Critically discuss the ways in which ill health is patterned according to ethnicity - Finished PDF

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Ethnic health inequalities ...

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UP773976 Critically discuss the ways in which ill health is patterned according to ethnicity The term ethnicity refers to “cultural differences such as language and religion” and is associated with the norms and values shared by major ethnic minority groups in the UK (Bartley, 2017, p. 151). It has been argued that ethnic differences in health and wellbeing have become an increasing focus of research in the UK (Mason, 2003, p.87). We can identify a number of trends with regards to ethnicity and health in the UK and it is evident that there are variations in health depending on ethnic groups. The parliament records have suggested that “Black and minority ethnic (BME) groups generally have worse health than the overall population” (Parliament, 2007). Evidence has revealed that those from a low socio - economic position from minority ethnic groups are the main victims of poor health. There are four prominent but conflicting explanations outlining patterns of ill health in relation to ethnicity: artefact explanation, biological explanation, cultural explanation and structural explanation. Firstly, the artefact explanation proposes that evidence concerning the variations in health levels in different ethnic groups is not adequate and remains a very complex field. This perspective suggests that the majority of the evidence gathered relies heavily on self – report studies and how individuals rate their own health, their views are therefore subjective and based on their own personal opinions. As a result, this creates a clinical iceberg as the evidence concerning the difference in health levels in different ethnic groups is not sufficient enough. Rahman defines the concept of a “clinical iceberg” as illnesses which are unreported to doctors and how statistics regarding health inequalities are gathered only through those that are reported to the medical profession (Rahman, 2010). Last (1963 cited by Rahman, 2010) found “as much as 94% of illness is not reported to doctors”. Black, Townsend & Davidson (1982, p. 105) convey that “health and class are artefact variables and their observed relationship may itself be an artefact of little causal significance”. The artefact explanation states that it is difficult to establish trends if ethnic minorities are subjectively diagnosing themselves. In contrast, the biological explanation proposes the view that patterns of ill health amongst ethnic minorities tends to follow that of their own country. The genetic explanation of health and illness is “based on the assumption that social life needs to be explained in terms of the characteristics and behaviours of individuals” (White, 2002, p.160). The biological view refutes the cultural explanation stating that the pattern of disease amongst immigrants tends to follow that of their own country. Nettleton (2006, p.142) feels genetic factors play a significant role in explaining ethnic inequalities. The biological explanation characterises “human society as being reducible to genes rather than social factors (White, 2002, p.160). In other words, the biological explanation argues that individuals “become diseased and die as a result of their genes and not the way society is organized” White, 2002, p.160). The concept “geneticizing of society” was put forward by Wertsz who argues that genetic explanations “justify inequality as natural and inevitable” (Wertz, 1992 cited by White, 2002, p.161). Although, the biological explanation is criticised for failing to acknowledge that structural factors and cultural factors also play a key role in ill health amongst ethnic minorities. For example, Willis argues that “the focus on genetics diverts attention from the social and economic environment” and instead focuses on “an individualistic explanation of disease” (Willis, 1996 cited by White, 2002, p.164). However, the significant debate lies between the cultural explanation and the critical structural explanation. The cultural explanation proposes that it is factors such as lifestyle, perceptions of illness, traditions and cultural values that are the major causes for high mortality and morbidity rates amongst ethnic minorities. This explanation portrays “the individual as a unit of analysis emphasising irresponsible behaviour or incautious lifestyle as

UP773976 the main determinant” of health inequality (Black et al, 1982, p.110). Cultural perceptions focus on behaviours such as smoking, poor diet and lack of exercise as reasons for the ill health suffered by ethnic minorities. Nazroo gives the example of “the use of ghee amongst Asians when cooking and a lack of physical exercise which have arguably contributed to high rates in heart disease and diabetes (1998, p.716). In addition to this, evidence has shown that the rates of throat and mouth cancer are particularly high amongst both Indian men and women due to their increased intake of beetle nut and chewing tobacco (Nazroo, 1998, p.716). The cultural theory proposes that immigrant groups experience language difficulties and this is responsible for their failure to use NHS facilities. However, it has been argued that language barriers should not be used as an excuse as the number of British born minorities is increasing (Marmot, 1984 cited by The British Academy, p.97). The cultural theory is criticised for failing to take in to account that some cultural effects do appear to weigh in the favour of ethnic minority groups (Ahmed, 1993 cited by Nettleton, 2006, p.196). Ahmed gives the example of how Indians have much lower alcohol consumption and levels of smoking compared to the white population and therefore mortality rates from chronic bronchitis and lung cancer are much lower (1993 cited by Nettleton, 2006, p196). The cultural perspective is criticised for making generalisations and assuming that all individuals are in control over their health and wellbeing. It fails to consider that ethnic minority groups do have social class, regional and religious variations too which could have an impact on health. The cultural view puts too much emphasis on individual responsibility but it fails to understand that choices may be limited for minority groups and that wealth and education also affect individual’s choice. The critical structural explanation opposes the cultural explanation and examines the quality of people’s material surrounding and living conditions as a key factor in explaining patterns of ill health in relation to ethnicity. This is supported by Davey Smith et al who argue that “material factors are relevant to the health of ethnic minority people and that they make the key contribution to differences in health between different ethnic groups (Davey Smith et al, 1996 cited by Nazroo, 1998, p.712). The structural perspective criticises the cultural explanation for failing to acknowledge that cultural practises are not voluntarily chosen but are actually shaped by the economic and social circumstances of the individual over which they have little or no control over. Bradshaw et al (2006) cited by Platt (2007, p.87) support this view arguing poverty is particularly common amongst those of Pakistani or Bangladeshi origin. In addition to this, it has also been argued that poverty can lead to debt, poor diet and stress which can negatively impact one’s physical and mental health which may lead to illness and early mortality (Kempson, 1996). Wilkinson (1996, p. 175) supports the psycho social explanation that those “ethnic minorities in a low socio-economic hierarchy” have less control over their working and living conditions. As a result of this lack of control, they are likely to suffer from stress, low self-esteem and can often lead to mental illnesses such as depression. They go on to argue that extreme inequalities weaken many ethnic minorities sense of social cohesion (sense of belonging to society) which could generate feelings of desperation, inferiority and insecurity. He suggests that these negative feelings could lead to stress and eventually psycho-social behaviour such as smoking, drinking, and lack of exercise. These factors are all linked to the increasing likelihood of high blood pressure and heart disease which all contribute to high mortality and morbidity rates (Wilkinson, 1996, p.176). There is a substantial amount of evidence that ties poverty and exclusion of ethnic minorities to racism and discrimination. Bowler’s study on midwives has revealed that they held a number of racist and stereotypical views of particularly Muslim and Asian women which may have an effect on the quality of care they received (1993, p.158). It has been argued that racism is a common occurrence in the medical profession and research has revealed that ethnic groups are likely to experience unequal access to healthcare as well as receiving a poor level of care through the NHS. For example Littlewood & Lipsedge (1982) recorded that

UP773976 “black patients are twice as likely to be detained involuntarily for mental illness, receive heavier doses of drugs and be allocated less experienced, junior doctors rather than professionals when being treated”. The inverse care law proposes another factor of discrimination in health, Tudor Hart (1971, p.405) states that the areas that need the most health care and doctors for example like the North of England and inner cities in London where there are large groups of ethnic minorities often receive less of it. This could therefore be a possible reason for high rates of ill health amongst ethnic minorities. Marxist views have placed blame on the organisation of capitalism and believe this is the reason for the inequalities in wealth and income which results in poverty. Therefore, they believe that it is no surprise why ethnic minorities experience higher rates of mortality and morbidity. Although, it can be argued that the structural explanation places all the blame on society as being the reason for the ill health experienced by minority ethnic groups and fails to acknowledge that ethnic minorities are also partially responsible for their ill health as a result of cultural factors. Smaje criticises the structural approach and argues that although “socio-economic disadvantage may contribute to health differences amongst ethnic groups” there is still “an essential component to ethnicity that could make a major contribution” in explaining these health differences (Smaje, 1996 cited by Nazroo, 1998, p.712). Smaje goes on to point out that “when explaining the relationship between ethnicity and health, ethnicity cannot be simply emptied into class disadvantage (1996 cited by Nazroo, 1998, p.712). In conclusion, the most adequate explanation for explaining how ill health is patterned according to ethnicity is the critical structural explanation. By improving working conditions and wages of ethnic minorities individuals are less likely to suffer from ill health and fall in to poverty. The artefact explanation proposes a fair comment in suggesting that the majority of evidence is taken from data collected from self - report studies and so cannot be relied on as individuals have different perceptions of health. If the validity and reliability of the structural perspective was to be improved it could consider the relationship between gender, age and region along with cultural circumstances. Despite this, the structural explanation is still the strongest of the four. Through educating individuals on healthy eating, improving quality of care given to ethnic minority groups, the general health of ethnic minorities would increase.

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