Ethnicity, socio-economic status, and health research: Insights from and implications of Charles Tilly's theory of Durable Inequality

Abstract

International audience ; Background. Ethnic inequalities in health status and health care remain substantial in Europe and addressing them is becoming a priority. However, the best way to respond to such a challenge is, as yet, unclear. The research community is grappling with the contribution of socio-economic discrimination to ethnic inequalities. Methods. We present a new theoretical analysis, based on the landmark work of Charles Tilly on 'Durable Inequality' and we apply it to the public health goal of reducing ethnic health inequalities. Results. Tilly claims that, for organisational reasons, ethnic categories and socio-economic categories are tied together. The theory of Durable Inequality claims that the matching of ethnic categories with socio-economic categories helps to enforce exploitation, leading to durable inequalities. We present the theory, and focus on its main components (categories, exploitation, opportunity hoarding, emulation, adaptation) and discuss the implications for health inequalities by ethnic group. In essence, the theory leads to four recommendations for the study of ethnic health inequalities: (1) to investigate organisational processes creating ethnic health inequalities ; (2) to investigate the role of networks and ties on health behaviours, health care use and their psychological factors; (3) to define ethnicity through flexible, multidimensional binary categories, that should vary according to context; (4) to assess cumulative inequality within a domain, across domains and across generations. Conclusions. Our paper, to our knowledge is the first attempt to analyse Tilly's theory in relation to ethnicity and health, opens a debate to refine the implications of these ideas prior to empirical testing.