Editorial

Citation

Sewell, H. (2012), "Editorial", Ethnicity and Inequalities in Health and Social Care, Vol. 5 No. 1. https://doi.org/10.1108/eihsc.2012.54505aaa.001

Editorial

Article Type: Editorial From: Ethnicity and Inequalities in Health and Social Care, Volume 5, Issue 1

Racism is given prominence in considering the subject of ethnicity and inequalities in health and social care in this issue. Increasingly in the UK antiracist language is being replaced with terms such as diversity and fairness (Equality and Human Rights Commission (EHRC), 2011) and socioeconomic and cultural explanations are more readily drawn upon to explain variations.

Notwithstanding the emergence of racism as a theme, this issue of the journal presents articles with different paradigmatic lines of analysis as well as some convergence across the contributions. The first piece, “Black African migrants’ perceptions of cancer: are they different from those of other ethnicity, cultures and races?” focuses mainly on how culture and ethnicity influence the perceptions of a study group of Ghanaian and Nigerian migrants in Luton, England. This proves to be an engaging article because of the effective use quotes from the focus groups throughout the article. Anxieties, fear and avoidance, influenced by culturally typical perspectives such as shame and the power of God, emerge amongst the study group. These are juxtaposed with research findings about the perceptions of other ethnic groups. The need for more understanding of reasons for cultural and ethnic influences on perceptions of cancer is highlighted in the paper as it is well demonstrated that these influences can be significant. In gaining knowledge about culture, staff need to be alert to the fact that interpretations of behaviour must remain as hypotheses only. Possibilities must not be converted to fact. The voice of the service user must always be given centrality. Cultural awareness must not evolve into stereotyping, which itself becomes a platform for racism.

The paper on “Toxic interaction theory” deals directly with racism and its impacts but avoids an accusatory finger pointing tone, in relation to front line practitioners. Rather, the article identifies a toxicity that emerges from relationships because of the wider social and historical context in which interactions between black and white people occur. The concept of toxic interactions cannot be understood without an appreciation and acceptance of the pernicious nature of racism in society. It is through an understanding of the mutating nature of racism that toxic interaction theory can provide a language for change without precipitating a de-skilling, emotionally laden and adversarial dynamic.

The third article “Inequities in visible minority Immigrant Women’s Healthcare accessibility” illustrates the intersectional nature of identity and discrimination. As with the first article, the quotes from the women interviewed provide a direct insight into the experiences of individuals in a way that quantitative research cannot. The potency of this article lies in the seriousness of the discrimination faced in healthcare in the Canadian settings studied. The account of a discriminatory tone of voice and remarks in relation to physical size and ethnicity brought together experiences of prejudice based on racial identity and views about the appropriate size and shape of a woman. The woman’s identity as an immigrant compounded the negative experience in a help seeking situation. Many of the immigrant women who participated in the research expressed their interpretation of the behaviours of healthcare staff as being driven by racism.

Discussions about racism cause discomfort, often both for those who feel subjected to it and those who feel accused of perpetrating it. The emotive nature of discussions about racism leads to the avoidance of conversations about it. Bhui (2002) made the point that people often consider alternative explanations for their experiences but in the face of repeated episodes that reinforce their view they settle on racism as the most likely explanation for their negative experiences.

In 2009, the then chairman of the EHRC, in a video posted on the organisation’s web site stated that the corrosive concept of institutional racism should be abandoned. The video is no longer on the EHRC web site but a transcript of sections of the speech is still available on The Guardian (2009) web site. This widely reported speech from such a key public figure set a tone for discourse in public services. The new Coalition Government that came to power in 2010 emphasised the language of fairness and equality in key documents such as the Coalition Agreement (Cabinet Office, 2010) and the NHS White Paper (Department of Health, 2010). There is, however, little reference in health and social care policy or official guidance to racism.

Explanations of racism are part of a picture. It is important to develop a sophisticated and well-informed analysis of inequalities. This can be easily demonstrated in the article on perceptions of cancer. An explanation of the later than average diagnoses of cancer in African immigrant communities cannot be simply described the result of as a series of racist acts or racism. The article provides insight into which cultural values and perceptions affect uptake of services. However, Karlsen and Nazroo (2002) show through research that racism has a negative impact on physical health of racial minorities, including cancer. The toxic interaction paper emphasises the point made by Karlsen and Nazroo (2002), that the negative experience of racism does not require a specific episode of racism but an awareness of racism in wider society.

It is apparent therefore that a health and social care context that is censorial about the role of racism in ethnic inequalities detracts from the ability of service users to articulate part of the basis for their inequalities from their perspectives. It also limits the paradigms utilised by those involved in analysing problems. Racism needs to be understood in its broadest sense. People across the world are racialised (i.e. seen as belonging to discrete non-white racial groups and seen as “other”, with varying negative consequences). This process of racialisation serves the purpose of social and economic stratification. Despite the low-scientific utility of the concept of race (Fernando, 2003) the notion of race, as it is commonly understood, still plays a powerful role in the ways in which people are perceived. The legacy and consequences affect such things as migratory patterns; access to wealth (particularly capital); education; employment; lifestyle choices; personal interactions and policies and institutional behaviours that favour the most powerful and the majority. An understanding of the breadth of the manifestations of racism inevitably demands that some attention is paid to it in analysing health and social care inequalities. Let us hope that the insights provided by the articles in this issue will contribute to race and racism once again being seen as pertinent to analyses of inequalities so that responses of services may be appropriately informed.

Hári Sewell