Ethnicity, Racismand Health

Week 20Sociology 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 reportspoor health

Age standardised Reported rates of‘not good’ healthApril 2001

England & Wales National Statistics online

Rates of long-term illness

• Pakistani and Bangladeshi

higher levels of illness and disabilityAge standardised rates

long-term illnessor disability whichrestricts daily activitiesApril 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 heathshould 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