International Journal of Drug Policy 10 (1999) 83–88

Commentary

Race, drugs and prevalence

At one level, the issue of the prevalence ofdrug use amongst the UK’s black and otherso-called ‘minority ethnic’1 communities isfairly straightforwardly responded to byputting the hypothetical question: is it possi-ble to conceive of a happy, healthy, goldencommunity, surrounded by a sea of drug useprevalence amongst the rest of the popula-tion, but remaining immune to it? Of courseit is not. Within the general trends in preva-lence in Britain, the UK’s visible minority

populations can be assumed to be as vulnera-ble to drug use as the rest of the population.This observation is based on knowledge andexperience of the field built up over a numberof years, and confirmed by research and eval-uation interviews carried out by the Race &Drugs Project with specialist drug servicesbased in the Greater London area2. Furtherconfirmation is provided by other availabledata, including data collected by probationservices according to which black and othervisible minority drug using offenders are dis-proportionately represented within the crimi-nal justice processes, compared to their whitecounterparts. So whether prevalence existswithin the visible minority populations is notthe problem. Indeed, even if these recordsabout drug use within visible minority popu-lations did not exist, what would still distin-guish such population groups from the rest ofthe population is where they live. Over 65%are concentrated in areas where only 10% ofthe white population live. These areas are ‘‘indecline with high unemployment, lack ofamenities, poor quality of en6ironment and

1 The use of terminology which would be acceptable to allthose concerned, and particularly those signified, continues tobe elusive. Perhaps there is no universally acceptable terminol-ogy. In the circumstances, it is more a question of avoidingterminology which is in itself racist or likely to cause offence,e.g. ‘ethnic minorities ’, ‘auslander ’, ‘allochton ’, ‘migrant ’ etc. Itis equally important to avoid terminology which is inaccurateor unclear, e.g. ‘Asian ’ for historical reasons has been used todenote people from the Indian subcontinent lumped together,and to the apparent exclusion of other people from Asia or ofAsian heritage living here, such as Chinese, Filipino,Malaysian and Vietnamese people; and also, for example‘black ’ as a generic term does not make clear who is to beexcluded or included—are Arab, Chinese, Iranian, Turkish,Vietnamese people, etc. to be excluded or included? For therest, what is important is to understand who are being referredto, i.e. those who, largely because of their physical characteris-tics, but also other features, are vulnerable to discrimination ofa racialist nature. For the purposes of this report, the term‘visible minority’ is used to describe population groups whichare of non-European heritage.

2 Race and Drugs Project, ‘Race–Drugs–Europe, Volume 1:City University (1997).

0955-3959/99/$ - see front matter © 1999 Elsevier Science B.V. All rights reserved.

PII: S 0955 -3959 (99 )00004 -3

Commentary / International Journal of Drug Policy 10 (1999) 83–8884

ser6ices, under-funded schools…and (where)exist the problems of policing ’’3. This factalone should alert us to assume a prevalenceof drug abuse and drug-related problemsamongst visible minority populations becausethese are areas also associated with problem-atic drug use. The real issue around ‘race’and prevalence only becomes problematic atthe level of statistical evidence. Why shouldthis be so?

On the one hand, there is the issue ofpublic health concern speaking in its clear,reassuring and pragmatic language: the im-perative at the heart of the British govern-ment’s various Advisory Council on theMisuse of Drugs reports attempting to reachthe ‘hidden population’ of drug users, in theinterests of the individual, of the community,and of society. Of course the reports did notexactly have visible minorities in mind whenthey used the term ‘hidden population’. Theymerely designated an undifferentiated popu-lation engaged in illicit activities and, there-fore, vulnerable to HIV and other infections.It is the multitude of voices of black profes-sionals working in the field which haveplaced the issue of ‘race’ and equality ofaccess to drug prevention, care and treatmentservices on the agenda of the day. On theother hand, as the report of the British gov-ernment’s Task Force4 points out, there is adearth of information about drug useamongst black populations. This is largelybecause in the drugs field as largely, thoughnot completely, elsewhere, one of the keyproblems is that of ‘ethnic monitoring’ andcounting, or rather the lack of it.

1. Ethnic monitoring

In case people have forgotten, any form of‘ethnic’ monitoring in the UK has tradition-ally encountered a great deal of anxiety andresistance amongst ‘minority ethnic’ popula-tion groups. For example, until the 1981 cen-sus there was very little co-operation fromblack people with being counted. The 1981and 1991 censuses were only more successful,relatively speaking, because the OPCS, to itscredit, went through strenuous consultationand pilot exercises before including ‘ethnic’questions in the census form. Nor should weoverlook the reasons for opposition to count-ing amongst black people. Historically, ‘eth-nic’ monitoring has been used against blackpeople and as part of the ‘numbers’ game byracists and others seeking to repatriate them.Such fears that this form of monitoring maybe used against black people need to be over-come if figures, such as those on drug preva-lence, are not going to remain ‘‘statistics,statistics and damn lies ’’.

Not only do fears need to be overcome butpositive reasons also given for ‘ethnic moni-toring’ of drug prevalence if the informationrequired is not to be skewed. Thus a numberof questions need to be clarified:1. Why is data on drug prevalence required?2. How is such data collected?3. By whom?4. What happens to it?

1.1. Why is data on the pre6alence of druguse needed?

The drugs phenomenon is multi-facetedand of global concern. Therefore, any dataon its prevalence is needed for a number ofreasons, mainly:� by the Department of Health and Na-

tional Health Service for purposes of plan-ning a public health response locally,regionally, and nationally;

3 Fraser, Dr. Peter D., ‘Report on Race Relations to Der-byshire County Council’, 1986.

4 ‘Task Force to Review Services for Drug Misusers: Reportof an Independent Review of Drug Treatment Services inEngland’, Department of Health, 1996.

Commentary / International Journal of Drug Policy 10 (1999) 83–88 85

� by the Home Office for purposes of pre-vention, enforcement and control;

� by research centres and institutes in orderto promote issues of concern and informpolicy making and planning.

1.2. How is such data collected, by whomand what happens to it?

We all know that data on drugs prevalenceis notoriously difficult to collect. Because ofthe illicit nature of the activity, nothing canbe said with any great degree of exactitude,and the data is always ‘soft’ and not ‘hard’fact. Criminologists and other sociologistshave, therefore, devised a formula for esti-mating the true extent of drug use whichmultiplies such information as has been col-lected. This information can come through anumber of sources. Importantly, through:� the Home Office Research and Statistics

Unit� the NHS data-base� research and epidemiology surveys� other agencies involved, though not cen-

trally, with drug related matters, e.g. theprobation service, the police, etc.A propos of ‘race’, the question then is why

the prevalence of drug use, amongst ‘minor-ity ethnic’ population groups, cannot be ex-tracted from such more general information?

The short answer to that question is that,until the 1990s, very little ‘race’ data wasavailable because ‘race’ indicators were notbuilt into processes of data collection5. Even

now what is available is patchy and uneven inquality. The most reliable such data is thatmade available by the Home Office6. Fromthe public health aspect, such data as is avail-able is of poorer and more dubious quality.One of the reasons for this is that the infor-mation on ‘ethnicity’ on data-base forms isnot compatibly and consistently collected7.

Hence it would be advisable not to respondto queries on drug prevalence data amongstparticular population groups in isolationfrom the context of general prevalence data.This does not, of course mean an oppositionto data collection on ‘race’ and drugs inprinciple. This is the position the Race &Drugs Project adopts in fielding inquiriesfrom researchers, the media and others.

On balance it is important to count so longas the reasons for doing so are understoodand explained. It can be said that, withoutcounting, imagined figures will still be thrownaround, as is already sometimes the case, andstereotypes of black drug users will highlightonly the negative aspects, demonising thosewho are already at the receiving end ofracism and social disadvantage. In this con-nection it is worth noting that some kinds of‘ethnic monitoring’ is already carried out bypolice and immigration authorities, not sim-ply in UK but also in other European Union(KU) member states8. Therefore, for health

6 For example: Leitner, M., Shapland, J. and Wiles, P.,Drug Usage and Drugs Prevention, Home Office (DPI), 1993;Ramsay, M., and Percy, J. ‘Drug Misuse Declared: Results ofthe 1994 British Crime Survey, Home Office; Mott, J andMirlees-Black C., ‘Self-Reported Drug Misuse in England andWales: Findings from the 1992 British Crime Survey, HomeOffice, 1995.

7 See Daniels, T., ‘Ethnic Monitoring and Drug Users’,Executive Summary No. 16, Centre for Research on Drugsand Health Behaviour. The author rightly questions the ap-propriateness of using the same macro categories as the OPCSfor local and regional data-bases.

8 See, for example, Happel, H-V., and Davies, N., ‘Accessfor All-Ethnic Minorities and European Drug Helpline Ser6ices:FESAT (1997).

5 On ‘race’, drug prevalence, incidence and patterns of druguse I have argued elsewhere that: ‘‘In a sense it would berelatively simple to collect such data and make it compatible.Drug research institutes and centres could build race indica-tors into their general work on prevalence. Similarly guidelineson ‘ethnic monitoring’ could be made available by the Depart-ment of Health to health authorities, hospitals, GPs, and toprevention, care and treatment centres.’’ (Race & Drugs Pro-ject Briefing for Members of the European Parliament and forthe European Commission, 15 February 1998).

Commentary / International Journal of Drug Policy 10 (1999) 83–8886

and social services authorities not to carryout ‘ethnic monitoring’ perpetuates racialstereotyping of visible minority drug users. Itis at the same time important to clarify thatthe relationship between data collection onprevalence and availability of services is not adirect relation. Service provision is linked tothe availability of financial resources anddata on prevalence may or may not be usedto set priorities. Purchasers rarely use ‘ethnic’data to set their priorities. Finally, it isequally important that the counting be evalu-ated and monitored. People can only becomemore cynical if, despite agreeing to beingcounted, they perceive no change in access toservices required. What is the point, as previ-ous commentators have pointed out9, of sim-ply collecting statistics for the sake of it?

1.3. Good practice example

An agency in the Netherlands regularlymonitors patterns and incidence of drug useamongst all population groups living locally.It does so through its outreach and street-work intelligence gathering. Thus, it was re-cently noted that some 200 people from aparticular visible minority population grouphad recently moved into the locality wherethe agency is based. The agency made theproactive assumption that drug use amongstthe newly arrived people may be on a parwith the average and acted accordingly toaccess them with prevention, care and treat-ment services. Of course this is not all there isto the matter, and cultural issues still remainto be evaluated: what happened when accesswas provided to drug users from this particu-lar population group? What were the socialattitudes around substance use within

families and amongst individuals in the par-ticular community in question? Were patternsof drug use similar to other clients from otherbackgrounds? To what extent, and what werethe significant differences requiring a cultur-ally sensitive approach? How were these spe-cific needs responded to? Was there anyclient-based evaluation carried out aroundsuch interventions? Are there any significantissues which arise, and to what extent canthese be generalised? These and other issuesare also important to mention, and they willhopefully be addressed in the near future10.For the present, it is important to note thatlogically ‘ethnic monitoring’, as a register ofequality of access, needs to come first.

1.4. Risk factors and effects of the use ofdrugs and dependency

In general the risk factors and effects canbe assumed to be the same as amongst therest of the population. Additionally, drugusers from visible minorities may be morelikely because of discriminatory stereotyping:� to be diverted towards the criminal justice

processes than health services;� to be diverted towards inappropriate psy-

chiatric care;� not to be in touch with prevention, care

and treatment services because they seesuch institutions as being for white people;

� to be ostracised from within their owncommunities and families and, therefore,more at risk in terms of health and socialcare;

10 The Race & Drugs Project is presently working with 10different European prevention, care and treatment institutionsfor drug users engaged in piloting race equality based changes.This programme of work is supported by the European Com-mission, and in principle also by the Department of Health. Areport will bepublished once the final evaluations have beencarried out.

9 For example, Dr Peter Fraser in his seminar on Race andEqual Opportunities Policies to the ‘Race, Culture and DrugsForum, SCODA, 1990.

Commentary / International Journal of Drug Policy 10 (1999) 83–88 87

� be marginalised by prevention and educa-tion practices and interventions;

� be stereotyped more as drug dealers andtraffickers;

� to deny that any drug use goes on withintheir own community for fear of beingfurther pathologised as a community11.

� to be under-reported with respect to gen-der issues.Patterns of drug use will vary according to

availability, peer group, social class and lo-cality among other things. In effect, the pat-terns need to be assumed to be very similar towhat is happening generally within the local-ity. Interventions based on this assumptionmay then be fine-tuned upwards or down-wards. As the Task Force Report12 recom-mends, it is the job of purchasers, inconsultation with local population groupsand their representatives, to access servicesfor them and reflect these in contracts. In thisconnection it is worth reminding people thatwhile the UK prides itself on having moreadvanced race relations legislation than otherEU countries, the Dutch Ministry of Healthhas leapfrogged over its British counterpartby building in contract compliance measuresfor drug service providers. There is no evi-dent reason why England should not followsuit.

2. Recommendations

If the needs of visible minorities are to beadequately met, the Anti-Drugs Strategy Co-ordinating team of the British governmentneeds to:� make the incorporation of issues of racial

and cultural diversity a matter of goodorganisational management by havingclear race equality objectives built into itsoverall strategy, including issues of ‘ethnicmonitoring’ at national regional and locallevels;

� encourage better preventative co-ordination;

� ensure that better prevalence intelligencesystems, sensitive to the needs of visibleminority populations, are created;

� issue guidance to lead purchasing bodieswithin Drug Action Teams, such as socialservices and health authorities, ensuringthat needs assessment amongst visible mi-nority populations is carried out and thatthese are contractually negotiated by rele-vant service providers. This is of coursethe minimum recommendation at the heartof the Task Force report.

Acknowledgements

The Race & Drugs project is a T3E/CityUniversity partnership project, promoting ex-change and peer training and disseminatinggood practice for professionals working inthe field of drug abuse. I am indebted toStephan Feuchtwang, John Marsden andMike Ashton for their helpful comments onthe original draft. I also wish to thankPhilippe Roux for raising an important issuewhen, during a subsequently held conference,some of the ideas contained in the draft wererepresented, albeit in a different context. The

11 Since it is axiomatic of public health and social welfareinterventions that, in order to avail oneself of public funds, itis necessary to pathologise oneself, visible minority popula-tions generally tend not to avail themselves of certain publicservices, such as drug abuse care and treatment services,because to do so may entail wearing the stigmata of both‘race’ and drug abuse. On self-pathologisation and access topublic funds, see, for example: Donzelot, J., ‘The Policing ofFamilies’; (1979), and Knowles, C., ‘Black Families and SocialServices’ in Cambridge, A X. and Feuchtwang, S., (eds.), ‘AntiRacist Strategies’, Avebury (1990)

12 Op. cit., p. 89. The Report is to be commended forspotting a lacuna in DoH and NHS thinking. It is a shamethat a government report which was published shortly before,‘Tackling Drugs Together ’ (HMSO 1994) omits an issue ofconcern to more than 4 million black and visible minoritycitizens in its strategic thinking.

Commentary / International Journal of Drug Policy 10 (1999) 83–8888

issue he raised was around the attitudes oftolerance or intolerance of substance use(including alcohol) amongst different cul-tures. In revising this paper, I have at-tempted to take this issue briefly intoaccount.

Kazim KhanDepartment of Sociology, City Uni6ersity,

Northampton Square, London ECIV OHB,UK

Tel.: +44-171-4778537;fax: +44-171-4778536

.