The previous sections outlined how health outcomes, socioeconomic circumstances and health behaviours vary across a range of ethnic groups. Yet the role of ethnicity has not yet been explored, so far serving as a convenient means to stratify these three elements according to a broad classification of ethnic group. An unrefined approach to defining ethnicity adds little to our understanding why differences between these groups might exist. This does not tell us about the various dimensions of an individual’s ethnicity which may hold clues to explaining inequalities. This section will now discuss how ethnicity is defined and explain why the categories commonly employed in health research inadequately capture the multidimensional nature of ethnicity. This will be concluded by a discussion of how measuring ethnicity over generations might aid our understanding of health differences between ethnic groups.
2.6.1 Constructing Ethnicity
Ethnicity reflects self‐identification with cultural traditions that provide personal meaning and boundaries between groups (Karlsen & Nazroo 2002). Factors commonly cited as most meaningful to an individual’s ethnic assignation include country or birth, ancestry and decent and a general common place of origin (Fenton 1999;Modood 1997a). Ethnicity might be considered in relation to a personal identity, an identity that is not innate or fixed, but rather it is ‘fluid’ and worked on or self‐constructed by groups and individuals, and liable to change taking on many different forms dependent upon the context (Ahmad 1996;Ahmad et al. 2002).
However, ethnicity is not entirely self‐constructed. The internally defined identity is in addition to, and possibly in response to, the externally imposed social identities (Jenkins 1997). Ethnicity can be considered relational where the externally imposed characterisation affects the experiences of living with that identity; and what it means to an individual in having that particular identity will vary according to the external audience. Therefore identity, and the lifestyles and behaviours associated with it, is constructed within social constraints (Nazroo &
Karlsen 2003). These constraints may be structural barriers present in wider society, such as social class inequalities and differential opportunities between groups, or discriminatory attitudes experienced by specific groups. This can reinforce a sense of group cohesion and political affiliation in an attempt to counter such disadvantage (Modood 1997a) and may be at the expense of behavioural components of identity (Karlsen & Nazroo 2002). Therefore ethnic
identity is internally defined according an individual’s personal values and priorities, and is in response to external social or structural factors.
It is important that health research recognises such complexity of ethnic identities and should attempt to include an assessment of the social, environmental and political contexts. It is the location of ethnicity within these contexts that is responsible for experiences leading to the patterning of health (Ahmad & Bradby 2007). Unfortunately the research tools available in survey data for defining ethnicity remain crude. The classification systems are ‘widely agreed to be unsatisfactory in both theoretical and practical terms’ (Bradby 2003) as they are limited in ability to assess the dynamic relationship between ethnic identity and the structural factors with which it interacts. However, these tools are all that is available for the examination of these important inequalities.
2.6.2 Ethnic Group Classification Systems
Ethnic categories are commonly derived through the use of either fixed categories, self definition, or researcher defined identity.
The fixed response categories, as used in large scale surveys and the last two censuses in the UK, permits an individual to select an ‘identity’ from a limited selection (ONS 2008). This system reaffirms the outdated ideology that human groups are mutually exclusive, where ethnic groups are fixed entities and can be simply distinguished from one another, thereby supporting a racialised view of humanity (Bradby 2003). Nazroo (1998) describes how this ‘untheorised’ and empirically driven approach essentialises ethnic groups and assumes they represent homogenous racial and cultural groupings, to apparently provide useful markers of genetic and behavioural risks (Nazroo 1998;Nazroo 2001a). Differences between groups are then assumed to be a result of cultural or ethnic effects, despite neither of these factors being measured.
Therefore the unexplored and fixed notions of ethnicity implicit within these categories leads to the incorporation of racial essentialism within explanatory processes (Ahmad 1994;Smaje 1997).
Importantly for a generational investigation of ethnic inequalities, fixed classifications provide little scope for mixed or multiple identities; a limitation that will only increase in significance.
For instance, the introduction of mixed category at the 2001 census led to many Black Caribbean and Black African people changing their choices from the 1991 census (Platt et al.
2005). This suggests that the provision of fixed categories fails to adequately reflect the overall target population (Rankin & Bhopal 1999).
Self‐assigned identities using free‐text can overcome some limitations of fixed categories. While self identification allows individuals to express complex and hybrid identities more easily, the practical aspect of survey analysis requires the re‐coding of responses into broader groups, and therefore reintroduces the notion of fixed categories.
Lastly, researcher defined identity can be determined through proxy variables for ethnicity, such as country of birth, languages spoken or religion. Consequently it is possible that self‐defined and researcher defined identities may differ. However, this is a more refined means of measuring ethnicity, where multiple indicators of ethnic group can be called upon by the researcher. By considering how each indicator of ethnic group status (e.g. country of birth, family origin) is reflective of an underlying construct, such as lifestyles, religion, culture or socioeconomic circumstances, it is possible to build up a picture of those dimensions of ethnic identity which are the likely true mediators of ethnic differentials in health.
All of these classification systems are limited in their ability to capture accurately the dynamic, relational and contextual nature of ethnicity. The challenge, then, is to find a way of conceptualising ethnicity in a meaningful way which reflects people’s life experiences and avoids reifying differences between groups, but is flexible enough to describe populations as their characteristics shift over time (Bradby 2003). Due to the limitations of survey data collection, this study will use self‐defined ethnicity, which is based upon family origins chosen from a list of fixed categories. However, this project will significantly build upon these simple labels, and examine what they mean in terms of structural factors, such as socioeconomic circumstances, and will incorporate the contextual influences of migration effects. These ethnic categories will also be explored in terms of cultural identities by measuring health related behaviours. This allows us to address a number of important questions concerning the fluidity of ethnic identity and its influence on health. By detailing the shifting patterns of ethnic identity over generations it will be possible to identify those factors most significant for the formation of health differentials between groups.