Abstract To understand ethnic inequalities in health, we must take account of the relationship between ethnic minority status, structural disadvantage and agency. So far, the direct effects of racial oppression on health, and the role of ethnicity as identity, which is in part a product of agency, have been ignored. We set out to redress this balance using data from the Fourth National Survey of Ethnic Minorities. Factor analysis suggested that dimensions of ethnic identity were consistent across the various ethnic minority groups. Initially some of these dimensions of ethnic identity appeared to be related to health, but in a multivariate model the factor relating to a racialised identity was the only one that exhibited any relationship with health. These findings suggest that ethnic identity is not related to health. Rather, the multivariate analyses presented here showed strong independent relationships between health and experiences of racism, perceived racial discrimination and class.