Racism and the production of ethnic inequalities in health Saffron Karlsen s.karlsen@ucl.ac.uk Department of Epidemiology and Public Health, UCL (University College, London)

What is racism and how might it impact on health What is racism and how might it impact on health? The Fourth National Survey of Ethnic Minorities (Modood et al 1997)

What is racism and how might it impact on health What is racism and how might it impact on health? The Fourth National Survey of Ethnic Minorities (Modood et al 1997) Pathways between racism and health using EMPIRIC (Sproston and Nazroo 2002)

What is racism and how might it impact on health What is racism and how might it impact on health? The Fourth National Survey of Ethnic Minorities (Modood et al 1997) Pathways between racism and health using EMPIRIC (Sproston and Nazroo 2002) Measurement issues

What is racism and how might it impact on health What is racism and how might it impact on health? The Fourth National Survey of Ethnic Minorities (Modood et al 1997) Pathways between racism and health using EMPIRIC (Sproston and Nazroo 2002) Measurement issues Responses to racism

Racism: evidence of social and economic disadvantage Classification of social groups as ‘different’ and ‘problematic’ ‘The distinguishing feature of racial violence and harassment is not simply that it involves members of different racial groups or ethnic groups; it is that the action is racially motivated…Racially-motivated behaviour, therefore, is not an attack aimed at a person purely as an individual, but an attack on a member of a category or group.’ Oakley (1992) ‘It wasn’t me, it was my colour’ (BM14) Negative interactions with individuals and institutions Social, health and economic disadvantage

Relationship between experiences of interpersonal racism and self-assessed fair or poor health (Karlsen and Nazroo 2002) controlled for age, gender and household occupational class

Relationship between experiences and perceptions of racism and self-assessed fair or poor health (Karlsen and Nazroo 2002) controlled for age, gender and household occupational class

Relationship between experiences and perceptions of racism, household occupational class and self-assessed fair or poor health (Karlsen and Nazroo 2002) controlled for age and gender

Relationship between concerns about racism and self-assessed fair or poor health (Karlsen and Nazroo 2004) controlled for age, gender and household occupational class

Relationship between concerns about, experiences and perceptions of racism, household social class and self-assessed fair or poor health (Karlsen and Nazroo 2002, 2004)

Qualitative findings ‘expected’, ‘happens all the time’. ‘part of growing up’ ‘everyone experiences it’ ‘got used to it’ ‘learn to accept it’, ‘cope’. ‘How long have Black people been in this country and you’re still going on with this crap, I should be just as frightened of you bouncing into me and nicking my wallet with my money in it…I’ve got credit cards like you, I’ve got money in my wallet…I haven’t got a prison record. I’ve never wanted to do anybody no harm…but this is what people put on us, this stigma’ (BM14) ‘there are people who [don't] even consider you to be a human being if you're not white’ (LA66)

Responses ‘Imagine you are alone in the street. I can hear that they are verbally abusing me but can't do anything. Late at night, will you fight with them? There is no question of shouting at them. You have to adjust. You have to behave in such a way that you don't know anything or you haven't heard anything. Just avoid and walk away...if you say anything at that moment, that means you are in trouble. That we all understand.' (LN50)

‘Covert’ or ‘hidden’ racism 'from the time I moved to North London...honestly, I can't remember feeling particularly threatened either by physical or verbal abuse. It has happened occasionally but it's just not something that I notice...I find it very hard to put a finger on anything definite. I mean anything that I'd notice would be kind of hidden, you know, people just being a bit awkward, a little bit funny with you, so you kind of suspect they're just being like that, but it's not like I've had threatening abuse of any sort or somebody shouting out stuff.’ (LN117) '...the thing about institutional racism, statistically after a while you can't explain away these things just on individual explanations [you] speak to other people … and they've had the same kind of experience.' (LN117)

Discrimination and health Racism can be recognised through direct and indirect interpersonal experiences and the discriminatory policies of institutions It operates to affect health through personal injury, psychological damage and socioeconomic disadvantage Measurement issues related to people’s ability and willingness to recognise and report the racist motivations of perpetrators

Karlsen S, Nazroo JY. (2002) The relationship between racial discrimination, social class and health among ethnic minority groups. American Journal of Public Health 92(4): 624-31. Karlsen S, Nazroo JY (2004) ‘Fear of racism and health’ Journal of Epidemiology and Community Health 58(12): 1017-1018.