J Y Nazroo. (Pp 196; £14.95). Policy Studies Institute, 2001. ISBN 0-85374-792-X.

Anyone concerned with the complex interrelations of ethnicity and class to health should peruse this volume. It is one of a series based on the Fourth National Survey of Ethnic Minorities in the UK; descriptions of the main findings of the initial analyses were published in three volumes in 1997. This volume focuses on an explanation of these findings and works through the complex interactions involving ethnicity, “race”, socioeconomic status, class, and important health outcomes including mental health.

The Fourth Survey is exceptional in terms of coverage of the ethnic minority groups (nationally representative sampling of the main minority groups along with a comparison sample of the white population), the use of community based interview data rather than hospital based records, the range of health assessments conducted (general health, C-V disease, diabetes, respiratory disease, mental health, and life style factors such as tobacco and alcohol use, its appraisal of socioeconomic status and other life features of the ethnic minority populations. Potential limitations of the survey: (a) cross sectional data so that the direction of possible causal relations cannot be assured and (b) self reported data (with questions not yet cross culturally validated).

The main ethnic groups—overall 5.5% of the UK population—are black (Caribbean, African, and other), South Asian (Indian, Pakistani, and Bangladeshi), and Chinese and others (Chinese, other Asian and other-other). Important differences in health status and in the patterns of disease from one ethnic minority group to another and from that of the white population are delineated and Nazroo carefully examines possible explanations for these health inequalities.

The assembled evidence points to socioeconomic factors as the major determinants of health in all groups and the principal reason underlying inequalities in health status of ethnic minorities. But class factors do not fully explain the differences. Other kinds of disadvantage that ethnic minorities face including life in a racist society with its overt harassment, many forms of exclusion and lifetime accumulations of disadvantages have added burdens of stress contributing to poor health.

The final paragraph states “ . . . (ethnic) inequalities in health . . . a component and a consequence of an inequitable capitalist society, . . . needs to be directly addressed.” I suspect that the highly vulnerable and disadvantaged ethnic minorities in China and the former Soviet Union areas have parallel problems.

This “conclusion” is unrelated to the extensive analyses of the volume and should not distract from the importance of this book.