The impact of racism on the health and well-being of ethnic minority people

1. The impact of racism on the health and well-being of ethnic minority people Professor James Nazroo Sociology, School of Social Sciences james.nazroo@manchester.ac.uk

2. Ethnic differences in reported fair or bad health Health Survey for England 1999

3. Ethnic inequalities in health: race and racism • Genetic/biological differences • Racism: exclusion and harassment • Migration effects: context, health selection, impact of migration • Lifestyle: culture • Socioeconomic position: material disadvantage, geography • Access to and quality of healthcare

4. Racism and health • An ideology of superiority, a belief that some races are superior to others, justifying institutional and individual practices that create and reinforce oppressive systems of race relations and inequality between racial, or ethnic, groups, so creating a racialised social order. • Reflected in racist interpersonal behaviour, and institutional polices and formal and informal practices, including everyday ‘minor’ incidents • Leading to: • Economic and social deprivation • Exposure to environmental hazards • Socially inflicted trauma (experienced or witnessed) • Targeted promotion of unhealthy consumption • Inadequate health care

5. Experiences of racism and discriminationin England and Wales • One in 8 ethnic minority people experience some form of racial harassment in a year. 3% experience physical attack on themselves or their property. • Repeated racial harassment is a common experience. • 25% of ethnic minority people say they are fearful of racial harassment. • 20% of ethnic minority people report being refused a job for racial reasons, and almost 3/4 of them say it has happened more than once. • 20% of ethnic minority people believe that most employers would refuse somebody a job for racial reasons, only 12% thought no employers would do this. • White people freely report their own prejudice: • One in four say they are prejudiced against Asian people; • One in five say they are prejudiced against Caribbean people. FNS: Modood et al. (1997)

6. Ethnic differences in experiences andperceptions of discrimination (2) Karlsen et al. 2005

7. Racialised socioeconomic inequalities • Lower incomes • Lower status occupations • Poorer employment conditions • Higher rates of unemployment and longer periods of unemployment • Poorer educational outcomes • Concentrated in economically and environmentally depressed areas • Housing tenure • Poorer quality and more overcrowded accommodation

8. Ethnic differences in equivalised household income in England Health Survey for England 1999

9. Racial harassment and health Karlsen and Nazroo 2002, Karlsen et al. 2005

10. Experienced discrimination at work and health Harris et al. 2006a

11. Any racist attack or discrimination and health(verbal or physical attack, discrimination in workplace, housing, and healthcare) Harris et al. 2006a

12. Believe most employers discriminate and health Karlsen and Nazroo 2002, Karlsen et al. 2005

13. Cumulative effect of exposure to racism:fair or poor health in New Zealand Harris et al. 2006a

14. Fear of racism and health • Racism need not be personally experienced to produce threat, because it can be viewed as (and is) an attack on a community as a whole. • People living in a climate of fear and insecurity may adapt by constraining their lives to avoid vulnerable situations, a response that may lead to stress. • Do you worry about being racially harassed? By racially harassed, I mean being insulted or physically attacked, or having property damaged for reasons to do with race or colour? • 23% of ethnic minority people in England and Wales say ‘Yes’ to this • And those who say yes have an odds ratio of 1.61 (1.24 - 2.09) for reporting fair or poor health

15. Racism, discrimination, occupational classand health: independence of effects Racial harassment Do employers discriminate? Occupational class (Karlsen and Nazroo 2002)

16. Explaining ethnic differences: fair or poor health Harris et al. 2006b

17. ‘Ethnicity’, identity and racialisation The boundaries of ethnic groups are symbolically represented – as the bearers of a specific language, religion, or more generally, ‘culture’; but they are also materially constituted within the structures of power and wealth. Thus ethnicity should be regarded as materially and symbolically constituted. Fenton 1999 Racial and ethnic groups ... are discursive formations, calling into being a language through which differences are accorded social significance, and by which they may be named and explained. What is of importance for social researchers studying race and ethnicity is that such ideas also carry with them material consequences for those who are embraced by them and those who are excluded from them. Solomos 1998 The contextual nature of this, and the operation of structure and agency, is clearly seen if we consider the ways in which white minority and Muslim identities have transformed over the last few decades

18. Concluding comments • Ethnic differences in health have been repeatedly documented • Explanation is typically focussed around essentialised notions of ethnicity/race, neglecting the social character of ethnic identities • Differences in health across ethnic groups are more appropriately understood as the product of social inequalities • But, we need to move beyond statistical correlations – inequalities associated with ethnicity can only be understood as a consequence of structural processes and social relations • Racism, and understanding racism, is central to this • Limited empirical models • Need to understand context and agency: for example, period/cohort effects (baby-boomers/60s generation), social class, generation, resistance (community/civic action/social support)