The Irish health disadvantage in England: contribution of structure and identity components of Irish ethnicity

Abstract

Background. Irish people living in Britain face a significant health disadvantage when compared to the white British host population.

Objectives. Using recent survey data, determine whether there is an ‘Irish health disadvantage’ independent of socio-economic factors and explore whether there is an Irish ethnic identity effect which operates on health.

Design. Data from the Census 2001 Individual Licensed SARs was analysed using binary logistic regression to study the relationship between the self-reported Irish ethnicity measure (which is presumed to reflect self-identification with Irish culture and community), considering country of birth subgroups, and the self-reported health measures of general health and limiting long-term illness. The analysis was adjusted for key demographic and socio-economic factors.

Results. When compared to the white British reference population, the self-reported ‘white Irish’ population overall, the Irish born in Northern Ireland, and UK-born Irish, show a significantly increased risk of both self-reported poor general health and limiting long-term illness. The increased risk of poor health of the Irish born in the Republic of Ireland is greatly diminished after the socio-economic adjustments, and only statistically significant in the case of general health. Finally, the Irish born in Northern Ireland who self-report as Irish are significantly more likely than those who self-report as British to report poor general health, which may suggest an Irish ethnic identity effect.

Conclusions. The findings demonstrate a persistent ethnic health disadvantage for first generation and UK-born Irish people living in England with respect to self-reported general health and limiting long-term illness, which cannot be fully explained by demographic and key socio-economic factors. Aspects of ethnicity related to both structure and identity may affect Irish self-reported health.

Keywords:

• Irish
• England
• self-reported health
• limiting long-term illness
• general health
• ethnicity
• identity
• socio-economic status

Notes

1. Except for Wild and McKeigue (1997) who failed to control for socio-economic position.

2. The indicator of social class has been criticised for lacking in validity owing to the heterogeneity of class groupings and the tendency for ethnic minority people to occupy a worse socio-economic position within each class group (Nazroo 2003). In order to more validly measure socio-economic position, various socio-economic indicators were used in addition to that of social class. Even so, the study was unable to measure the entirety of the structural context (e.g., discrimination experiences).

3. While the self-reported ethnicity variable is an improvement over country of birth, it remains imperfect and somewhat lacks in validity since self-declared ethnicity is a complicated issue. People may feel that their ethnicity is Irish and yet not declare that on their census form for various reasons, e.g., they take ethnicity to mean nationality or country of birth or, having parents from different ethnicities, find the lack of a combined option difficult to contend with (Walter 2002 cited FIS 2007). This is likely to lead to an under-representation of second and third-generation Irish people.

4. Including ‘white British’ Northern Irish born individuals did not significantly alter the results.

5. This category includes mostly second-generation Irish people. Some Irish people of third or subsequent generations could be included in this population. However, this is expected to be a minority since self-identification with being of Irish ethnicity decreases with subsequent generations. Moreover, most third-generation Irish would have been younger than 16 in 2001 when the survey was conducted.

6. The same analysis could not be carried out for the Republic Irish born since the vast majority (90%) stated having a ‘white Irish’ ethnicity, nor for the second-generation Irish since the SARs do not provide information on Irish parentage (in this study, the second-generation Irish were identified by considering those individuals who stated having a ‘white Irish’ ethnicity and were born in the UK).

7. The FIS (2007) study also used self-reported ethnicity but, as previously mentioned, did not adjust health analyses for socio-economic factors. Moreover, they did not disaggregate the ‘white Irish’ population by country of birth.