Ethnic inequalities in quality of life at older ages: subjective and objective components
Project lead: Dr James Nazroo
Dr James Nazroo
Dr Madhavi Bajekal
Professor David Blane
Ms Ini Grewal
May 2000 - May 2002
Dr James Nazroo
Department of Epidemiology and Public Health
University College London
1-19 Torrington Place
London WC1E 6BT
Tel: +44 207 679 1705
With one or two exceptions, the circumstances of older ethnic minority people in Britain, let alone issues relating to their quality of life (QoL), have not been a key issue for either policy makers or researchers. This is perhaps because they are considered to be a small population whose needs will be met by their families. However, those who migrated to Britain as young adults in the 1950s and 1960s are now moving into retirement. They represent a unique generation who, since migrating to Britain have made a major contribution to Britain's economy working mostly in arduous low paid occupations in public service and manufacturing industries. Addressing the needs and perspectives of this generation is a task of the present.
It has been suggested that ethnic minority older people face 'multiple hazard'. The implication is that having an ethnic minority background in addition to being older adds extra dimensions of disadvantage. It is also possible that this will interact with both gender differences, given the marked ethnic differences in family structure and gender roles, and socioeconomic position.
Current evidence suggests that there is some truth to theories of multiple disadvantage. Across the material and health dimensions of QoL some ethnic minority groups are considerably disadvantaged compared with older white people. However, little empirical evidence has been produced on the factors underlying such possible inequalities, and the evidence is more equivocal on disadvantage across other possible dimensions of QoL. For example, in terms of family contact South Asian people are more likely to live in households containing two generations of adults, and, compared with white people, older Caribbean and South Asian people are much more likely to be living with a child. So, while it seems to be clear that 'multiple hazard' for ethnic minority older people exists, ethnic disadvantages in QoL may not be present across all of its dimensions.
It is also likely that the nature and relevance of particular dimensions of QoL will vary across ethnic groups. This means that understanding ethnic inequalities in QoL, both in terms of its extent and its causes, depends on an understanding of ethnic differences in what might be important to older people.
Aims and objectives
The research will be concerned with improving our understanding of ethnic differences in the definitions and experience of QoL among older people, and the determinants of ethnic inequalities in QoL among older people.
Specific objectives are:
A description of ethnic differences in older people's definitions of QoL and the relative importance they place on particular elements of QoL.
An assessment of ethnic inequalities in QoL among older people, whether ethnically specific assessments amplify or narrow formal estimates of inequality in QoL, and the key determinants of ethnic inequalities in QoL.
To assess how far gender differences operate in these relationships.
To contribute to the methodological development of studies of minority groups and the development of combining qualitative and quantitative methods in a study.
To contribute to theoretical debates around ageing, particularly the contrasting structured dependency and third age approaches.
The study will be conducted in two phases, the first qualitative and the second quantitative. Both phases will be based on the Fourth National Survey of Ethnic Minorities, which was a large representative survey of ethnic minority and white people living in England and Wales, conducted in 1993-94.
The aim of the survey was to describe and explain the experiences of ethnic minority people, so it collected detailed information on: household and family structure; socioeconomic position, including economic activity, sources of income and size of income; perceptions of the quality of the neighbourhood; education; dimensions of ethnic identity; experience of crime and harassment; social networks and participation; both general and specific health outcomes; and use of health and social services.
The qualitative phase of the study will involve in-depth interviews with a purposively identified sub-sample drawn from the Fourth National Survey respondents, focussing on respondents who were pre-retirement age at the initial interview. This will allow us to explore issues relating to transitions into retirement. Respondents will be identified from four ethnic groups, selected to represent heterogeneity of experience across groups, rather than comprehensive coverage of all groups.
The groups to be covered will include: white; Caribbean; Indian; and either Pakistani or Bangladeshi. Twenty respondents will be interviewed in each ethnic group, giving 80 in-depth interviews in total. The qualitative interview will cover: exploration of the meaning of QoL; levels of QoL; changes in QoL over retirement and reasons for changes; and aspirations for the future. Retrospective data will be collected to cover migration and employment histories using 'lifegrid' methods. Interview data will be analysed using 'Framework', a method developed for the systematic analysis of qualitative data that involves the indexing and charting of verbatim data within a thematic matrix, so that associations within and convergence and divergence between accounts can be determined.
For the quantitative phase we will conduct secondary analyses of the Fourth National Survey data on those who were within 10 years of retirement age and those of post-retirement age. Multivariate techniques will be used to explore the inter-relationships between dimensions of QoL and how they vary by ethnic group, age and gender. Importantly, findings on the relative importance of particular dimensions of QoL at the qualitative phase of the study will be used to inform and interpret the quantitative analysis. This means that the quantitative analysis will be sensitive to the views of those being researched and that we will be able to determine whether inequalities are greater or smaller once these subjective accounts are considered.
Understanding ethnic differences in older people's definitions of QoL, and the value they place on particular aspects of their lives, will be of great importance to the development of ethnically sensitive policies to promote QoL for older people. We anticipate that our findings will, in the long term, feed into the development of policies concerned with enhancing the QoL of older people and help ensure that such policies are sensitive to ethnic diversity.
Addressing ethnic inequalities in QoL requires an understanding of the dimensions and determinants of such inequality. Our research would contribute to such an understanding, and take into account the perspectives of older ethnic minority people. This information will be of direct relevance to policies that are designed to prolong active life, economic and social participation, and reduce dependency and social exclusion. It will allow policy initiatives to be assessed in terms of their probable impact on different ethnic groups, allow the development of policies that can be targeted at particularly disadvantaged ethnic groups and help ensure that policy development is sensitive to ethnic diversity in experience and aspirations.