Ethnic Relations Examine the major health concerns for Asian and African descent individuals and communities in the UK. The discussion of health concerns
Ethnic Relations
Examine the major health concerns for Asian and African descent individuals and communities in the UK.
The discussion of health concerns in relevance to those who are of African or Asian descent living in the UK is one with many underlying issues. There are many different perspectives people may take on the issue depending on their own experiences and to a degree their upbringing. For example somebody from a white middle-class background will have a different opinion on the issues regarding this subject then someone of Afro-Caribbean descent living in a working class area.
Research on the subject of health concerns for ethnic minorities in the UK is often flawed due to the fact that a variety of different ethnic groups may be classed under the same category. This problem was highlighted in the 1991 census which included questions on ethnic groups and respondents were asked to categorise themselves into eight different groupings or a final grouping of "other" in which they were asked to specify. The definitions of ethnicity were based on a mixture of terms such as skin colour, national origin, self-definition and religion all of which seemed important aspects of defining difference in modern Britain. However , many people opposed this. One objection suggests that categories such as "Indian" are oversimplified and contain a range of sub-cultures and other groupings in one single category.
A study conducted by 'The Bolton Drug Action Team' showed that there are a number of issues about staff competence and confidence in collecting ethnic monitoring data and the subsequent ability of agencies to analyse the data. This means that there are no clear mechanisms at the DAT level to monitor and evaluate work in relation to South Asian or African communities and it is therefore difficult to comprehensively assess the current level of support for these communities. The degree to which equal opportunities policies were understood and implemented within the drugs agencies was identified as a significant factor. In particular the research found that staff groups shared little or no ownership of the development of equality strategies within agencies and that there was a low level of awareness or knowledge about existing polices. often such policies are seen as little more than paper exercises, they are not subject to regular review and agencies are not required to demonstrate that they are implementing the policies effectively.
One area of concern which arises from this topic is that of the health beliefs held by various Ethnic groups and the impact of these beliefs upon their daily lives. Morgan (1996) emphasises a concern with these health beliefs by studying small samples of Afro-Caribbean patients suffering from 'hypertension', which is commonly known as high blood pressure. She studies the way these patients define and explain the condition and how consequences such as dietary and activity restrictions are interpreted. She noted that many of the views appear to be heavily influenced by people's origin in the Caribbean particularly concerning the use and dangers of certain foods and dietary advice from GP's. Morgan compares the views of Afro-Caribbean and white patients and notes that both groups regard stress as the major cause of their ill health.
The latest study from the Policy Studies Institute clearly states that members of ethnic minority groups, particularly, Pakistani and Bangladeshis, are 50% more likely to suffer from ill health than their white counterparts. With this in mind it is vital to understand cultural differences when studying health. Peoples meanings and beliefs can be better understood by listening to their own accounts on health (Nazroo, 2001). This is emphasised by several studies conducted to stress the importance of communication between professionals in the health services and the actual patient. The Race' and Public Policy Research Unit 1996 showed that the misunderstanding or lack of communication between doctors and patients of differing cultures is often used as an explanatory factor for poor health amongst minority groups. The misinterpretation of information received from doctors is largely evident amongst differing cultures due to the language barrier between them. For example the language barrier between doctor and patient applies if the patient is from a different culture and class.
As previously stated , Morgan studied a small group of Afro-Caribbean and white patients diagnosed with hypertension and the meanings of this to the individual. The process of making sense of an illness and assigning personal meanings to it involves different sources of information and interpretation which may conflict with each or overlap (Nazroo, 2001). Common images and patterns of beliefs in society are conveyed by media and family and friends. An understanding of the meanings of medical conditions amongst differing groups is crucial in promoting communication between doctors and patients. Also ensuring that the information provided by ...
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As previously stated , Morgan studied a small group of Afro-Caribbean and white patients diagnosed with hypertension and the meanings of this to the individual. The process of making sense of an illness and assigning personal meanings to it involves different sources of information and interpretation which may conflict with each or overlap (Nazroo, 2001). Common images and patterns of beliefs in society are conveyed by media and family and friends. An understanding of the meanings of medical conditions amongst differing groups is crucial in promoting communication between doctors and patients. Also ensuring that the information provided by health professionals accord with peoples needs and concerns.
The main stimulus for Morgan's research arose from a GP's concerns regarding the difficulty he experienced in communicating with his Afro-Caribbean hypertensive patients and controlling their high blood pressure effectively. This ultimately raises questions regarding the existence of cultural barriers arising from differences in cultural responses to this condition among Afro-Caribbean people compared to the 'lay' population.
People who classify themselves as Black-Caribbean form the second largest ethnic minority group in England and Wales. According to the 2001 census, the black-Caribbean population consisted of 565,876 people (www.statistics.gov.uk). The largest migration of people from the Caribbean occurred from the mid 1950's to the early 1960's during a period of labour shortage in Britain. Afro-Caribbean people aged 40+, who are the majority of the hypertensive patients, thus consist mainly of people who grew up in the Caribbean and came to Britain as young adults during this period of migration. This is significant because they have retained aspects of their traditional cultural beliefs and behaviours, such as the widespread use of herbal remedies amongst some sections of this group.
Individuals from these different backgrounds may find that they have different explanations for different diseases based on the historical background of their culture. These theories may be very different then the scientific ones adopted by the UK, and therefore may have faith in herbal remedies instead of those that have been scientifically recommended..
The study conducted by Morgan covered the different aspects patients understandings of high blood pressure and its meanings in their lives. This was conducted with thirty Afro-Caribbean and white patients being treated for high blood pressure in Lambeth, London. The Afro-Caribbean population is the biggest ethnic minority group in Lambeth, compromising of 12.6% of the total population. All the interviews were taped recorded and lasted between 40 and 90 minutes. In the interest of fairness both ethnic groups also shared a similar economic situation.
The research found that as a group the Afro-Caribbean's had a high degree of integration into British society due to living in the country for 40-50 years. However the vast majority still maintained aspects of their traditional culture, including aspects of their diet and forms of worship (Nazroo, 2001). It also found that many of the Afro-Caribbean respondents did not take the blood pressure tablets as prescribed, and were found to have been more reliant on their traditional herbal remedies.
Morgan concluded that the respondents had an awareness of the significance of high blood pressure, in terms of its relationship with increased risks of heart attacks or strokes. However 80% of the Afro-Caribbean respondents were not very worried on the initial diagnosis. Many respondents simply believed that it "ran in the family" and that to suffer from high blood pressure was a "normality" or "to be expected" in their culture (Nazroo, 2001). So despite an awareness of the risks, many afro-Caribbean respondents did not feel threatened due to the familiarity of the condition amongst several family members.
A fact which supports the idea of a language or cultural barrier as a factor for health concerns is that a large amount of respondents were unaware that the word "hypertension" was another word for high blood pressure. The white respondents did identify with this word and understood the dangers associated with it. The lack of knowledge shown by the Afro-Caribbean respondents is believed to reflect the GP's reluctance to use and explain this term, preferring instead to talk about high blood pressure.
Differences in responses between ethnic groups related differences in the relative risks. For example, Afro-Caribbean respondents identified stroke as a higher risk factor, this accords with its greater prevalence among the afro-Caribbean population.
It seems as , although the Afro-Caribbean respondents have lived in the UK for almost half a century, they still appear to hold traditional beliefs and views of their medical condition and have a folk model of their condition as opposed to a medical model. It seems that GP's either are ignorant to this fact or choose to ignore it as otherwise more work would be done to combat this lack of awareness.
So far I have mainly talked about health concerns in the medical world faced by those from ethnic backgrounds. However one of the major concerns for people from an ethnic background is that of drug use. Drug use can be a cause for major health risks. It is true drugs such as Cannabis can be used for medicinal purposes and it is possible that individuals who feel as though they may not be receiving the proper care from their GP's may resort to these methods. "The influence of ethnicity on illicit drug use is an under-researched topic. Ethnicity is not a single dimension of experience but a composite of identity, beliefs, expectations, cultural history and language. Many of these components are liable to change over time across successive generations. In addition, there will be a degree to which ethnicity overlaps with other social variables including...unemployment. A necessary first step is to establish accurate information on the extent of drug use within different ethnic groups." (Advisory Council on the Misuse of Drugs (ACMD): Drugs and the Environment: 1998)
Research shows that the concentration of the most serious drug-related problems are in areas that are marked by high levels of unemployment and social deprivation (Haw, 1985 ), and it is in such areas that the majority of Black and minority ethnic groups tend to live. Indeed, drug taking patterns among Black and minority ethnic communities are found to be similar and in some cases more problematic than the white population (Ahmed 1997; Awiah et al, 1992; ).
Different drug using patterns have been identified between different ethnic groups, for instance, Heroin has been found to be the drug of choice among young South Asians, particularly Pakistani and Bangladeshi males (Perera. 1998) while Crack Cocaine use has been marked within African-Caribbean communities though increasing use of Heroin among Crack Cocaine users was also reported. (Perera et al 1993) and both solvent and Crack Cocaine use has been identified among South Asians (Chaudry et al, 1997; Patel and Sherlock, 1997; ).
This suggests that while there is some evidence of distinct patterns of drug use among different Black and minority ethnic groups the trends appear to be towards greater levels of experimentation across a wider range of substances. There are also significant concerns about injecting drug use within the South Asian communities as the dominant impression is that the pattern of Heroin use is that of smoking, though there is evidence of injecting and there are reportedly low levels of take-up of needle exchanges by this group (Patel et al. 1995, 1997).
Various reasons have been put forward, many concentrating on a select few key themes. These include: a lack of awareness about drug services within Black and minority ethnic communities; language barriers; lack of cultural sensitivity and understanding within agencies; ethnicity of drug agency staff and a lack of provision for Black and minority ethnic women. There is a general perception that drug services have poor equality strategies. Equal opportunity statements are seen to be inadequate in themselves (Adebowale et al, 1992; Shahnaz, 1993) and that more pro-active responses as part of wider anti-discriminatory strategies are needed. A whole systems approach that seeks to address inequality across all aspects of service delivery including training for managers and workers is recommended (Awiah, undated).
The national context is one of increasing evidence of drug use as would be expected given the concentration of communities in areas of high unemployment and deprivation coupled with the experience of both overt and institutional racism that inhibits use of services and prevents effective delivery of drug education and prevention initiatives. The general picture of services is that they are failing to meet the needs of Black and minority ethnic drug users and that there is a lack of coherent strategies and poor involvement of local communities in any action taken.
A review of current drug service provision for the south Asian community in Bolton taken by the Drug Action Team in June 2001 showed that, the provision of specific drugs education to the wider South Asian communities has not been delivered in a strategic and consistent manner. On the whole, South Asian communities have received little drugs education, although some drugs awareness raising work has been delivered on an ad hoc basis.
There is also evidence of increasing interest in delivering drugs education within religious settings though this highlights how the communities are attempting to address drugs issues within their own resources and outside of mainstream drugs education provision.
Given the remit and timescale of the service review, a thorough audit of drugs education within schools was not possible. However respondents highlighted a number of key issues related to drugs education in schools, that drugs education is not delivered consistently between schools and across pupils from different ethnic groups.
The responses of South Asian parents were identified by teachers as a factor in preventing the delivery of drugs education to South Asian children, though it is unclear how they are excluded from drugs education when it takes place and whether or not it is actual resistance among South Asian parents or anticipated responses that are causing these problems.
The report also concluded that drugs education resources do not reflect the diverse needs among children from different ethnic and cultural groups, in particular, language issues among South Asian parents and children are not sufficiently addressed .
It did not prove possible to access young South Asian women for interviews or focus groups however, community agency respondents reported increasing experimentation with drugs among young South Asian women and girls who they regarded as particularly vulnerable. Agencies dealing with domestic violence reported increasing drug use among young South Asian women accessing these services and there is little of no contact with drug agencies (Parker, 1995).
Respondents reported that there is little preventative education reaching this group on a range of issues such as drug use, sexual health and teenage pregnancy. Respondents also reported low levels of youth service provision targeting young Asian women and girls.
There was a general perception that stereotypical assumptions about South Asian young women and girls in particular i.e. they do not use drugs and are not sexually active has resulted in the poor levels of service responses.
It is very clear that there is a problem with drug use in these communities. This is a major concern for the health and well being of the individuals in these areas. A lack of initiative in dealing with this problem seems to be the main factor. A lot of assumptions have been made, and what seems to be a lack of understanding of different cultures, languages and backgrounds means that these young people are having trouble relating to the education being provided. As a whole the UK seems to have a lack of understanding as a whole, and it is this lack of knowledge within the country which seems to be the major factor for health concerns faced by Asian and African descent individuals and communities in the UK.
Bibliography
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