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Combining the strengths of UMIST andThe Victoria University of Manchester
The impact of racism on the health and The impact of racism on the health and well-being of ethnic minority peoplewell-being of ethnic minority people
Professor James Nazroo
Sociology, School of Social Sciences
james.nazroo@manchester.ac.uk
Combining the strengths of UMIST andThe Victoria University of Manchester
Ethnic differences in reported fair or bad health
Age adjusted odds ratio compared with white English
0.5
1
1.5
2
2.5
3
3.5
4
Caribbean Indian Pakistani Bangladeshi Chinese White minority
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Health Survey for England 1999
Combining the strengths of UMIST andThe Victoria University of Manchester
Ethnic inequalities in health: race and racism
Genetic/biological differences
Racism: exclusion and harassment
Migration effects: context, health selection, impact of migration
Lifestyle: culture
Socioeconomic position: material disadvantage, geography
Access to and quality of healthcare
Combining the strengths of UMIST andThe Victoria University of Manchester
Racism and health
• An ideology of superiority, a belief that some races are superior to others, justifying institutional and individual practices that create and reinforce oppressive systems of race relations and inequality between racial, or ethnic, groups, so creating a racialised social order.
• Reflected in racist interpersonal behaviour, and institutional polices and formal and informal practices, including everyday ‘minor’ incidents
• Leading to:• Economic and social deprivation• Exposure to environmental hazards• Socially inflicted trauma (experienced or witnessed)• Targeted promotion of unhealthy consumption• Inadequate health care
Combining the strengths of UMIST andThe Victoria University of Manchester
Experiences of racism and discriminationin England and Wales
One in 8 ethnic minority people experience some form of racial harassment in a year. 3% experience physical attack on themselves or their property.
Repeated racial harassment is a common experience.
25% of ethnic minority people say they are fearful of racial harassment.
20% of ethnic minority people report being refused a job for racial reasons, and almost 3/4 of them say it has happened more than once.
20% of ethnic minority people believe that most employers would refuse somebody a job for racial reasons, only 12% thought no employers would do this.
White people freely report their own prejudice: One in four say they are prejudiced against Asian people; One in five say they are prejudiced against Caribbean people.
FNS: Modood et al. (1997)
Combining the strengths of UMIST andThe Victoria University of Manchester
Ethnic differences in experiences andperceptions of discrimination (2)
0%
10%
20%
30%
40%
Irish Caribbean Bangladeshi Indian Pakistani
Employment related discrimination
Karlsen et al. 2005
Combining the strengths of UMIST andThe Victoria University of Manchester
Racialised socioeconomic inequalities
• Lower incomes
• Lower status occupations
• Poorer employment conditions
• Higher rates of unemployment and longer periods of unemployment
• Poorer educational outcomes
• Concentrated in economically and environmentally depressed areas
• Housing tenure
• Poorer quality and more overcrowded accommodation
Combining the strengths of UMIST andThe Victoria University of Manchester
Ethnic differences in equivalised household income in England
48% 45%
69%
90%
41%
27% 31%
0%
20%
40%
60%
80%
100%
Caribbean Indian Pakistani Bangladeshi Chinese Whiteminority
WhiteEnglish
Bottom tertile Middle tertile Top tertile
Health Survey for England 1999
Combining the strengths of UMIST andThe Victoria University of Manchester
Racial harassment and health
0.5
1
1.5
2
2.5
3
3.5
4
Verbalabuse
Physicalattack
Verbalabuse
Physicalattack
Verbalabuse
Physicalattack
Verbalabuse
Physicalattack
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Fair or poor health Hypertension Common mental disorder
Psychosis
Karlsen and Nazroo 2002, Karlsen et al. 2005
Combining the strengths of UMIST andThe Victoria University of Manchester
Experienced discrimination at work and health
0.5
1
1.5
2
2.5
Fair or poor health Cardiovasculardisease
Smoking Common mentaldisorder
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Harris et al. 2006a
Combining the strengths of UMIST andThe Victoria University of Manchester
Any racist attack or discrimination and health(verbal or physical attack, discrimination in workplace, housing, and healthcare)
0.5
1
1.5
2
2.5
3
Fair or poor health Cardiovasculardisease
Smoking Common mentaldisorder
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Harris et al. 2006a
Combining the strengths of UMIST andThe Victoria University of Manchester
Believe most employers discriminate and health
0.5
1
1.5
2
2.5
Fair or poor health Hypertension Common mentaldisorder
Psychosis
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Karlsen and Nazroo 2002, Karlsen et al. 2005
Combining the strengths of UMIST andThe Victoria University of Manchester
Cumulative effect of exposure to racism:fair or poor health in New Zealand
Adjusted odds ratio: minorities comparedwith white European
1
1.5
2
2.5
3
3.5
4
One Two Three to Five
Range of events
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Harris et al. 2006a
Combining the strengths of UMIST andThe Victoria University of Manchester
Fear of racism and health
• Racism need not be personally experienced to produce threat, because it can be viewed as (and is) an attack on a community as a whole.
• People living in a climate of fear and insecurity may adapt by constraining their lives to avoid vulnerable situations, a response that may lead to stress.
• Do you worry about being racially harassed? By racially harassed, I mean being insulted or physically attacked, or having property damaged for reasons to do with race or colour?
• 23% of ethnic minority people in England and Wales say ‘Yes’ to this
• And those who say yes have an odds ratio of 1.61 (1.24 - 2.09) for reporting fair or poor health
Combining the strengths of UMIST andThe Victoria University of Manchester
Racism, discrimination, occupational classand health: independence of effects
Predicted per cent reporting fair or poor health
0%
10%
20%
30%
40%
50%
None Verbal Physicalor property
No or afew
Some ormost
Nonmanual Manual
(Karlsen and Nazroo 2002)
Racial harassment Do employers discriminate? Occupational class
Combining the strengths of UMIST andThe Victoria University of Manchester
Explaining ethnic differences: fair or poor health
Adjusted odds ratio Māori compared with white European
0.5
1
1.5
2
2.5
Age and sex Age, sex and level ofdiscrimination
Age, sex anddeprivation
All factors
Adjustment factor
Od
ds
ra
tio
(a
nd
95
% C
.I.)
Harris et al. 2006b
Combining the strengths of UMIST andThe Victoria University of Manchester
‘Ethnicity’, identity and racialisation
The boundaries of ethnic groups are symbolically represented – as the bearers of a specific language, religion, or more generally, ‘culture’; but they are also materially constituted within the structures of power and wealth. Thus ethnicity should be regarded as materially and symbolically constituted.
Fenton 1999
Racial and ethnic groups ... are discursive formations, calling into being a language through which differences are accorded social significance, and by which they may be named and explained. What is of importance for social researchers studying race and ethnicity is that such ideas also carry with them material consequences for those who are embraced by them and those who are excluded from them.
Solomos 1998
The contextual nature of this, and the operation of structure and agency, is clearly seen if we consider the ways in which white minority and Muslim identities have transformed over the last few decades
Combining the strengths of UMIST andThe Victoria University of Manchester
Concluding comments
Ethnic differences in health have been repeatedly documented
Explanation is typically focussed around essentialised notions of ethnicity/race, neglecting the social character of ethnic identities
Differences in health across ethnic groups are more appropriately understood as the product of social inequalities
But, we need to move beyond statistical correlations – inequalities associated with ethnicity can only be understood as a consequence of structural processes and social relations
Racism, and understanding racism, is central to this
Limited empirical models
Need to understand context and agency: for example, period/cohort effects (baby-boomers/60s generation), social class, generation, resistance (community/civic action/social support)
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