combining the strengths of umist and the victoria university of manchester the impact of racism on...

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

[email protected]


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


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


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


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)


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


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


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


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


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


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


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


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


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


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


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


‘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


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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