures from the paper by Fischbacher above, Scottish figures are compared separately to people born in England and in Scotland. People born in Pakistan and living in Scotland did not have a lower risk of all-cause mortality in comparison to the English population, but in comparison to the Scottish population their risk was clearly lower (Table 1). This reflects the significantly higher risk of all-cause mortality in the Scottish born population compared to English born. For CHD and Stroke the mortality risk for people born in Pakistan and living in Scotland was higher than the risk for the English, but about the same as the risk for the Scottish-born population.

Table 1: Deaths and Standardised Mortality Ratio (SMR), including 95% confidence interval, for Pakistan-born residents of Scotland (25 years and older), Jan 1997-Mar 2003 using Scottish-born residents of Scotland as reference.

* two tailed significance testing, p

Source: Fischbacher, C. M., Steiner, M., Bhopal, R., Chalmers, J., Jamieson, J., Knowles, D., & Povey, C. 2007, "Variations in all cause and cardiovascular mortality by country of birth in Scotland, 1997-2003.[erratum appears in Scott Med J. 2008 May;53(2):66]", Scottish Medical Journal, vol. 52, no.4, pp.5-10.

These figures emphasise that minority ethnic groups should not be assumed to have worse health across the board. They also emphasise that, in general, the health needs of ethnic minorities should be assessed using absolute measures, such as numbers of deaths, rather than relative ones, such as Standardised Mortality Ratio (SMR).

Published data reveal differences in rates of hospital admission by ethnic group for both men and women. In 2013 White Scottish men and women had age-standardised hospital admissions rates of 231 and 229/1,000 population, respectively. For both sexes, the rates of admissions where notably higher for those in the White Other British, White Other,  Pakistani ethnic group and Other Ethnic Group. The rates were similar to the White-Scottish admission rates for those who identified as being Indian, Caribbean/Black and African. Admission rates were lower for White Polish, Chinese, White Irish, White Gypsy/Traveller and Arabic men and women.

Routine data on hospital admissions by ethnic group suggest that rates of psychiatric admissions also varied by ethnic group.  In 2015, age standardised psychiatric admissions rates for White Scottish men (4.8/1,000) and women (3.8/1,000) were higher than they were for the majority of other ethnic groups – including the Pakistani, Indian, Bangladeshi, Chinese, African, and Arabic ethnic groups. Rates of admission for the White other British, Black/Caribbean, and Other Ethnic Group were higher than they were for White Scottish men and women.

A caveat to bear in mind is that the observed differences in hospital admissions may not necessarily be due to underlying differences in health across ethnic groups but instead may be due to cultural differences in how poor health is defined, prevented, and responded to across ethnic group (Napier, et al. 2014).