Minority ethnic women's experiences in Scotland 2024: intersectional evidence review

8. Health

Evidence and data related to health finds that experiences and outcomes differ between ethnic groups. Evidence reviewed for this report also considers the presence of other intersecting characteristics, which highlights the layers of complexity when assessing the impact of ethnicity and gender or sex together.

8.1. Health Problems and Disability

This sub-chapter explores evidence related to health problems and disability, which may link to additional findings explored for this chapter generally.

The full Scotland Census 2022 dataset, including intersectional equality breakdowns, was not yet available at the time of publishing this Evidence Review and alternative sources, such as the Scottish Health Survey, were unable to produce intersectional breakdowns for this Evidence Review.

Instead, we looked to analysis from the 2011 Census, which found a wide variation in rates of long-term limiting health problems or disability amongst women from different ethnic groups. Once Census 2022 results are published, future analysis could investigate if there are any updates in the trends identified in the 2011 Census or whether the data shows a similar picture. ‘Bangladeshi’, ‘Pakistani’ and ‘Gypsy/Traveller’ women recorded higher rates of 'health problems or disability' than the ‘White Scottish’ population. Differences were most pronounced with Gypsy/Traveller women being twice as likely to report a long-lasting health condition or disability than the ‘white: Scottish’ population. A similar trend emerged for self-determined ‘poor general health’, with Gypsy/Traveller women more than three and a half times likely to report they had poor general health than the ‘White: Scottish’ population. However, similar findings were found for Gypsy/Traveller men (in relation to health problems and disability, and self-determined ‘poor health’). In comparison, Pakistani and Bangladeshi women were more likely to have a health problem or disability or have self-reported ‘poor general health’ than men from these ethnic groups. The extent to which the identified differences are based on the intersectional experiences of sex and ethnicity, rather than just solely ethnicity, is unclear.

Further research that explores the use and access of health services (outlined in the sub-chapter below) may provide contextual understanding of how statistics of health problems and disability translate into experience.

8.2. Access to Services and Quality of Care

Access to services and quality of care are important to understand in the context of healthcare experiences. No intersectional quantitative evidence was found for this sub-section, however qualitative evidence provides insights that may not have been possible to explore in general population or quantitative surveys.

Although intersectional data, at the time of this publication, was not available, results from the Health and Care Experience Survey give some insights into people’s experience of care received at their General Practices specifically. The results show that men and women had a similar likelihood of rating overall care received by their General Practice positively. Separately, respondents who described themselves as ‘Asian, Asian Scottish, or Asian British’, ‘mixed or multiple ethnic groups’ and other (including ’Caribbean or Black’ and ‘Other ethnic group’) had a similar likelihood of rating overall care received by their General Practice positively, compared to ‘white’ respondents. Respondents from an ‘African’ background were more likely to rate overall care received positively than the ‘white’ respondents. However, interaction effects were not included in the analyses and therefore intersectional data is not available. Qualitative evidence, outlined below, suggest that there is a difference in experience of care in the UK and in Scotland when considering intersecting characteristics.

IPSOS carried out research in 2022 which focused on the cultural beliefs and experiences of health care of women from a range of ages and backgrounds. Their research, Hysterical Health: Unpacking the cultural beliefs that shape women’s experiences, published findings that showed black women experience delayed diagnosis and negative experiences in healthcare, such as maternity care or pain management treatments, due to racial discrimination and assumptions. Similarly, a 2023 Scottish Government evidence review and qualitative research project found that minority ethnic women participants spoke of the lack of knowledge or experience about health conditions presenting in or on people from a variety of ethnic backgrounds other than white, resulting in unnecessary repeat appointments, delayed diagnosis, and feeling as though there was a “lack of care”. In addition, participants spoke of micro-aggressions, such as being spoken to negatively by healthcare professionals or being ignored, which participants attributed directly to racism. It is important to note here that the researchers found that these experiences also intersected with other characteristics, such as language, age, migrant status, religion and nationality.

8.3. Mental Health and Wellbeing

Scottish Government statistics analysed for this report on mental health suggest that there is little difference between minority ethnic women and other population groups. However, qualitative research portrays a different picture as it reveals how mental health is negatively impacted by racism and discrimination.

According to statistics produced for this report by the SSCQ, minority ethnic^[60] and white^[61] females experienced similar average mental wellbeing according to the shortened Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)^[62]. The scale runs from 7 to 35 and a higher score indicates a higher level of mental wellbeing. In 2022 the average score for minority ethnic females was 23.8 out of 35 and the average score for white females was 23.7 out of 35. This indicates no significant difference in average mental wellbeing across these groups, however other evidence suggests that women’s experiences racial discrimination can contribute to or impact support received for poor mental health.

Although these statistics reveal no difference in average mental health generally, qualitative evidence indicates that racial discrimination can have an adverse impact on mental wellbeing for minority ethnic women which may suggest there are some differences. A 2023 Scottish Government evidence review and qualitative research project exploring women’s experiences and perceptions of health in Scotland found that minority ethnic women experienced cultural, institutional and interpersonal based racism in healthcare and wider society. The three minority ethnic women who participated in this research described how racism outwith healthcare resulted in poorer mental health, specifically exclusion, isolation and exhaustion from “anticipating and expecting racism”. Although these experiences are important to consider, they are not comparable to population-weighted level statistics due it’s small sample sizes, therefore further research specifically focused on comparable experiences of mental health across ethnic groups and sex and gender may be required.

Evidence also suggests a difference when taking a more focused view of experiences of poor mental health. When considering detentions under the Mental Health Act, the Mental Health Commission for Scotland found a complex picture for minority ethnic women. Analysis was undertaken of differences in whether an individual’s detention was justified due to i) risk to self, ii) risk to other people, or iii) risk to self and other people. The report highlighted differences in detention due to being a risk towards ‘self and others’ for women from certain ethnic groups. The analysis found that black women (48.4%) and ‘other ethnicity’ women (43.6%) were detained more often for safety to ‘self and others’ in comparison to white Scottish women (33.8%). The report highlights reasons that this may be the case, such as age and socio-economic deprivation, but does not rule out racial bias as a contributing factor to detention.

Access to green and blue spaces

The NPF currently monitors people’s access to green and blue spaces as access to these spaces results in better mental health and wellbeing.

Additional analysis of SHS results undertaken for this report on access to green and blue spaces, did not show any statistically significant differences between minority ethnic women and white Scottish/British women. In 2022, over half of minority ethnic women (65%) and white Scottish/British women (69%) lived within a 5-minute walk of their nearest green or blue space. There was a difference when comparing the access to green and blue spaces between minority ethnic women (65%) and white Scottish/British men (72%), with the latter being more likely to live within a 5-minute walk of a green or blue space. Further research would be required to understand if there is a link between this and comparative experiences of mental health.

Loneliness

Public health evidence indicates that loneliness has a negative impact on health and wellbeing and is monitored by the SHS data through one measure.

Additional analysis of SHS data found that in 2022 there was no statistically significant difference between minority ethnic women (25%) and white Scottish/British women (24%) who felt lonely some, most or all of the time in the last week. Findings from the Evidence for Equality National Survey on Racism and Ethnic Inequality (EVENS) in a Time of Crisis highlight that loneliness figures during the COVID-19 pandemic show a mixed picture across ethnic groups.^[63] The research suggests that people from Gypsy/Traveller, Roma, Chinese and black African ethnic groups were less likely than the white British group to experience loneliness during COVID-19. In contrast, mixed white and black Caribbean, Any Other, and Arab ethnic groups were more likely to report an increase in loneliness during the COVID-19 pandemic. It was not possible to ascertain whether intersectional data specific to Scotland would be available in the EVENS dataset prior to publication, therefore further analysis be required to understand community connections, loneliness and mental health among minority ethnic women in Scotland.

Summary of evidence:

• Limited statistical data was available exploring health outcomes of minority ethnic women, however this may be because the Scottish Health Survey and Scotland’s Census 2022 data was not published at the time of this report.
• Only qualitative was found for minority ethnic women’s experiences of quality and access to healthcare. This may reflect the ability of qualitative research to capture the nuanced experiences of minority ethnic women better than quantitative data. 
• Mental health statistics analysed for this report suggest that minority ethnic women do not suffer poorer mental health than comparative groups, however there is evidence to suggest that they face additional issues of racial discrimination that impact experience of mental health.
• Evidence cited in this chapter suggests that other intersecting characteristics may influence health and wellbeing experiences and outcomes.

Based on this chapter, what lessons can we learn about analysis and publication of intersectional evidence?

• It is important to consider a wide range of both quantitative and qualitative evidence when assessing intersectional experiences of health and wellbeing, as one type of research may not provide the full picture. The difference in results and findings may vary across type of evidence for a number of reasons, such as the research questions asked, methodology, sample size, and respondents demographics.
• Other intersecting characteristics may also have an influence, such as language, age, migrant status, religion and nationality, which highlights the layers of complexity when assessing the impact of ethnicity and gender on equality outcomes.