Addressing Ethnic Disparities in Health and Well-being

Introduction

The policy makers are concerned with addressing or correcting imbalances that impact directly on ethnic minorities’ well-being, such as socioeconomic, health, housing, education, lifestyle and discriminatory factors. Aggleton (1990, p.5 as cited in Baggott, 2004) posited that health can be defined in two ways; ‘‘the positive approach, where health is viewed as a capacity or an asset, and the negative approach, which emphasises the absence of specific illnesses, diseases and disorders’’. Similarly the World Health Organisation (1946 as cited in Baggott, 2004) defined health as ‘‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’’. This definition is significant in that it highlights physical as well as mental aspects of health while emphasising the ‘positive sense’ as in Aggleton’s definition of health. According to Giddens (2009, p.633) ‘‘ethnicity refers to the cultural practices and outlooks of a given community of people which sets them apart from others’’. Ethnic groups have different traits that set them apart from other groups, such as religion, dress style, language, and history. However, ethnic differences are learned to an extent there have been associations made with health for most of these minority groups. While there is nothing innate about ethnicity, it is central to group and individual identity and similarly important to the health professions who suggest there is a relationship between health and ethnicity. Giddens (2009) argues that this relationship is partial at best but concedes that there is a rather high incidence of illnesses among individuals or groups of ethnic origins. This essay will critically examine and explain the relationship between ethnicity and health.

In Britain as the 21st century progresses, its population composition of ethnic minorities is rapidly changing, despite Queen Elizabeth the 1st’s proclamation in 1601 that ‘negroes and blackamoors’ should be deported. She believed they were responsible in part for the social and economic dilemmas, such as famine and poverty (Haralambos & Holborn, 2000, p.199). In contemporary Britain this contentious issue has continued amongst a mass population about what they believe to be ‘Britishness’ when it comes to ethnic minorities. According to Stillwell & Van Ham, (2010) some see it as a disaster, which will lead to spatial segregation, communities breaking down and a burden to the health delivery system. Perhaps this could be explain why extreme right-wing parties such as the British National Party, which contests immigration and blames all social predicaments on ethnic minorities continues to attract support. While others will argue that this will be good in terms of diversity and see it as an opportunity for an integrated society (Stillwell & Van Ham, 2010).

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There are various ways in which health and ethnicity are related. For example there are differences in population structures, education, genetics, generational and socioeconomic factors between different ethnic groups that impact differently on their health (Bardsley, Hamm, Lowdell, Morgan & Storkey, 2000). Prevalence of health related behaviours such as diabetes or cardiovascular disease to mention a few can be distinctively different for different ethnic groups, which indicates an association between ethnicity and health. However, Karlsen, (2004) posits that indicators or factors employed to investigate the relationship between ethnicity and health are likely to fail accounting for the central facets of ethnic minorities’ experiences which could influence health, especially the impact of socio-economic disadvantage, housing, poor health services, harassment and discrimination. As already mentioned above factors such as discrimination, socioeconomic, housing, education and the accessibility of health services have a direct impact and possible relationship between health and ethnicity.

In the UK alone, research indicates that at least one in eight from the ethnic minority group experiences some form of racial harassment each year. While two fifths believe that half of the British employers would decline to offer someone a job on the basis of their ethnicity. Ethnic minorities have been shown to experience repeated health and socioeconomic disadvantages than the majority ethnic group. This has a direct impact on the mental health of ethnic minority individuals who experiences such. In a study using data from the Health survey for England, (1999) plus a follow up study, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) to explore relationships between interpersonal racism experienced, discrimination as perceived in wider society, occupational class and various indicators of physical and mental health for the diverse ethnic groups in England including minority and majority white groups. The results indicated that there were significant independent relationships found between each of the factors explored and health. Hence, from these results current assessments were urged to take into account the different forms of structural disadvantages experienced by ethnic minorities and the diverse ways in which racial expressions can impact on health (Kalsen, 2004).

However, there are a number of important but varied factors bearing on the health of ethnic groups and the overall population, which Stubbs (1993) argued that to understand these health patterns of ethnic groups there has to be a comparison with the host group (majority ethnic group). For instance, demographic, housing, lifestyle, socioeconomic and health service factors have a direct impact on the health of individuals (Baggott, 2004). Bannister (1901 as cited in Haralambos & Holborn, 2000) argued that an individual’s ethnic background contributes to whether or not they are at a decreased or increased risk of developing a certain disease (s). For instance, he was very critical of Jews and their lifestyle describing them as ‘‘Yiddish money pigs’’ who did not like taking baths hence, were prone to blood and skin diseases. Conversely, it is opined that Bannister in this instance was expressing his hostile feelings towards this particular ethnic minority group instead of advancing an evidence based argument for the association(s) of certain diseases and ethnicity. African-Caribbean and South Asians are more prone to developing diabetes than white Europeans. However, African-Caribbeans are far less likely to suffer from coronary heart disease than white Europeans which is more prevalent within the South Asians (Harding & Maxwell, 1997; Nazroo, 1998).

Suffice to say access to high quality health services is vital in sustaining a state of total physical, mental and social well being. According to Bunker, Frazier, and Mosteller (1994 as cited in Baggott, 2004), preventative measures such as screening, immunisation and medicine add at least 18-19 months to an individual’s life expectancy. A similar effect is also found when curative medicines are taken increasing the life expectancy by between 44-45 months. Generally this has not really happened with the ethnic groups as there are factors like discrimination and language barriers that impinge on the accessibility of health care. The social context in which ethnic minorities live and experience presents various challenges and disadvantages that will directly impact on their health negatively (Giddens, 2009). Pickett and Wilkinson (2008), argued that one’s health could be determined by the neighbourhood in which one lives, for example if a minority low status individual lives in a higher quotient vicinity of their own racial or ethnic group then their health is likely to be better than those that live in lower quotient vicinities, this is referred to as the ‘group density effect’. Conversely, Smaje (1995) posits that concentration of ethnic minorities into poor vicinities has an independent and direct bearing on their health.

Social structures for ethnic patterning in health show that African-Caribbean and Asians are more disadvantaged (Baggott, 2004). Harding and Maxwell’s (1997) study of the health of ethnics suggested that Indian, Pakistani and Bangladesh have a particularly high rate of diabetes and ischemic heart disease in comparison to other ethnic groups. This could be attributed to poor or overcrowded housing facilities amongst other factors already mentioned briefly above. Nazroo, (1998) from the findings of his study on the health of ethnic minorities agrees that Pakistani and Bangladeshi ethnic minorities experience high morbidity in comparison to other ethnic minority groups. He also found out that African Caribbean men had a lower mortality rate due to coronary heart disease, but were more prone to dying of a stroke compared to their counterparts including the majority ethnic group population. African-Caribbean and Asians ethnic groups do tend to record higher rates of hypertension, diabetes and are three times more liable to having renal replacement therapy compared to the ethnic majority population (Raleigh, 1997). The health of ethnic minorities as mentioned above can be negatively affected by socioeconomic factors such as, employment and employment conditions. The majority of ethnic minority groups work in hazardous occupations, receive poor remuneration with diminished prospects for career progression. Their employment relationships are akin to the bourgeoisie and proletariat relationship.

Bartley, Lynch, Sacker and Dodgeon (1998) suggest that the above findings of poor employment conditions and remuneration highlight the relationship between work conditions and high morbidity and mortality in ethnic minorities. Conversely, unemployment has an association poor health in that it cultivates financial hardship, stress, poor diet and living conditions. Factors such as socioeconomic disadvantages, poor housing, discrimination and poor health services create a knock on effect in one’s life cycle, ultimately exposing individuals to a host of disease and illnesses through a lack of equal opportunities. This leads to, anxiety, hypertension, depression and social isolation loss of one’s self esteem and purpose in life, which may result in the development of physical and mental health problems (Bartley, 1994 as cited in Naidoo & Willis, 2000).

However, Hull (1979) suggested that there is a correlation between migration and health. He attributed this to factors such as nature of symptoms and language barrier hindering ethnic minorities from accessing the right treatments because of the existing contextual cultural differences. Furnham and Bochner (1986) argue that if the host group does not offer any social support, and discrimination is displayed within vital institutions such as work environment, health, judiciary, and welfare. It creates more social stress resulting in mental illnesses for the migrating ethnic minorities. In addition Smaje (1995) links discrimination stressors to the psychological well-being as he suggests that racism has a bearing on differences in health between minority ethnic groups and the majority ethnic population.

According to Pilgrim and Rogers (1999) black ethnic minority groups have a relatively short life expectancy and often have the worst health amongst ethnic minorities. In addition to that they posit that black ethnic minorities who experience mental health issues are likely to be discriminated against, often being depicted as an added threat or risk compared to the majority ethnic group. The Ethnicity and Health Report (2007) suggested that ethnic minorities have a higher probability rate of being confined in psychiatry through the criminal justice system unlike through diagnosis from the health system compared to the host group, especially Afro-Caribbean and Black Africans. Giddens (2009) supports the above statement by positing that indeed ethnic minorities mostly afro-Caribbean and black Africans are more likely to be stopped by law enforcers than their white counterparts. This form of institutionalised racism by law enforcement agents and the whole criminal justice system has significant negative effects on minority groups’ psychological well being. Smith, Kelly and Nazroo, (2008) posited that racial discrimination, socioeconomic factors and policies that do not allow for equal opportunities and generally improve their existence within a host group could lead to a lasting effect on their mental and emotional health. In addition, injustice within the vital systems that provide help, health, work, and education further corrode ethnic minorities’ dilemma in terms of their physical and mental health (Smaje 1995).

Evidence provided from the Ethnicity and Health Report, (2007) indicating the disparities in mental health between ethnic minorities and the host group is to some extent contentious, given that a cosmic amount of data employed is based on treatment rates. Consequently, this research indicated that ethnic minorities, particularly Afro-Caribbean people have higher rates of psychosis which is seven times more compared to the host group. Kalsen, Nazroo, Mckenzie, Bhui & Weich (2005) from their research in the UK, on racism and mental health in ethnic minorities found that there was a significant relationship between racial discrimination and psychological well being. Indication from the results suggested there was a recurrence rate of psychosis annually of six per thousand for Bangladeshi people, ten per thousand for Indians, thirteen per thousand for Pakistani people, while they was sixteen per thousand for Afro-Caribbean people (Nazroo & King, 2002 as cited in Kalsen et al., 2005). Nazroo (1998) from his studies posits that ethnic minorities’ mental health is worse than that of the host group. His findings were based on comparisons of the rates of reported suicide and para-suicide cases. Furthermore, Afro-Caribbeans are much more likely to be diagnosed as schizophrenics than their white counterparts (Smarje, 1995).

Evidence reviewed in this essay has shown that there is a relationship between ethnicity and health (Kalsen, 2004). However, some of the evidence is contentious in that treatment rates were used to make a general assumption on ethnic minorities’ health (Ethnicity and Health Report, 2007). Evidence also suggests that indicators such as low-economic statuses, migration, and discrimination, poor access to health services, local area deprivation and high unemployment have a direct bearing on ethnic minorities and their health. It could be argued that the determinants of health vary between ethnic groups as a result of differences in genetic and socioeconomic factors which cannot be generalised across all ethnic groups. The evidence reviewed demonstrates differences in health across ethnic groups. These findings are important indicators of the need for investment programmes that are specifically targeted at improving the quality and quantity of health and other related services for ethnic minority groups. Future policies need to move away from a capitalist approach were ethnic minorities are exploited for their services with little reward and improvement of their social being. There should be a balance of socio-economic factors in-order to stimulate change and shape policies that improve accessing of quality health and related services such as education. They are fundamental to the health of both ethnic minorities and ethnic majority in modern day Britain.

References

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