Ethnicity Culture and Health

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Information about Ethnicity Culture and Health
Education

Published on March 27, 2008

Author: liamgr

Source: authorstream.com

Lecture 7/8:  Lecture 7/8 Ethnicity Culture and Health Ethnicity Culture and Health:  Ethnicity Culture and Health Race Culture and Ethnicity Racism, racialisation and health Ethnic Differences and Inequalities Cultural competence in service provision The ‘Black’ politics of health Race: A dangerous concept:  Race: A dangerous concept Particular caution must be employed when using the race concept in health-related research. Some have argued that the concept should be abandoned, based on the overwhelming scientific evidence that human races do not exist. Others argue for retaining the term, but limiting its application to the social, as opposed to the biological, realm. The problem of ‘race’:  The problem of ‘race’ Historically, race, genetics, and disease have been inextricably linked, producing a calculus of risk that implicates race with relative health status. Racialized groups have been associated with particular diseases and their spread. Sometimes these associations are accurate and sometimes they reflect underlying social prejudice Racial Ideology:  Racial Ideology Race-based etiological theories may become hegemonic, effectively eliminating explanations of illness that take account of environmental or behavioural factors associated with social class, racism, discrimination or culture Contended that race should not be considered a valid biological classification: The "racial" worldview was invented to assign some groups to perpetual low status, while others were permitted access to privilege, power, and wealth. The use of race:  The use of race Race continues to be used erroneously, even harmfully, as a scientific variable, particularly in biomedical research designed to explain health behaviour. From 1910 to 1990, race was used in 64% of articles appearing in the American Journal of Epidemiology. A review of biomedical literature claiming links between race and disease reveals that researchers rarely describe their racial and ethnic measurement or classification methods. Lack of precision conflating biology and culture makes it impossible to tease out the causes of health disparities between economically disadvantaged racialized populations and more privileged groups Ambiguity & Inaccuracy:  Ambiguity & Inaccuracy Fundamental ambiguity in the concept of race obscures the role that genetic variation plays in our current understanding of disease. Socially defined notions of race are treated as legitimate biological variables; race itself is often used as a proxy for disease risk. Epidemiological studies employ race as shorthand for social and environmental factors that are associated with particular racialized groups. When treated in this way, race is understood to have some contributory effect to particular conditions and diseases, but in a very imprecise way The (mis-)use of racial concepts:  The (mis-)use of racial concepts In a review of articles published in Health Services Research, Williams noted, "Terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors." The tautology of race:  The tautology of race Research utilizing race serves to "naturalize" the boundaries dividing human populations, making it appear that the differences found reflect laws of nature. In fact, the use of race and ethnicity in biomedical research is problematic because it is caught in a tautology, both informed by, and reproducing, "racialized truths." We assume that racial differences exist, and then proceed to find them. While the scientific validity of racial distinctions between human populations has long since been disputed, the cultural logic of stratifying populations by race/ethnicity exerts a powerful pull Culture and ethnicity:  Culture and ethnicity Even though we have tried to move away from a loose use of the term ‘race’, confusions still exist around notions of ethnicity and culture Ethnic classifications are problematic to the extent that they are based on unsystematic and often inaccurate mixtures of skin colour, culture and nationality Culture, racism and ‘racialisation’:  Culture, racism and ‘racialisation’ Racism is typically articulated through notions of culture and ‘otherness’ in late capitalist societies, rather than biology Culture becomes a ’racialised’ means of defining national identity, citizenship and rights (including access to health resources) Cultural ‘backwardness’ often used to explain health differentials in non-national groups Health care and the new racism:  Health care and the new racism Pseudo-biological notions of race transformed into ‘cultural awareness’ amongst health professionals The ‘tools of cultural understanding’ used to re-socialise deviant others to facilitate the ‘proper use’ of health services Cultural ‘difference’ used to explain health inequalities and simultaneously to pathologise certain cultures and make them a cause of health inequalities (e.g. young female Asian suicide) Mental health & ethnicity:  Mental health & ethnicity Problems with ethnic/racial classifications:  Problems with ethnic/racial classifications Variations by ‘race’ do not necessarily coincide with variations by country of birth Certain ethnic groups under-use services due to access barriers Variations within race/country of birth (e.g. social class, migration status) may be more important than variations across race/country of birth classification Inequalities Ethnicity & Health:  Inequalities Ethnicity & Health In considering ethnic inequalities it is important to remember that ethnicity does not inevitably coincide with skin colour. ‘Ethnic’ does not mean ‘black’ or ‘non-white’ However, being black or non-white can have an impact on health due to the effects of racism, discrimination, low social status, or diminished access to services Structural Racism:  Structural Racism Lower incomes for ethnic minorities within social classes when compared to ‘whites’ (Nazroo, 1997) Ethnic minorities more likely to be found in lower status jobs with poorer job security, higher levels of occupational stress, and more likely to work longer hours (Nazroo, 1997, Williams, 1994) More likely to be unemployed longer than whites More likely to live in poorer quality housing Structural racism and health:  Structural racism and health Accumulation of disadvantage across the life course Knowledge of disadvantage and exclusion ‘Ecological’ concentrations of migrant/ethnic minority groups Lack of cultural competence amongst service providers Case Study: Travellers in Ireland:  Case Study: Travellers in Ireland The Equal Status Act ( 2000 ) defines the Traveller Community as follows: “ TRAVELLER COMMUNITY MEANS THE COMMUNITY OF PEOPLE WHO ARE COMMONLY CALLED TRAVELLERS AND WHO ARE IDENTIFIED (BOTH BY THEMSELVES AND OTHERS) AS PEOPLE WITH A SHARED HISTORY, CULTURE AND TRADITIONS INCLUDING, HISTORICALLY, A NOMADIC WAY OF LIFE ON THE ISLAND OF IRELAND.” Age & sex distribution (2006):  Age & sex distribution (2006) Life Expectancy of Travellers:  Life Expectancy of Travellers Key Health Statistics:  Key Health Statistics Infant mortality rate 18.1 per 1000 live births (National figure is 7.4) At birth Traveller men can expect to live 9.9 years less than settled men Women 11.9 years less than settled women SIDS rate (cot death) among Traveller families is more than 3.7 times higher than national figures Disability rates higher than total population (11.4% v 9.3%) Traveller life expectancy is now that of the general population in 1940s Source: Health Board Research 1987 Infant Mortality amongst Travellers:  Infant Mortality amongst Travellers Traveller Mental Health:  Traveller Mental Health 71% of the women reported that they experienced verbal abuse because they were Travellers 25% of these included physical violence. 10% had taken anti-depressants prescribed by their GP in the previous year. 34% of Traveller women interviewed suffered from long term depression compared with a finding of an approx. 9% amongst their settled peers. 46% of women described their own general health as "poor" or "fair". Pavee Point survey on the Health of Traveller women (1997) Attitudes to Travellers:  Attitudes to Travellers In terms of accepting or including Traveller socially or into the community: 36% of Irish people would avoid Travellers. 97% would not accept Travellers as a member of their family 80% would not accept a Traveller as a friend 44% would not want Travellers as community members. The main reasons for excluding Travellers are perceptions of their way of life/lifestyle and a feeling that Travellers are in some way not socially acceptable (27%) (Citizen Traveller survey, 2000). Explanations of Traveller Ill-Health:  Explanations of Traveller Ill-Health High use of obstetric services but lower uptake of other maternity services. There was a low up-take of ante-natal classes and a low up-take of ante-natal and post-natal check-ups. Low uptake of family planning services and a low rate of breast feeding. Low uptake of child health services and immunisation Low levels of public health nursing intervention (despite the poor health status of the Traveller population). Reluctance on the part of Travellers to visit the PHN at the clinic because of hostility from other clients, inadequate waiting facilities for small children, low literacy levels (making form filling difficult) and lack of transport. Explanations of Traveller Ill-Health:  Explanations of Traveller Ill-Health Travellers have difficulty accessing mainstream services due to institutional discrimination Difficulties occur in attempting to access GPs, Accident and Emergency services, crisis services, and related support services. GPs are generally reluctant to go out on call to halting sites, particularly unofficial sites. Travellers attending surgeries tend to be accompanied by large numbers of family members which GPs regard as disruptive. Often members of the settled community will not wait in a waiting room with Travellers. Due to pre-literacy or illiteracy, Travellers experience difficulties in accessing health information Employment status by age 2006:  Employment status by age 2006 Household size (2006):  Household size (2006) Explanations of Traveller Ill-Health: The 3rd World living in the 1st:  Explanations of Traveller Ill-Health: The 3rd World living in the 1st One in every four Travellers has no piped water supply (or at best has a shared cold water supply) no flush toilet no bath or shower no access to mains electricity no refuse collection. Further reading:  Further reading Journal of Health Gain (2001) Special issue on Traveller health Vol 6 Issue 1 Murphy JHA (2002) Traveller Health: A National Strategy 2002-2005 Dublin: DOHC available at http://www.dohc.ie/publications/traveller_health_a_national_strategy_2002_2005.html

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