Ethnicity and Inequalities in Health and Social Care

ISSN: 1757-0980

Article publication date: 17 November 2011



Sewell, H. (2011), "Editorial", Ethnicity and Inequalities in Health and Social Care, Vol. 4 No. 4. https://doi.org/10.1108/eihsc.2011.54504daa.001



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited


Article Type: Editorial From: Ethnicity and Inequalities in Health and Social Care, Volume 4, Issue 4

The papers in this issue support the case made by the Public Health Outcomes Framework (Department of Health, 2012). Ill health cannot be effectively considered outside of the social context. Each paper tackles ethnic health and social care inequalities from a unique perspective and read together they create a good picture of how inequalities emerge for different minority ethnic communities.

The Lee paper “A comparison of the health status of European Roma and Australian Aborigines” compares and contrasts the inequalities for the two groups and provides evidence for the ways in which participation, leadership and analysis of population and service utilisation data can play a role in achieving some progress, however limited.

The paper “Impacts of a social support intervention for Somali and Sudanese refugees in Canada” by Stewart et al. provides an insight into the unmet needs and challenges of a cohort of refugees. The Canadian context for assimilation serves as a reminder of the complexity of the concept of ethnicity. Consider as the immigrants become settled and take potentially adopt elements of Canadian culture and idioms. Reading the article from the perspective of an outsider to Canada emphasises the element of ethnic identity that is determined in response to the perceptions held by others from outside the group (Fernando 2002). They may remain Sudanese and Somali to Canadians and to others (e.g. visitors to the country) they may be seen as Canadian Sudanese or Canadian Somali.

“Time period trends in ethnic inequalities in limiting long term illness in England and Wales” by Smith identifies the changes in limiting long-term illness in minority ethnic groups in representative cohorts from 1991 and 2001. The paper concludes that despite the upward social mobility of some minority ethnic groups there has not been the corresponding health improvement usually associated with this.

“Learning from an Iranian man about CBT for treatment of PTSD” by Bernardes is a practice piece that shifts focus from trend data to an account of an individual’s experience of cognitive behavioural therapy following a racist attack.

The mix of national and international papers reflect the extensive international evidence that informed the Marmot (2010) review of health inequalities and the Public Health Outcomes Framework (Department of Health, 2012). In this issue we see that the encounters of immigrant groups in Canada, the experience of European Roma and Australian Aborigines reinforce the point that though needs are being considered through the prism of ethnic differences the reality is that the basic human needs exemplified by Maslow (1943) are typical. The challenge in the UK is to identify the ways in which histories, context, personal or system-based discrimination create obstacles to people’s needs being met consistent with the Human Rights Act 1998.

The themes that emerge from the papers in this issue can be summarised in five areas, developed each in turn below.

A lack of data indicates a lack of attention to a subject (or group) and the absence of data reinforces the perceived lack of importance – and this leads to the perpetuation of inequalities (Lee and Stewart et al.). This point was powerfully made when Lee contrasted the experience of Aborigines with Roma people in Europe. The first stage in addressing inequality is when previously invisible people become visible – in census data, policies and service utilisation data. The Stewart et al. paper seeks to create an evidence base for social support interventions for African refugees. Without a knowledge of the nature and scale of needs and gaps in services, ethnic inequalities cannot be appropriately incorporated into strategic planning and commissioning decisions. Though the papers in this issue focus on specific communities the learning can be more generally applied to current health and social care systems. Certain groups that are under-represented often receive scant attention in policy reports and research. Researchers may learn from the approach adopted by Stewart et al. to building an evidence base and service providers may begin to specifically engage less often heard communities in their area as a means of gathering information to inform strategy and commissioning.

People’s histories, linked to their ethnic identities are determinants of health and social care outcomes irrespective of the progress they have made via socially or through migration. These points made by Stewart et al. and Smith, amongst other researchers and academics, illustrate the point that current socioeconomic status is linked with ethnicity and combined they have a serious negative impact on health outcomes. The long shadow cast by historical inequalities either in societies, communities or families needs to be acknowledged otherwise there is potential for causing alienation by unduly linking causes of inequality with lifestyle or by failing to recognise that even factoring for socioeconomic factors, ethnicity is a determinant of inequality.

Inequality emerges through socioeconomic inequalities and discrimination which has psychological consequences (Bernardes) and physical consequences (Smith) – integration is needed between physical and mental health and across strategies of all functions in the public sector. The Cartesian split between mind and body may be beneficial conceptually but the reality is that people do better when they are seen as whole people in service delivery. The national mental health strategy acknowledges this and is cross departmental as a consequence (Crown, 2011). The NHS Confederation publication into the views of leaders in mental health about race equality reports the views of those interviewed that the national strategy is yet to have the desired impact (Sewell and Waterhouse, 2012). The report makes recommendations about the potential role of health and wellbeing boards to bring together whole system population needs analysis and planning. The Bernardes and Smith papers could equally support such a recommendation.

There are benefits in considering if modifications are needed to the approaches and technologies used in health and social care sometimes to increase their effectiveness with people from BME backgrounds (Bernardes and Lee). Health and Social Care systems often believe in the transferability of technologies across ethnic groups as they are responding to the needs and desires that are common to all humankind. There are occasions however when technologies which are more psychologically based may benefit from modifications (Miranda et al., 2005; Rathod et al., 2010). The concept of universalism perhaps should always be questioned. This would allow co-production with service users in personalised services which truly step outside the constraints of a service driven approach.

The papers also bring into focus the complexity of work with people from Black and Minority Ethnic backgrounds. One consequence of the single equalities approach that emerges from the Equality Act 2010 is that when race is given attention as one of nine protected characteristic this is seen as a fragmentation. The additional distillation required, i.e. of the needs of different minority ethnic communities, will often fall off the agenda as the potentially significant numbers of groups are collectively considered under the race/ethnicity umbrella as one of nine equality priorities.

The case has been made by all these papers for more detailed understandings of ethnicity and inequalities. Despite the years of tackling inequalities there continues to be unacceptable variations in outcomes and experiences. We are however becoming more sophisticated in our understanding of the issues and we are grateful to have four good papers which add to the growing body of knowledge. Enjoy and learn.

Hari Sewell


Crown (2011), No Health Without Mental Health: A Cross-government Mental Health Outcomes Strategy for People of All Ages, Crown, London

Department of Health (2012), Improving Outcomes and Supporting Transparency: A Public Health Outcomes Framework for England, 2013-2016, Department of Health, London

Fernando (2002), Mental Health, Race and Culture, 2nd ed., Macmillan Press, Basingstoke

Marmot, M. (2010), Fair Society, Healthy Lives, The Marmot Review, London

Maslow, A. (1943), “A theory of human motivation”, Psychological Review, Vol. 50, pp. 370–96

Miranda, J., Bernal, G., Lau, A., Khon, L., Hwang, W.C. and LaFromboise, T. (2005), “State of the science on psychosocial interventions for ethnic minorities”, Annual Review of Clinical Psychology, Vol. 1, pp. 113–42

Rathod, S., Kingdon, D., Phiri, P. and Gobbi, M. (2010), “Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users’ and health professionals’ views and opinions”, Behavioural and Cognitive Psychotherapy, Vol. 38 No. 5, pp. 511–33

Sewell, H. and Waterhouse, S. (2012), Making Progress on Race Equality in Mental Health, NHS Confederation, London

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