Relationships between ethnicity, racism, class and health Saffron Karlsen Department of Epidemiology and Public Health University College London

2 Outline Ethnic differences in health Common explanations Effects of racist victimisation on health social class ethnic and community awareness

3 Ethnic differences in reported fair or bad general health in England Source: Health Survey for England 1999

4 Explaining the relationship between ethnicity and health Genes Attitudes and behaviours Environment Racism Social class Identity

5 Ethnoreligious differences in reported fair or bad general health in England (women only) Source: Health Survey for England 1999/2004

6 The impact of racist victimisation on health Direct health effect Social exclusion Social disadvantage Environmental disadvantage Self perception Community development

7 Experiences of interpersonal racism and health controlled for age, gender and household occupational class Karlsen and Nazroo (2002)

8 Experiences and perceptions of racism and health controlled for age, gender and household occupational class Karlsen and Nazroo (2002)

9 Fear of racism and health controlled for age, gender and household occupational class Karlsen and Nazroo (2004)

10 The impact of racist victimisation on health Direct health effect Social exclusion Social disadvantage Environmental disadvantage Self perception Community development

11 Ethnoreligious differences in reported fair or bad general health in England (women only) Source: Health Survey for England 1999/2004

12 Feeling ‘British’ and perceived racism in Britain odd ratios, controlled for age, migration and socioeconomic status. Ethnic minority men only. Source: EMPIRIC (2002)

13 Not being ‘accepted’ as ‘British’ [People] judge you the minute you walk into a room, they have certain expectations of you and how they… expect you to behave I’m English, that is my number one culture…I may not be accepted but my culture is English I always Pakistani…you can’t change…if I go out people won’t say I’m English, they will say, “oh you’re Asian… you’re coloured” Karlsen (2006)

14 Common stigma as source of group identity How long have Black people been in this country and you’re still going on with this crap [distrust]?…but this is what people put on us [Black people], this stigma It happens all the time as a Black person…I know to expect it really Every person with colour has to learn…to restrain [from reacting to harassment] Karlsen (2006)

15 Racism as part of everyday life it's very, you know, downhearting because…you're not appreciated and that is very sickening…[but] you can't just shut [the shop] and say, well, I'm going home because I'm getting abuse...you've got a family to feed …it was just accepted as it happened. You got used to being abused Karlsen (2006)

16 Being ‘let down by the system’ Society tends to close their eye to some of the racism that goes on Black people are not going out there [and voting] because no matter what they do nobody listens It doesn't matter if the system isn't helping you - we help ourselves… as a group: if one is stuck we'll ask each other and then we'll find out where to go [how to help] Karlsen (2006)

17 Acknowledgements: James Nazroo ESRC Department of Health HSE, EMPIRIC and ME teams

18 Religious differences in indicators of racism Source: Health Survey for England 1999/2004

19 The impact of racism on feeling at home in Spain among Moroccan Muslims living in Madrid Source: Muslims in Europe Study 2004