Health is everywhere: Unravelling the mystery of health
Health is everywhere: Unravelling the mystery of health

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Health is everywhere: Unravelling the mystery of health

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.

  1. That youth and health were viewed as virtually synonymous.

  2. That large body size was generally viewed as an indicator of healthiness.

  3. 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.

  4. 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)

Figure 4
Figure 4: A group of young people in multi-cultural Britain

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

0 hours 15 minutes

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.

Download this audio clip.
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Transcript: Comparing two cultures

You will hear from Liz, who has married into an Indian family. She talks about how her views on health have been influenced by her husband and his family.
Health is not viewed as something difficult, or broken down into lots of different problems. There's a much more holistic approach, you know, about your general life … the way you live your life, especially to do with diet. It’s not a question of having access to huge resources. But, even the diet of the poorest people in India is probably more nutritious and better than here. And they're very concerned about, you know, having balanced elements in their diet, and how they eat and how they cook …and eating fresh food, never eating processed food.
That is, you know, very important … that your basic … the way you live your life … you should work hard, you don't have to keep fit or take exercise, you just work hard at what you do in normal life, and you eat well. You know, if you are concerned about big issues of life but you don't worry about little things, and you trust your instinct and intuition. And women, for example, in pregnancy … there are things that you eat that are very nutritious … and you take care of yourself, and you're taken care of by the family. After childbirth you don't do anything. The family look after you and you're given very nutritious soups made with milk, and so on. And you have all these things that actually keep you well, because the western medicine is very expensive. And they look after you as a whole person, and give you social companionship … and help and support in many practical ways, which I think a lot of these things are missing and have to be bought in or constructed here.
So I think there's a huge difference in regards of mental health as well. And that is very deeply culturally different, because of the attitude towards individualism. I've learned very much how to trust my instincts with regard to things like health and parenting. But, occasionally, we do have differences because, say … well, you know, science says this, and then there are things which are sort of folk wisdom … and my mother-in-law has all sorts of things to do with health and nutrition and what is good for you, and what is bad for you equally, which don't seem to bear any relation to any scientific investigation. But I'm sure they all sound like common sense and they probably are right.
And I think they still maintain … and they still have a whole fount of folk knowledge which, when it is investigated, is usually found to have some meaning in it, which they've still got … which science has actually deprived us of. And we're taking … you know, our rights to knowledge have been taken away by making into expertise.
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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.


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