Download - Ethnicity, Racism and Health
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Ethnicity, Racismand Health
Week 20Sociology of Health and Illness
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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
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Outline
• Consider the evidence for an association between ethnicity and health
• Look at completing explanations– Biological– Social– Racism
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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
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Reporting of general health
• Pakistani and Bangladeshi higher reportspoor health
Age standardised Reported rates of‘not good’ healthApril 2001
England & Wales National Statistics online
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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
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• Why do you think certain minority-ethnic groups have worse health than:
– The white population– Other minority-ethnic groups
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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
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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
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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
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Social Explanations
• Similar list in some ways to that of gender
– Artefact– Social-class– Migration– Lifestyles
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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
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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
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• Do you think that social class is more important in explaining the health inequalities of minority-ethnic groups?
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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
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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
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• To what extend do you think that cultural beliefs and behaviours can explain health inequalities?
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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
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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
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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
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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
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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
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• To what extent to you think racism can account for health inequalities?
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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
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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
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Summary
• Considered the evidence outlining an association between ethnicity and health
• Looked competing biological and social explanations
• Considered the impact of racism on health
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Next week
• Look at chronic illness and disability
• Consider to what extent illness is a ‘biographical disruption’
• Look at the social model of disability