3.3 Health and ethnicity
Clearly ethnicity, religion and culture have a great deal of influence on the way people view health. It was noted in the introduction to Section 2 that most of the early work was on health beliefs and that it was anthropological, focusing on ‘other’ cultures. Britain is a multicultural, multiracial society, yet attention to the perceptions of health held by minority ethnic groups within British society is only recently beginning to be paid. But if racist attitudes in health work are to be avoided we need to be aware of cultural differences in the ways that health is viewed. This is a complex issue as immigrant populations absorb many attitudes of the indigenous culture. As we move into second and third generations of immigrants the tensions and complexities of living in two cultures becomes difficult to disentangle.
Some studies are beginning to emerge which try to draw out the understandings of health held by specific minority ethnic groups in Britain. One such study was that of Greenhalgh, Helman and Chowdhury (1998). They interviewed 40 British Bangladeshi people who were recruited from three GP practices in East London which had high proportions of Bangladeshi people. Their study was primarily focusing on diabetes, but their findings were also informative about their respondents' general views on health.
They identified four specific perspectives on health.
That youth and health were viewed as virtually synonymous.
That large body size was generally viewed as an indicator of healthiness.
That balance was the key to good health where the notion of balance was very specific to the balance of food entering the body being balanced by emission of body fluids. In the context of diabetes sweat was thought to be particularly important because in the cold British climate people did not sweat enough.
That exercise has little cultural meaning in relation to health and in fact their language has no expression for physical activity in the Western sense of vitality and fitness. Their word for exercise has quite negative connotations. However ritual Muslim prayers were thought to be a health giving form of exercise.
However, Greenhalgh et al. also pointed out that ‘The similarities between Bangladeshi and non-Bangladeshi subjects were as striking as their differences’ (1998, p. 978).
Certainly the first point – an association of health with youth – is strong in Western culture. The association of largeness to health is somewhat different to the current Western obsession with thinness. But this has not always been the case. A big, bonny, bouncing baby was considered very healthy not very long ago in Britain. The association then was with material conditions where malnutrition was a far greater risk to health. In fact, Greenhalgh et al. point out that structural and material issues were as great an influence on how health was viewed as were ‘cultural’ ones.
A much larger survey of the health and lifestyles of black and minority ethnic groups in England (HEA, 1994) interviewed 3,549 people, including people from African-Caribbean, Black-African, Indian and East-African Asian, Pakistani and Bangladeshi communities. The main focus of the survey was on their state of health and their health behaviours, but they did draw some broad themes on how their respondents viewed health. They confirm that structural and material concerns were very influential:
Respondents tended to view health holistically; their definition appeared to encompass concepts of mental and spiritual well-being. Worries and anxieties were cited by many as being a cause of ill health, although factors contributing to this varied between first and second generation UK residents. For the first generation at the top of their list of ‘stressful’ factors were financial stability, housing, employment, children's future, loss of cultural values, isolation, and racism. For the second generation key factors were again employment and racism, but cultural conflict and education were also paramount.
(HEA, 1994, p. 8)
It is interesting that cultural conflict becomes an issue for second generation residents. The tensions and difficulty of holding both ‘traditional’ concepts of health based on values and meanings embedded in their culture of origin and more recently-acquired ones which draw on the host culture was also identified by Airhihenbuwa (1995), who was concerned with developing culturally appropriate health programmes. This highlights the importance of listening to people's accounts of health which are based on their knowledge and experience and not making assumptions based on stereotypical notions about how someone from a particular culture will view health. But it also raises the issue of how immigrants from other cultures influence the health accounts of the indigenous population. Certainly there has been a surge of interest in non-Western forms of therapy, and the notion of holism and balance is one which pervaded many of the accounts of health that we have encountered so far in this course. In the next activity you will hear from an English woman, living in Birmingham, who is married to an Indian man. She talks about experiencing two cultural views on health and the influence of her husband's family and cultural traditions on her.
Activity 5: Absorbing cultural differences
Listen to the audio clip, ‘Comparing two cultures’. Liz Thussu, who is an English woman married to an Indian, talks about the influence on her of her husband's family and their cultural traditions and views on health.
Note down what you think are the important influences on the way she sees health.
Transcript: Comparing two cultures
Liz talks about the emphasis on holism and balance in Indian culture and how this has affected their diet. She also notes the social support and companionship that is an important element in her husband's cultural tradition as opposed to the more individualistic Western view. But I think the most important influence on her has been to learn to trust her instincts and not discount ideas that do not conform to current Western scientific knowledge.