Skip to main content

Advertisement

SpringerLink
Log in

Diminished Returns in Europe: Socioeconomic Status and Ethno-Racial Health Disparities Across 30 Countries in the European Social Survey

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Ethnic and racial minorities in many countries experience worse relative health outcomes and earlier mortality compared to national averages or outcomes of the majority population. Although socioeconomic status often contributes to a portion of ethno-racial health disparities, there are many unanswered questions about the relationship between socioeconomic status and ethno-racial health disparities across contexts. Recent scholarship in the USA has found support for a “diminished returns” effect in which the socioeconomic health gradient is systematically smaller for marginalized groups, yet it is unclear whether this pattern exists in other national contexts. This study tests the interaction between socioeconomic status and ethno-racial minority status in 30 countries across six waves of the European Social Survey. The results include evidence of the diminished returns pattern, particularly for populations with origins in Sub-Saharan Africa and the Middle East. Multilevel mixed-effects models find variation across countries in the interaction between socioeconomic status and ethno-racial minority status. The findings suggest racism and socioeconomic status interact to affect health and health disparities in multiple contexts and highlight the importance of cross-national comparison to further understand variation across countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Code Availability

A replication package with the author’s code is available upon request and will be posted to an online repository upon publication.

Notes

  1. The sample begins with survey round 4 because the ESS switched its question for measuring household income in 2008 to reflect country-specific income decile rankings. Prior survey waves used different income questions that make cross-survey and cross-national comparison less straightforward.

  2. Table 7 in the Appendix depicts the number of missing values for each variable. More than 20% of values for the household income variable were missing, whereas for most other variables included less than 1% were missing.

  3. Because the analysis hinges on comparison of interaction effects at multiple levels, linear probability models offer a more straightforward interpretation of coefficients than logistic regression and similar methods that can be affected by omitted variables and are challenging to compare across models [64].

References

  1. Teitler JO, Reichman NE, Nepomnyaschy L, Martinson M. A cross-national comparison of racial and ethnic disparities in low birth weight in the United States and England. Pediatrics American Academy of Pediatrics. 2007;120:e1182–9.

    Google Scholar 

  2. Bakhtiari E, Olafsdottir S, Beckfield J. Institutions, incorporation, and inequality: the case of minority health inequalities in Europe. J Health Soc Behav. 2018;59:248–67.

    Article  PubMed  Google Scholar 

  3. Ramraj C, Shahidi FV, Darity W, Kawachi I, Zuberi D, Siddiqi A. Equally inequitable? A cross-national comparative study of racial health inequalities in the United States and Canada. Soc Sci Med. 2016;161:19–26.

    Article  PubMed  Google Scholar 

  4. Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, Nazroo J. Racism and health: the relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med. 2006;63:1428–41.

    Article  PubMed  Google Scholar 

  5. Shedlin MG, Decena CU, Noboa H, Betancourt O.´ Sending-country violence and receiving-country discrimination: effects on the health of Colombian refugees in Ecuador. Journal of Immigrant and Minority Health. 2014;16:119–24.

  6. Perreira KM, Telles EE. The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Soc Sci Med. 2014;116:241–50.

    Article  PubMed  Google Scholar 

  7. Williams DR, Collins C. US socioeconomic and racial differences in health: patterns and explanations. Annual Review of Sociology. 1995;349–86.

  8. Link BG, Phelan JC. Social conditions as fundamental causes of disease. Journalof health and social behavior. 1995;80–94.

  9. Elo IT. Social class differentials in health and mortality: patterns and explanations in comparative perspective. Ann Rev Sociol. 2009;35:553–72.

    Article  Google Scholar 

  10. Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health socio-economic status, stress and discrimination. J Health Psychol. 1997;2:335–51.

    Article  CAS  PubMed  Google Scholar 

  11. Brondolo E, Gallo LC, Myers HF. Race, racism and health: disparities, mechanisms, and interventions. J Behav Med. 2008;32:1.

    Article  PubMed  Google Scholar 

  12. Williams DR. Stress and the mental health of populations of color: advancing our understanding of race-related stressors. Journal of Health and Social Behavior. SAGE Publications Inc; 2018;59:466–85.

  13. Bhopal RS. Racism in health and health care in Europe: reality or mirage? The European Journal of Public Health. 2007;17:238–41.

    Article  PubMed  Google Scholar 

  14. Fiscella K, Sanders MR. Racial and ethnic disparities in the quality of health care. Annual review of public health. Annual Reviews; 2016;37:375–94.

  15. Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical mistrust, racism, and delays in preventive health screening among African American men. Behavioral Medicine Taylor & Francis. 2019;45:102–17.

    Article  Google Scholar 

  16. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and wellbeing of preterm infants and their families. Pediatric Research Nature Publishing Group. 2020;87:227–34.

    Google Scholar 

  18. Krieger N, Van Wye G, Huynh M, Waterman PD, Maduro G, Li W, et al. Structural racism, historical redlining, and risk of preterm birth in New York City, 2013–2017. American Journal of Public Health. American Public Health Association; 2020;110:1046–53.

  19. Bailey ZD, Krieger N, Ag´enor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. The Lancet. 2017;389:1453–63.

  20. Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Ann Rev Sociol. 2015;41:311–30.

    Article  Google Scholar 

  21. Farmer MM, Ferraro KF. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005;60:191–204.

    Article  PubMed  Google Scholar 

  22. Assari S, Chalian H, Bazargan M. High education level protects European Americans but not African Americans against chronic obstructive pulmonary disease: national Health Interview Survey. International journal of biomedical engineering and clinical science. 2019;5:16–23.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Assari S, Bazargan M, Caldwell CH. Parental educational attainment and chronic medical conditions among American youth; minorities’ diminished returns. Children. 2019;6.

  24. Assari S, Bazargan M. Minorities’ diminished returns of educational attainment on hospitalization risk: National Health Interview Survey (NHIS). Hospital practices and research. 2019;4:86–91.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Assari S. Socioeconomic determinants of systolic blood pressure; minorities’ diminished returns. Journal of health economics and development. 2019;1:1–1.

    PubMed  Google Scholar 

  26. Braveman PA, Heck K, Egerter S, Marchi KS, Dominguez TP, Cubbin C, et al. The role of socioeconomic factors in Black–White disparities in preterm birth. American Journal of Public Health. American Public Health Association; 2014;105:694–702.

  27. Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using multiple-hierarchy stratification and life course approaches to understand health inequalities: the intersecting consequences of race, gender, SES, and age. Journal of Health and Social Behavior. SAGE Publications Inc; 2016;57:200–22.

  28. Colen CG, Ramey DM, Cooksey EC, Williams DR. Racial disparities in health among nonpoor African Americans and Hispanics: the role of acute and chronic discrimination. Soc Sci Med. 2018;199:167–80.

    Article  PubMed  Google Scholar 

  29. Bambra C, Eikemo TA. Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. Journal of Epidemiology & Community Health. 2009;

  30. Krieger N. Discrimination and health inequities. Int J Health Serv. 2014;44:643–710.

    Article  PubMed  Google Scholar 

  31. Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv. 1999;29:295–352.

    Article  CAS  PubMed  Google Scholar 

  32. Assari S, Bazargan M. Educational attainment and subjective health and well-being; diminished returns of lesbian, gay, and bisexual individuals. Behavioral Sciences. 2019;9.

  33. Assari S, Bazargan M. Education level and cigarette smoking: diminished returns of lesbian, gay and bisexual individuals. Behavioral Sciences. 2019;9.

  34. Assari S, Bazargan M. Unequal associations between educational attainment and occupational stress across racial and ethnic groups. International Journal of Environmental Research and Public Health. 2019;16.

  35. Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the New York Academy of Sciences. 1999;896:173–88.

  36. Grollman EA. Multiple disadvantaged statuses and health: the role of multiple forms of discrimination. Journal of Health and Social Behavior. SAGE Publications Inc; 2014;55:3–19.

  37. Beckfield J, Olafsdottir S, Sosnaud B. Healthcare systems in comparative perspective: classification, convergence, institutions, inequalities, and five missed turns. Ann Rev Sociol. 2013;39:127–46.

    Article  Google Scholar 

  38. Olafsdottir S, Beckfield J, Bakhtiari E. Contextualizing disparities: the case for comparative research on social inequalities in health. Social determinants, health disparities and linkages to health and health care. Emerald Group Publishing Limited; 2013. p. 299–317.

  39. Olafsdottir S, Bakhtiari E, Barman E. Public or private? The role of the state and civil society in health and health inequalities across nations. Soc Sci Med. 2014;123:174–81.

    Article  PubMed  Google Scholar 

  40. Aspinall PJ. Approaches to developing an improved cross-national understanding of concepts and terms relating to ethnicity and race. Int Sociol. 2007;22:41–70.

    Article  Google Scholar 

  41. Beaman J, Petts A. Towards a global theory of colorblindness: comparing colorblind racial ideology in France and the United States. Sociology Compass. 2020;14:e12774.

  42. Goldberg D. Racial Europeanization. Ethnic and racial studies Routledge. 2006;29:331–64.

    Article  Google Scholar 

  43. Gkiouleka A, Huijts T, Beckfield J, Bambra C. Understanding the micro and macro politics of health: inequalities, intersectionality & institutions - a research agenda. Soc Sci Med. 2018;200:92–8.

    Article  PubMed  Google Scholar 

  44. Quillian L, Heath A, Pager D, Midtbøen A, Fleischmann F, Hexel O. Do some countries discriminate more than others? Evidence from 97 Field Experiments of Racial Discrimination in Hiring. Sociological Science. 2019;6:467–96.

    Article  Google Scholar 

  45. Semyonov M, Glikman A. Ethnic residential segregation, social contacts, and anti-minority attitudes in European Societies. Eur Sociol Rev. 2009;25:693–708.

    Article  Google Scholar 

  46. Benassi F, Bonifazi C, Heins F, Lipizzi F, Strozza S. Comparing residential segregation of migrant populations in selected European Urban and Metropolitan Areas. Spatial Demography. 2020;8:269–90.

    Article  Google Scholar 

  47. Blom N, Huijts T, Kraaykamp G. Ethnic health inequalities in Europe. The moderating and amplifying role of healthcare system characteristics. Social Science & Medicine. 2016;158:43–51.

  48. Malmusi D. Immigrants’ health and health inequality by type of integration policies in European countries. The European Journal of Public Health. 2015;25:293–9.

    Article  PubMed  Google Scholar 

  49. Bhopal RS. Research agenda for tackling inequalities related to migration and ethnicity in Europe. J Public Health. 2012;34:167–73.

    Article  Google Scholar 

  50. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty seven community studies. J Health Soc Behav. 1997;38:21.

    Article  CAS  PubMed  Google Scholar 

  51. Schnittker J, Bacak V. The increasing predictive validity of self-rated health. PLoS ONE. 2014;9:e84933.

  52. De Bruin A. Health interview surveys: towards international harmonization of methods and instruments. WHO Regional Publications, European Series, No. 58. ERIC; 1996.

  53. Harzing A-W. Response styles in cross-national survey research a 26-country study. International Journal of Cross Cultural Management. 2006;6:243–66.

    Article  Google Scholar 

  54. Jorm AF, Ryan SM. Cross-national and historical differences in subjective wellbeing. International Journal of Epidemiology. 2014;dyt188.

  55. Ju¨rges H. True health vs response styles: exploring cross-country differences in self-reported health. Health Economics. 2007;16:163–78.

  56. King G, Murray CJL, Salomon JA, Tandon A. Enhancing the validity and cross cultural comparability of measurement in survey research. American Political Science Review. 2004:191–207.

  57. Bacak V, Olafsdottir S. Gender and validity of self-rated health in nineteen European countries. Scandinavian Journal of Public Health. 2017;45:647–53.

    Article  PubMed  Google Scholar 

  58. Dowd JB, Todd M. Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the health and retirement study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2011;66B:478–89.

  59. Huisman M, van Lenthe F, Mackenbach J. The predictive ability of self-assessed health for mortality in different educational groups. Int J Epidemiol. 2007;36:1207–13.

    Article  PubMed  Google Scholar 

  60. Jylha¨ M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E. Is self-rated health comparable across cultures and genders? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 1998;53B:S144–52.

  61. Erving CL, Zajdel R. Assessing the validity of self-rated health across ethnic groups: implications for health disparities research. Journal of Racial and Ethnic Health Disparities. 2021;

  62. Van Oyen H, Bogaert P, Yokota RTC, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). Archives of Public Health. 2018;76:25.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Darin-Mattsson A, Fors S, K˚areholt I. Different indicators of socioeconomic status and their relative importance as determinants of health in old age. International Journal for Equity in Health. 2017;16:173.

  64. Mood C. Logistic regression: why we cannot do what we think we can do, and what we can do about it. Eur Sociol Rev. 2010;26:67–82.

    Article  Google Scholar 

  65. Kaminska O. Guide to using weights and sample design indicators with ESSData. 2020;15.

  66. Kaminska O, Lynn P. Survey-based cross-country comparisons where countries vary in sample design: issues and solutions. Journal of Official Statistics Statistics Sweden. 2017;33:123–36.

    Article  Google Scholar 

  67. Kennedy S, McDonald JT, Biddle N. The healthy immigrant effect and immigrant selection: evidence from four countries. Social and Economic Dimensions of an Aging Population Research Papers: McMaster University; 2006.

    Google Scholar 

  68. Griesshaber N, Seibel V. Over-education among immigrants in Europe: the value of civic involvement. Journal of Ethnic & Migration Studies. Routledge; 2015;41:374– 98.

  69. Assari S, Lapeyrouse LM, Neighbors HW. Income and self-rated mental health: diminished returns for high income Black Americans. Behavioral Sciences. Multidisciplinary Digital Publishing Institute; 2018;8:50.

  70. Christian M. A global critical race and racism framework: racial entanglements and deep and malleable whiteness. Sociology of Race and Ethnicity. SAGE Publications Inc; 2019;5:169–85.

  71. Weiner MF. Towards a critical global race theory. Sociol Compass. 2012;6:332–50.

    Article  Google Scholar 

  72. Karlsen S, Nazroo JY. Relation between racial discrimination, social class, and health among ethnic minority groups. American Journal of Public Health. American Public Health Association; 2002;92:624–31.

  73. Smith GD, Chaturvedi N, Harding S, Nazroo J, Williams R. Ethnic inequalities in health: a review of UK epidemiological evidence. Critical Public Health Taylor & Francis. 2000;10:375–408.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Sociology, William & Mary, 100 Ukrop Way, Williamsburg, VA, 23185, USA

    Elyas Bakhtiari

Authors
  1. Elyas Bakhtiari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elyas Bakhtiari.

Ethics declarations

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Research Involving Human Participants and/or Animals

The author did not collect data from human subjects for this article. All data was collected and made publicly available by the European Social Survey.

Informed Consent

All data was collected and made publicly available by the European Social Survey, following the Declaration on Professional Ethics of the International Statistical Institute: https://www.europeansocialsurvey.org/about/ethics.html.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 6 Sample size by country and survey round, ESS (n = 192,080)
Full size table
Table 7 Missing data in ESS sample
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bakhtiari, E. Diminished Returns in Europe: Socioeconomic Status and Ethno-Racial Health Disparities Across 30 Countries in the European Social Survey. J. Racial and Ethnic Health Disparities 9, 2412–2426 (2022). https://doi.org/10.1007/s40615-021-01178-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-021-01178-2

Keywords

Search

Navigation