S/L Sociology

Identify difference between ethnicity and race

Outline some health experience of minority ethnic groups

Consider specific health care needs of some ethnic groups

Consider the issue of racism and access to care and within health service

Race - biological characteristics such as skin colour, Other problems occur: tendency to stereotype individuals by colour and physical characteristics and no allowance made for individual variation

Also, this makes little allowance for traditions and culture and religious faith or belief systems

but these issues also raise questions about how groups are classified and by whom?: is there any relationship between race, racism and health-illness?

Is it a sharing of a common culture? Language? Religion? Customs and traditions? Or more than these?

How are these labels applied and by whom? Does ethnicity always mean a minority?

Is it only ‘others’ who belong to an ethnic group - we need to be mindful of political and cultural sensitivities

Ethnic groups have been and often remain the ‘other’ - an identifiable group or groups who may be blamed for problems within a society or community; who also carry the weight of undesirable moral, physical, social, cultural characteristics or conditions and may be stigmatised e.g. ‘dirtiness’/unclean-ness, diseases such as syphilis or AIDS, TB or leprosy, ‘immorality’ or ‘ignorance’

Have communities made up from waves of immigration and to some extent these are legally protected and socially assimilated. Depending on where you are in the UK for example the impression of the extent of ethnic diversity varies such as Tower Hamlets, Hackney or Southall will be very different from rural areas such as Devon, Cornwall or Scottish Highlands

Different groups have different needs e.g. Afro-Caribbean's have higher rates of sickle cell anaemia that White Europeans, but less rates of haemophilia

Most waves of immigration have settled in urban, inner city areas where poverty and deprivation and health/environment and social risks are already present.

Like other waves of immigration, Irish migration too is aligned with poorer housing, poverty and poor health as well as discrimination and prejudice.

Excluded groups tend to undertake more risky physical labour, low status and therefore higher levels of injury and occupational disease and ill health.

Poverty often means that health promotion strategies are difficult or not within traditional patterns of cultural activity.

Genetic/biological factors

Individual behaviour/cultural factors

Material/structural factors

Migration & racism

Inequalities in access to Health Care

Artefact

The ‘faulty genes' e.g. sickle cell; or Ty-Sachs in Jewish populations (1 in 250 of general population but 1 in 25 Jews). Adults may be healthy carriers but two carriers have 1 in 4 chance of passing to children who then have 3-4 year life span.

Biological explanations often underpin racist links between race, biology and illness.

Individual behaviour/cultural factors

Emphasis on individual responsibility but choices may be limited and vary among populations

Individual choice is affected by wealth and also education - how do people know what is healthy? Do these ‘healthy options conform to individual/cultural beliefs/religious practices?

When there is a choice why do some chose unhealthy option?

Culture is significant and affects individual choice. e.g. high use of ghee (butter) and fats has been linked to high rates of heart problems in Indians. However, in S.Asia vegetarian diets is very healthy. Indian women rarely smoke but both men and women chew tobacco and consume beetle nuts and there is a high incidence of throat and mouth cancer

There are similarities here to blaming the victim such as Edwina Currie’s condemnation of northerners for eating unhealthy food ‘too many chips!’

The social conditions and context that affect the health and life-chances of individuals such as poverty, bad housing, environmental conditions. Many people in ethnic communities experience these in addition to the other cultural implications of health and illness

Un/Employment is linked to health status and risk, ethnic minorities more likely to be unemployed or in low status high risk jobs where there may be more chance of accident or encountering hazardous substances or conditions

Housing is crucial! Ethnicity is linked with poor housing and therefore increased health risks. There are fewer home owners in the same social class than white home owners and more in social housing

Lissauer et al (1994) showed that 35% of people in B&B Local authority housing in Paddington were from black ethnic minorities - only 56% spoke English as their first language: their complaints include Lack of space (70%); Nowhere for children to play (68%) ; Isolation (58%); Noise (38%); Lack of privacy (32%)

People in such poor housing are more likely to be transient and experience frequent moves and caught in ‘the poverty trap’ where there is greater need for care and where they:

experience more illnesses and use hospital services

have difficulty in accessing health care because cannot register with a GP, and establishing and maintaining relationships with health carers or social networks

have a poor diet

How does migration affect health and illness, and does it affect the ‘host’ culture? Migration and racial discrimination may itself provide basis for ill-health and suffer victimisation, stress and personal injury, physical or emotional abuse

Cultural and racial stereotyping that may limit employment prospects and opportunities for choice

NHS and nursing itself has been identified as racist - .(RCN 1999) in the division of labour by race and gender

Exclusion by language

Different working patterns, such as Chinese working in catering industry, makes conventional GP surgeries difficult to use, so Chinese health centres established.

Black patients are twice as likely to be detained under the mental health act than whites,(why? When Black doctors are more likely to see Black patients) and to then experience higher levels of drug therapies

This suggests that social class is more important than ethnicity in explaining inequalities, since the ethnic minority is likely to be poorer. However this has a problem because it tends to aggregate a number of other variables such as gender - patterns are produced because of the way the researcher gathered the data!

Perhaps there is more than one explanation! - SEE Senior & Viveash p178ff concerning differences perinatal mortality rates between Pakistani and Bangladeshi populations in UK.

Ethnicity is a key element in the relationship between health and the individual

Cultural factors are significant but must also include reference to the wider social context where there may be conflicting interests and values

Ethnicity must be considered in relation to other structural factors such as housing, poverty and inequalities

How may racism affect access and quality of health care?