Ethnicity, Racism and Health

Ethnicity, Racismand Health Week 20 Sociology of Health and Illness

Recap • Thought about how health and illness are structured by society • Considered the ‘sick role’, medicalisation, surveillance medicine and ‘lay’ understandings of health • Considered different explanations about the relationship between social class and gender and health

Outline • Consider the evidence for an association between ethnicity and health • Look at completing explanations • Biological • Social • Racism

Ethnicity and health • Statistical evidence shows an association between minority-ethnic groups and poor health • Biomedical statistics are not very sensitive to the complexity of ethnicity • Some evidence that different minority-groups do significantly worse than others

Reporting of general health • Pakistani and Bangladeshi higher reports poor health Age standardised Reported rates of ‘not good’ health April 2001 England & Wales National Statistics online

Rates of long-term illness • Pakistani and Bangladeshi higher levels of illness and disability Age standardised rates long-term illness or disability which restricts daily activities April 2001, England & Wales National Statistics online

Why do you think certain minority-ethnic groups have worse health than: • The white population • Other minority-ethnic groups

Explanations forhealth inequalities • Like the debates around social class and gender, the association between ethnicity and health have competing explanations • Ideological frameworks often influence their construction • We can group them into the same three categories: Biological, Social, Structural

Biological Explanations • Biological explanations focus on genetic and physiological differences: • Different ethnic groups have different risks for different illnesses • Some Asian groups higher risk for diabetes and CHD • Some genetic disorders more common such as Sickle Cell and Thalassaemia

Biological Explanations • Although genetic and physiological differences play a role they cannot fully explain the health differences • Biological factors may make people susceptible but health and illness always mediated by social and economic circumstances

Social Explanations • Similar list in some ways to that of gender • Artefact • Social-class • Migration • Lifestyles

Artefact • The first reason suggested is artefact • Statistical differences due to processes in data collection and measurement • ‘Race’ and ethnicity are difficult to measure, but most now accept this cannot be the whole reason

Social-class • People from minority-ethnic groups more likely to be working-class • Not ethnicity itself but material circumstances • Some studies concentrate on class others on ethnicity, few look at both

Do you think that social class is more important in explaining the health inequalities of minority-ethnic groups?

Migration • Two theories have been put forward in terms of migration and health: • Mostly the healthy migrate, so heath should be better than home (and host) population • Migration is stressful and associated with downwards mobility, so health will be worse

Lifestyles • Just like social class, explanations often focus on ‘lifestyles’ • Focus on factors such as: • Diet • Lack of exercise • Smoking rates • Religious beliefs and behaviour

To what extend do you think that cultural beliefs and behaviours can explain health inequalities?

Is it racism? • Many argue that a better explanation for health inequalities is racism: • Institutional racism in the health care system • Impact of everyday racism in society

Institutional racism? • People from minority-ethnic groups have disproportionate access to healthcare services • Conditions associated with minority-groups are not properly resourced • Racist stereotyping leads to different treatments and outcomes

Institutional racism? • The Acheson Report (1998) found that although use of primary-care was similar • Minority-ethnic groups are more likely to: • find physical access difficult • have longer waiting times • feel the appointment was inadequate • Referrals to secondary care less likely

Institutional racism? • Sickle-cell and Thalassaemia are both Haemoglobinopathies (inherited blood disorders) • Sickle cell trait carried by 1/10 African-Caribbeans • Thalassaemia trait carried by 1/20 South Asians • If both parents are carriers, ¼ children will have the condition • Rare conditions in white families • Yet national screening programme only began to be rolled out in 2004

Impact of Racism • Modood argues that racism has health implications • One in 8 minority-ethnic people experience racial harassment in a year • 25% of minority-ethnic people say they are fearful of racial harassment • Repeated racial harassment is a common experience

To what extent to you think racism can account for health inequalities?

The case of Rickets • In 1960s Asian children were increasingly diagnosed with Rickets • Explanations included: • Asian diet • Asian clothes • Failure of Asian women to follow antenatal advice • Solutions proposed trying to change behaviour

The case of Rickets • Yet Rickets was common in white working-class children prior to WW2 • Linked to poverty • The solutions included free school milk and the fortification of basic foodstuffs with vitamin D • At risk group were not blamed nor required to change their behaviour

Summary • Considered the evidence outlining an association between ethnicity and health • Looked competing biological and social explanations • Considered the impact of racism on health

Next week • Look at chronic illness and disability • Consider to what extent illness is a ‘biographical disruption’ • Look at the social model of disability

Ethnicity, Racism and Health