INEQUALITIES IN HEALTH 2: ETHNICITY

G672

Recap: Whiteboards

What do we mean by ‘ethnicity’?

How does this differ from race and nationality?

Race, Ethnicity & Nationality

Concept Meaning

Race Biological differences, linked to phenotypes (physical characteristics) and genotypes (underlying genetic differences).

Ethnicity Groups within society that share things like culture, traditions, language, religion, race, ancestry etc.

Nationality A sense of ‘belonging’ to a particular nation through origin, birth or naturalisation.

Q: Which Sociologist described the different features of ethnicity?

Ethnicity(Modood;

2005)

Culture

Descent &Geographical

Origin

Sense of Identity

Language

Clothes, religious values, food,

tradition

Definitions Check: Whiteboards (define min. 3)

MULTICULTURALISM

SUPERDIVERSITY

CULTURAL DIVERSITY

HYBRIDITY

ETHNIC MINORITY

CODE SWITCHING

Race or Ethnicity?

Race is often regarded as an outdated concept and sociologists prefer the broader concept of ethnicity...

However, some argue that race is a better term for explaining the position of ethnicities at the bottom of the social stratification system – because sociologists like Miles (1989) have identified racism as the main cause...

Whiteboards: Which are the main ethnic groups in Britain?

Ethnic Groups: England & Wales

Q: Which groups are not represented above?Q: Why does this differ from the usual ‘official’ figure of 9% ethnic minority groups in the UK?

Difficulties in studying Ethnicity/Health

In Pairs:

What extraneous factors might complicate these studies? Identify at least three factors.

Look at Modood’s definition of ethnicity: Why might it be difficult to use the concept of ‘ethnicity’ in studying health?

Difficulties in studying Ethnicity/Health

Extraneous Factors:

Does ethnicity matter more than income, occupation, gender, age, class, birthplace etc. in measuring health?

Difficulties in studying Ethnicity/Health

Operationalising Ethnicity:

Researchers wanting to measure ethnicity will need to operationalise (make measurable) the concept.

Different researchers may operationalise the concept differently, making results and studies difficult to compare.

Difficulties in studying Ethnicity/Health

Extraneous Factors: What does this table show – and what does it suggest about difficulties in studying ethnicity/health?Group Under 15

(%)16-44 (%) 45-64 (%) 65-74 (%) 75+ (%)

White 19 42 22 9 7

Black, Caribbean

22 48 25 4 1

Black, African

29 59 10 1 0

Pakistani 43 43 12 1 0

Bangladeshi

47 38 14 1 0

Chinese 23 59 12 2 1

Ethnic differences in Health Most minority groups have higher mortality

rates. Most ethnic groups have higher rates of still-

birth and infant mortality Africans and Afro-Caribbeans are 50% more

likely to die of stroke Asians 50% more likely to die of heart disease Most ethnic groups have lower rates of cancer Afro Caribbeans are 7 times more likely to be

diagnosed as psychotic

Age-standardised “not good” health rates (2001) – based on self-reporting.

Consider the different types of explanation. For each, decide on at least two explanations as to why some ethnic minorities experience lower life expectancy and higher rates of illness:

ARTEFACTBIOLOGICAL

CULTURAL/BEHAVIOURALSTRUCTURAL/MATERIAL

MIGRATION/RACISM

In Pairs

Genetic/Biological Factors

Genetic/Biological Factors

Some disorders have clear genetic causes e.g. Tay Sachs disease among the Jewish population; sickle-cell anaemia among Afro-Caribbeans.

http://www.nhs.uk/conditions/tay-sachs-disease/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Sickle-cell-anaemia/Pages/Introduction.aspx

Genetic/Biological Factors However, this explanation only works for

a few such disorders.

Zubin & Spring (1977) pointed out that some people are genetically vulnerable to schizophrenia but it is mainly down to lifestyle that decides if or how symptoms ever appear.

Individual/Behavioural Factors

Individual Behaviour

As individuals, we make choices about how to behave...

...Therefore, it is up to us whether we make the right or wrong decisions regarding our health. “The real cause of

poor health among Northerners is their choice of diet. People should look after themselves better.” – Edwina Currie, 1986

Individual Behaviour (Things YOU do/avoid): Copy & Complete

Activity High or low risk to health?

Why a risk?

Short-term or long-term risk?

Why do you do/avoid the activity?

Individual Behaviour: Table

Are your choices/decisions similar to those of others?

How closely are your choices/decisions linked to your ideas about health risks (e.g. Do you always avoid things with long-term risks?)

Identify at least five healthy activities.

Individual Behaviour

There is some argument that certain ethnic groups are more likely to make healthy lifestyle choices than others (e.g. Choice of diet).

http://www.youtube.com/watch?v=x3D3geTEIco

However, this view is debatable: Many of these ‘choices’ might be more closely linked to cultural beliefs (e.g. Particular foods might be eaten/avoided for religious reasons, not as a lifestyle choice).

What does the graph suggest about individual behaviour and ethnicity? What problems might there be with this data?

Cultural Factors

Cultural Explanations

To what extent does the way of life of different ethnic groups affect their chances of getting ill?

In terms of smoking rates, you cannot make generalisations about ethnicity. It is vital to take into account social class, regional or religious variations.

Cultural Explanations

To what extent does the way of life of different ethnic groups affect their chances of getting ill?

‘Asians’ (statistically) experience high levels of heart disease. This has been linked to their use of fats like ghee in cooking......But many ‘Asians’ (e.g. Those from South India) traditionally eat very healthy, vegetarian diets...

...So statistics that describe ‘Asians’ as a single group are flawed – as are such assumptions about ethnic groups.

Cultural Explanations

To what extent does the way of life of different ethnic groups affect their chances of getting ill?

Many cultural factors actually favour the health of ethnic minorities.For example, as we’ve seen, Bangladeshi women have the lowest smoking rates of any group.Mortality rates from lung cancer and chronic bronchitis are extremely low in people from the Indian sub-continent.

Cultural Explanations

Complete the evaluation of cultural explanations by filling in the

missing words on your worksheets.

Beneath this, in a couple of sentences, summarise the meaning

in your own words.

Material/Structural Factors

Material/Structural Explanations

Key Question: To what extent do people’s material surroundings/living conditions and position in the social structure explain their ill-health?

Are some ethnic groups materially better off than others?

Labour Force Survey (1998-2000)

41% of white men in the highest two social class groups, compared to:

47% of Indian men 44% of Chinese men 33% of black men 31% of Pakistani men 23% of Bagladeshi men and…

Labour Force Survey (1998-2000)

41% of Chinese women 34% of white women 34% of black women 33% of Indian women 29% of Pakistani/Bangladeshi women

Material/Structural Explanation #1: Unemployment

Unemployment: Place in order of likelihood of being jobless:

Material/Structural Explanation #2: Type of Work

Amin (1992) claimed that some ethnic minorities are concentrated in more hazardous work – therefore suffer more accidents/work related illnesses.

Material/Structural Explanation #3: Housing & Homelessness

A survey of homeless households (placed in B&B accommodation) found that:

1. The majority were of ethnic minority background

2. The majority of the adults were between 16-34

3. Only 56% spoke English as a first language

Material/Structural Explanation #3: Housing & Homelessness

Lissauer et al (1994) examined complaints made by this group, many of which have potential risks to health and wellbeing:

Nature of complaint How many complained

Lack of space 70%

Nowhere for children to play 68%

Isolation 58%

Noise 38%

Lack of privacy 32%

Material/Structural Explanation #3: Housing & Homelessness

People in this situation experience: Having to relocate regularly... ...Therefore difficulty registering with a

GP Increased likelihood of using hospital

emergency services Higher rates of depression Higher rates of mild childhood illnesses

Evaluation: Whiteboards

For the following statements, you need to decide which is a strength and which is a weakness of material/structural explanations.

Write S or W on your whiteboards...

Strength or Weakness?

The material explanation is supporting by a variety of evidence

that shows ethnic groups suffer higher rates of unemployment and

deprivation.

Strength or Weakness?

The material explanation often treats ethnic minorities as one

homogenous group rather than exploring differences between them

Strength or Weakness?

The material explanation does not consider the relationship between

lifestyle and material circumstances

Strength or Weakness?

The material explanation doesn’t consider the relationship between

gender, age and region with material circumstances

Strength or Weakness?

The material explanation does not ‘blame’ victims for their illnesses

Strength or Weakness?

Material factors are useful in explaining some illnesses (e.g.

Depression) but not all illnesses

Migration & Racism

Migration & Racism

Brown (1994) states that racial discrimination and harassment may have an adverse effect on health (e.g. for stress, personal injury).

Asians are 50 x more likely than white people to suffer racial victimisation...

Black people are 36 x more likely...

Artefact Explanations

Artefact Explanations

‘Evidence’ linking ethnicity to illness and death can be misleading.

Material/structural factors like unemployment are probably more significant overall...

...Plus there are many additional variables to be taken into account e.g. Gender, age, region...

Homework

Outline and evaluate the view that genetic/biological factors cause

some ethnic minorities to experience more ill health than

others [33]

Due: Next Lesson

Ethnicity & Mental Illness

Ethnicity & Mental IllnessNazroo (1997) African-Caribbean people are more likely

to suffer depression but less likely to suffer anxiety. They are also over-represented in treatment for psychotic disorders.

People of South Asian origin have the lowest rates of depression.

Ethnicity & Mental Illness Black adolescents (especially those born

outside of the UK)are over-represented in mental health services (Tolmac & Holmes; 2005).

People of African-Caribbean origin are most likely to be referred to mental health services via the police, courts or prisons (Rogers & Pilgrim; 2005).

Explanations

If you get a question on ethnicity and mental health in the exam, you

should use the same CULTURAL AND MATERIAL EXPLANATIONS as those that explain general ethnic health

inequalities.