ethnicity and culture: an unequal power

7/28/2019 Ethnicity and culture: an unequal power.

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and cui r .an unequal powerM

odern Britain is culturally diverseand most recent figures suggestthat the minority ethnic populationincludes 4.6 million people, or 7.9per cent of the population (ONS,

2002) (see table 1). It is widely acknowledged thatspeech and language therapists (and all otherhealth professionals) should be sensitive to the cultural needs of various minority ethnic groups.However, Holland & Hogg (2001) have rightlyidentified that, whilst health professionals areencouraged to do this, there is a definite lack ofleadership within the health care services on suchcultural issues.Table 1: The UK Popul at ion by ethn ic grou p, April 2001

PercentagesPercentage Percentageof total of minoritypopulation ethnicpopulation

White 92 .2 nfaMixed 0.8 11 .0Asian or Asian British Indian 1.7 21.7 Pakistani 1.3 16.7 Bangladeshi 0.5 6.1 Other Asian 0.4 5.7 Black or Black British Black Caribbean 1.0 13.6 Black African o.g 12 .0 Black Other 0.1 1.5 Chinese 0.3 4.2Other 0.6 7.4 Not stated 0.2 nfa All minority ethnic 7.6 100.0 population All population 100 nfaSource: ONS (2002)It is useful to begin by defining what we mean

by the terms 'race' and 'ethnicity'. The term 'race'is commonly used and usually refers to genetic orphysical variations between groups of people skin colour is a good example of this. However,soc iologists pre fer to use the term 'ethnicity' as thisrecognises the socially constructed nature of 'difference'. Sociologists usually agree that ethnicity

refers to a common ancestry, a particular geographical territory, and those who share a language, religion and social customs (Fenton , 1999).Other indicators of ethnicity might include diet,name and nationality.HeterogeneityIt is important to recognise that minority ethnicgroups are not homogenous, and that there is agreat deal of heterogeneity, including differencesof socio-economic status, gender and age,amongst others. More recently, sociologists havehighlighted how the term 'ethnic' usually refersto those in minority ethnic groups, rather thanthe 'White' majority. However, Pfeffer (1998)argues that the term 'White ' is unhelpful as it caninclude people of Irish origin and Jews, amongstothers, reflecting a rather diverse range of needsand experiences. Defining ethnicity is complexand there is no universally agreed classification.However, the most recently recommended classifica-tion for ethnic identification can be seen in figure 1.

Figure 1 Classification of Ethnic Groups n BritainWhiteBritishIrishOther WhiteMixedWhite and Black CaribbeanWhite and Black AfricanWhite and As ianOther MixedAsian or Asian BritishIndianPakistaniBangladeshiOther AsianBlack or Black BritishBlack CaribbeanBlack AfricanOther BlackChinese or Other ethnic groupChineseOther ethnic groupSource: ONS (2002)In spite of the difficulty of defining ethnicity

and measuring differences between ethn icgroups, research studies time and again demonstrate wide-ranging inequalities .

Surveys have consistently shown that the healthof most minority ethnic groups is significantly

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that of the general population. The research with Black and White stu However, it is important to beIt should beSurvey for England (DoH, 1999) dents in the United States, they cautious when considering culrecognised that thethat Pakistani and Bangladeshi men are argue that White people are more tural differences. Ahmad (1994)to four times more likely to describe thei r likely to perceive Black people's therapist is always argues that minority ethnic cultures

as 'bad' or 'very bad'; Black Caribbean speech negatively: as loud, ostenta are often demonised as 'wrong'in a position ofas likely. The same survey tious, aggressive, active and argu or 'bad' in comparison to thosepower relative tothat Pakistani and Bangladeshi men and mentative. This is relevant to thera of the so-called 'White' majority.

Black Caribbean women, are most pists because, as they argue, speech their client. Studies also demonstrate that,to report suffering from cardiovascular dis- style stereotypes exist' not on Iy to within education, children from

conditions (for example, heart attack, stroke, describe "what is" but to prescribe "what should minority ethnic groups feel devalued, and assump-. Indeed, Bangladeshi men report rates of be'" (Popp et ai, 2003: 317). Figure 2 lists points to tions are often incorrectly made by teachers, based

disease that are 70 per cent higher consider in relation to ethnicity and language. on perceived cultural 'differences' (for example, seeof the general population. Rates of dia Brah & Minhas, 1983).Figure 2 Ethnicity and languag e: points to co nsideralso significant with Bangladeshi men Other theorists suggest that it is impossible to wh y children from minority ethnic groups understand the experiences of minority ethnicsix times more likely to may be either over or under-representedrt this cond ition (DoH, 1999). groups without considering structural factors andwithin your case load;is relevant to ask if speech that an analysis of culture alone is inappropriate

services for adults plan for (Smaje, 1996; Karlsen & Nazroo, 2002) . In generalhigher incidence of stroke in people from some

whether you expect English to be thedominant language; terms, people in minority ethnic groups are more

. There is some evidence to likely to be socially excluded; that is, they are whether you perpetuate racist speech more likely to be living in poverty, to be unemstyle stereotypes.an inferior service from the NHS compared ployed or in low -paid employment and are moreservice received by others. Torkington (1991), Understanding ethnic inequalities is complex likely to have a lower standard of living than the

that there is a lack of knowl and there are several perspectives. One explanation general popu lation (ONS, 2002). Indeed, NazrooNHS staff of the conditions that suggests a genetic component. Traditionally, this (1997) argues that material deprivation probably

affect people from minori ty ethnic groups. explanation has been used to explain differences in accounts for most of the inequalities betweenalso show evidence of levels of IQ, although this has been widely discredited. ethnic groups and Karlsen & Nazroo (2002) argue

and racist discrimination, leading to poorer More recently, theories of genetic variation have that experiences of racism and perceptions ofcare (for example, see Bowler, 1993). been used to explain differences in the prevalence racist disc rimination are also strongly related toand privilege can be mediated and perpet o f some health conditions, for example, diabetes, inequality. In other words, many sociologists suggest

2001). Indeed, hypertension and sickle cell disease. However, Braun that it is not ethnic culture and identity per se& Jones (1999: 530) suggest that language has (2002) argues that our knowledge of the history of which leads to inequality, but the marginalisation

social realities, populations and thei r identities and affiliations is of people in minority ethnic groups.discourses, and representing particular too vague and incomplete to make such an asser- There is no single explanation that can accountbe overlooked, nor tion , and furthermore that, for ethnic inequalities and it is likely that there

is not surprising, therefore, that 'the current emphasis on genetic explanations rei- are multiple factors. A recent study of languageen from minority ethnic groups are often over fies racial and ethnic classifications by reinforcing development in West African children (Law,

in referrals to speech and language the notion of biological difference rooted in 2000), for example, demonstrates that delays in(Law, 2000), although it is difficult to assess genetics . This reification leads to stigmatization of speech and language may be related to stress,

how widespread this is. There is also evidence racial and ethnic minorities and to research strate- unemployment, financial worries, immigrationsome areas, minority gies that divert attention from status, as well as the influence of cultural beliefsbe under-represent It is important confronting the multidimensional and expectations, which place high expectationsn relation to the overall population ways in which racism, not race, on children .to recognise1999) . influences patterns of disease.' Speech and language therapists clearly need tothat minority (Braun, 2002: 160). be aware of cultural differences that may affectethnic groups This implies that other factors practice. Clients from some minority ethnic back

English is the language must contribute to the patterns of grounds may differ in relation to language, reliare notin Britain, inequality that can be found with- gious beliefs, and beliefs about health, illness andhomogenous,language use is extensive in healthcare, education and else- disability; these may all influence compliance andand that there isprobab ly underestimated. Pugh where. adherence to treatment. Similarly, the therapist

(1999) argue that mistaken a great deal of needs to be wary of stereotyping clients accordingabout Dynamic and changing to so-called ethnic categories, recognising bothheterogeneitylanguages and that minority Cultural variations between ethnic homogeneity across ethnic groups and hetero

issues may be oversimplified in practice . groups are often thought to account for a wide geneity within groups. e x a m p l ~ of this was noted by the Royal variety of inequalities. Sociologists regard culture as It should be recognised that the therapist is

of Nursing (cited in Holland & Hogg, a set of beliefs and values which are shared by all always in a position of power relative to their who identify some of the difficulties members of a cultural group. However, culture is client. Speech and language therapy is a predomi

believed to be dynamic and changing, rather than nantly 'White' profession whose 'expert' status is of important concepts static. Culture is thought to influence the interpre derived from a predominantly Western biomedical

tation of experiences and to guide behaviour. For model. It is, therefore, important for therapists toand distortion; example, beliefs about food, diet and body image reflect on whether they operate within an ethnoof confidentiality. are thought to contribute to higher rates of cardio centric framework which serves to marginaliseal (2003) also highlight the prevalence vascular disease and diabetes amongst some minor and exclude those with different cultural beliefs

racist speech style stereotypes. Drawing on ity ethnic groups (Holland & Hogg, 2001). and values, or whether they operate within a

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model of openness and informed sensitivity to cultural needs (figure 3). To conclude, as Henley and Schott (1999 :76) suggest: 'The only person who can tell youwhat will or will not be right for them is the patient. If we really want to find out,we have to ask.'Figure 3 Action points for speech and language therapists improve your inter-cultural communication skills; respond adequately to cultural and religious needs; portray positive attitudes to minority ethnic clients and their families; avoid stereotyping and listen to individual needs.

Dr Sarah Earle is Senior Lecturer in Health Studies at University CollegeNorthampton. Address for correspondence: Centre for Healthcare Education,Boughton Green Road, Northampton NN2 7AL, tel. 01604 735500, e-mailsarah [email protected].

ReferencesAhmad, W. (1994) Consanguinity and related demons: science and racism in the debate on consanguinity and birth outcome. In: C. Samson & N. South (Eds .) Conflict and Consensus in Social Policy. Basingstoke: Macmillan . Brah, A. & Minhas, R. (1983) Structural racism or cultural difference: schooling for Asian girls. In : G. Weiner (Ed.) Just a Bunch of Girls . Buckinghamshire: Open University Press. Braun, L. (2002) Race, Ethnicity, and Health : can genetics explain disparities? Perspectives in Biology and Medicine, 45 (2), (Spring): 159 - 74. Bowler, I. (1993) 'They're not the same as us': midwives' stereotypes of South Asian maternity patients. Sociology of Health & llness, 15 (2): 157 - 178. Crawford, M. (2001) Gender and language. In: R. Unger (Ed.) Handbook of the Psychology of Women and Gender. New York: Wiley, 228 - 244 . DoH (1999) The Health of Minority Ethnic Groups, Health Survey for England 1999. London: DoH. Fenton, S. (1999) Ethnicity: Racism, Class and Culture. London, Macmillan. Henley, A. & Schott, J. (1999) Culture, Religion and Patient Care in a MultiEthnic Society. London, Age Concern. Holland, K. & Hogg, c. (2001) Cultural Awareness in Nursing and Health Care. London : Arnold . Karlsen, S. & Nazroo, J.Y. (2002) Agency and structure: the impact of ethnic identity and racism on the health of ethnic minority people. Sociology of Health & '"ness, 24 (1): 1 - 20. Law, J. (2000) Factors affecting language development in West African children: a pilot study using a qualitative methodology. Child: Care, Health and Development. 26 (4): 289 - 308. Nazroo, J.Y. (1997) Health and health services. In: T. Modood, R. Berthoud, J. Lakey, P. Smith , S Virdee & S. Beishon (eds.) Ethnic Minorities in Britain: Diversity and Disadvantage. London: Policy Studies Institute, 224 - 258 .

ONS (2002) Social Focus inBrief: Ethnicity. London: ONS.Pfeffer, N. (1998) Theories ofections race, ethnicity and culture.ensure translators appreciate British Medical Journal, 317 (14e need fo r accuracy, impartiality Nov) : 1381 - 1384.Popp, D., Donovan, R.A .,that heterogeneity Crawford, M., Marsh, K.L. &a feature of all ethnic groups, Peele, M. (2003) Gender, Racemy own? and Speech Style Stereotypes.seek (o r provide) leadership Sex Roles, 48 (7/8): 317 - 325.issues? Pugh, R. & Jones, E. (1999)Language and Practice:

Minority Language provision with the Guardian ad litem Service. BritishJournal of Social Work, 29: 529 - 545.Smaje, C. (1996) The ethnic patterning of health: New directions for theoryand research. Sociology of Health & Illness, 18 (2): 139 - 171.Torkington, P. (1991) Black Health: A Political Issue. London: CatholicAssociation for Racial Justice.Winter, K. (1999) Speech and language therapy provision for bilingual chil dren: aspects of the current service. International Journal of Language &Communication Disorders, Jan-Mar, 34 (1): 85 - 98.

18 SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2003

~ V I EVVSCONVERSATIONAL PRACTICEDOES HALF OF WHAT IT SAYSThe Sourcebook of Practical Communication(A programme for conversational practice and functionalcommunication therapy)Sue Addlestone Speechmark ISBN 0-86388-317-6 29 .95 This photocopiable sourcebook will be useful for clients who wish to continue working in a therapeutic way on their output. The 90 topics, with open questions, are structured enough to be given directly to assistants or family members who require ideas to continue with conversational practice. Recording forms can be used to monitor which topics have been discusse d, success at conversation and amount of time spent on each topic. It will not replace naturalistic interaction, the use of conversation ramps 0 truly functional communication. It does half of what it says on the cover and is value for money if you need 'a programme for conversational practice'. Ruth Williams is a specialist speech and language therapist with the Prima ryCare Rehabilitation Team, Sa ndwe II, West Midlands.PHONOLOGICAL AWARENESSRECOMMENDED FOR CONTENT AND VALUESoundaroundAndrew Burnett & Jackie WylieDavid FultonISBN 184312001 1 14 .00I enjoyed using this photocopiable book of games to help children developearly phonological awareness skills. It is fun and interactive, and designed tobe used either in a group or individual setting in mainstream classes for foundation through to Key Stage I.It has a clearly understandable section on the developmental progression ofphonological awareness starting with the development of concepts (oftenoverlooked) right through to developing an understanding of letters/symbols.It includes very simple games which are often overlooked in other books. Thelayout is simple and easy to follow.The developmental framework and record keeping forms allow the therapist orteacher to plot programmes and chart progress easily. The photocopiable picturesand vocabulary lists are good time savers . Although many practitioners will befamiliar with the games, Soundaround presents them in a new and fun way.Children enjoy the games especially those such as 'worm sandwiches' and 'syllable steps'. The games are easily adaptable to an individual child or group's need.I would recommend this little book both in terms of content and value formoney. It is a very useful tool to develop collaborative working betweenteachers and therapists.Wendy Wellington is a senior specialist speech and language therapist for specific language impairment with Sheffield Speech & Language Therapy Agency.SEMANTICSQUICKLY EXHAUSTEDSemantic WorkbooksCaroline Davidson, Kaye Beveridge & Carol NelsonSpeechmarkISBN 0 86388 267 6 90 .00On first impressions this is a well-presented boxed set of basic training exercises. Patients find the worksheets easy to access, as the pictures are clear andthe text is a good size.It is useful for supplementing therapy, but the volume of exercises is quicklyexhausted. As the pages are photocopiable they may be appropriate for takehome packs but there are few explanations within the workbooks, thereforesometimes it is unclear what the therapist is expected to do. This promotes creativity with the resources but, as there is nothing new that goes beyond otherwell-established products, departments may find it of limited value . This resourceis probably most useful for those starting out in semantic therapy who need someideas and a guide to the breadth of basic exercises to try with their patients.Mary Bailey is a speech and language therapist with Surrey and SussexHealthcare NHS Trust.
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ethnicity and culture: an unequal power

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