Examining the differential association between self-rated health and area deprivation among white British and ethnic minority people in England Laia Bécares a, * , James Nazroo a , Christo Albor b , Tarani Chandola a , Mai Stafford c a University of Manchester, School of Social Sciences, Oxford Road, Manchester M13 9PL, UK b Department of Health Sciences, University of York, UK c MRC Unit for Lifelong Health and Ageing, UK article info Article history: Available online 21 December 2011 Keywords: Ethnicity Environment Health Multi-level modelling England Health inequalities abstract Recent discourses in the area of neighbourhood effects on health have advocated for a relational perspective of space and place, focussing on the mutually reinforcing and reciprocal relationship between the environment and the individual. An example of such relationship is that of the interaction between area deprivation and individual ethnicity on reports of self-rated health, which we explored using cross-sectional data from the 2007 Citizenship Survey linked to the 2001 UK census. We aimed to examine whether the association between area deprivation and poor self-rated health differs for ethnic minority groups, as compared to white British people. Following from this, we also examined whether possible differential associations were mediated by ethnic density effects and perceptions of and satis- faction with neighbourhood characteristics. Results of random effects multilevel logistic regression models showed the detrimental association between area deprivation and self-rated health to be of greater magnitude and stronger for white British people than for ethnic minority people. This differential association was not mediated by ethnic density effects or perceptions of and satisfaction with neigh- bourhood characteristics. Ó 2011 Elsevier Ltd. All rights reserved. Introduction Much has been written on the distinction between contextual and compositional effects on health (Diez Roux, 2001; Macintyre, Ellaway, & Cummins, 2002), and it is now well established that area characteristics are associated with increased mortality and morbidity, independent of individual-level attributes (Pickett & Pearl, 2001; Riva, Gauvin, & Barnett, 2007). The literature on neighbourhood effects has identified two main domains of contextual attributes that are relevant to health: features of the neighbourhood physical environment, including air pollution, public spaces and access to resources; and features of the neigh- bourhood social environment, including social norms and social cohesion (Diez Roux & Mair, 2010). Although a large part of the extant research on the association between health and place has focused on differentiating and isolating the independent effects of individual and area-level attributes on health, recent theoretical discussions argue for an end to the “false dualism” (Cummins, Curtis, Diez Roux, & Macintyre, 2007 , p. 1835) in the distinction between compositional and contextual effects on health, promoting instead a relational perspective of space and place, where focus is placed on the interaction between the environment and the individual, recognising the mutually reinforcing and reciprocal relationship between people and place (Cummins et al., 2007; Curtis & Riva, 2010). One such interaction is that between an area’s contextual characteristics, including area deprivation, and an individual’s ethnicity. Existing neighbourhood studies in the UK show that Black Caribbean, Black African, Pakistani, Bangladeshi, and to some extent Indian people, are over-represented in deprived areas (Bécares, Nazroo, & Stafford, 2009; Karlsen, Nazroo, & Stephenson, 2002), which are characterised by poor neighbourhood physical environment attributes, including low quality and quantity of leisure facilities, transport, housing, food shopping opportunities, and primary and secondary health services (Macintyre et al., 2002). This unequal spatial separation, into deprived areas, of ethnic minority people from the majority white population contributes to and exacerbates existent ethnic health inequalities (Williams & Collins, 2001), which are partly attributed to ethnic minority people’s lower socioeconomic resources and poorer standard of living (Nazroo, 2001; Williams, 1999), as well as to experiences of interpersonal racism and discrimination (Bécares, Stafford, & Nazroo, 2009; Harris et al., 2006; Nazroo, 2001; Williams, 1999). * Corresponding author. Tel.: þ44 (0) 2076791704. E-mail address: laia.becares@manchester.ac.uk (L. Bécares). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.11.007 Social Science & Medicine 74 (2012) 616e624