Chapter 24 Ethnicity and health

It is important for health professionals to consider their roles in developing and delivering equitable health services for all ethnic groups as this population is considered one of the most ethnically diverse within the European community. Ethnic minorities in the UK are sometimes referred to as Black and minority ethnic (BME) communities.

Race, culture and ethnicity

In order to monitor whether equitable access to health care is achieved, the UK government requires NHS hospitals to record the ethnicity of all admitted patients. Ethnicity is also collected as a variable in epidemiological research. However, defining the concept of ethnicity in relation to understandings of race and culture is fraught with difficulties.

The concept of ‘race’ does not exist in any biologically meaningful way; genetic explanations for the differences seen in health status have long been shown to be scientifically flawed. There is more genetic variability within than between so-called racial groups, and over 99% of the genetic make-up of human beings is shared by all ethnic groups. Although there are clear differences in physical characteristics between people whose ancestry lies in different parts of the world (colour of eyes, skin or hair), these characteristics are of no major importance to health apart from certain genetic disorders such as the haemoglobinopathies, which have more to do with geographical conditions than genetics. Physical characteristics are only important when values are attached to them in a society, so that one group defines another as ‘different’ and assumes them to have particular behavioural characteristics because of the way they look. It is equally important to consider how health professionals perceive non-indigenes because these perceptions can cloud their judgement and affect service provision and delivery.

Culture is a set of shared beliefs, values and attitudes that guide behaviour. People identify themselves as members of a group on cultural grounds; they may share similar language, religion, lifestyle and origins and this helps them define heir ethnic group. We all have ethnic identities, whether we consider ourselves to be ‘Scottish’, ‘English’, ‘Bangladeshi’ or any combination that describes our national, cultural and social identities. Thus the concepts of ‘race’, culture and ethnicity, although interrelated, have different meanings.

How might the various components of your ethnicity and culture relate to your experiences of health and illness?

Ethnicity is measured by asking people to assign themselves to a category, as in the 2001 census in England. This approach attempts to capture the way people think of themselves in relation to colour of skin, continent of ancestral origin and cultural background. Other questions included country of birth and religion, these data should help in the planning of services that are appropriate in relation to religious observance and diet. The notion that this classification of populations aids services planning and delivery is flawed because the inconsistencies in the categories used, e.g. skin colour, continent or country of origin, portrays different meanings and in themselves do not give accurate information to direct services, therefore perpetuates inequality. Self-classification of ethnic group, can also pose problems for those interpreting the data.

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