Ethnicity, Racism and 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 for health 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