Peter J. Aspinall

Collective terminology to describe the minority ethnic population: The persistence of confusion and ambiguity in usage

A wide range of terminology is used, often interchangeably, to describe the minority ethnic group population as a whole and major segments of it.While some terms have been extended to give clarity, as in ‘Asian, Black and other minority ethnic’, much in this lexicon remains cumbersome or ambiguous in usage. Further, white minority groups such as the Irish frequently get omitted in the category shuffle, creating ‘injustices of recognition’. Imprecision in terminology can equally apply to ‘pan-ethnic’ terms like ‘Asian’ and ‘Black’, the specific terms having the potential to describe quite different populations in the absence of explanation about the concept being measured and method of assignment. The use of terminology that is precisely defined and acceptable to those being described is advocated.

The conceptualisation and categorisation of mixed race/ethnicity in Britain and North America: Identity options and the role of the state

Estimates of around 1.7–2.4% of the population in the USA, 2% in Canada, and 0.6% in Britain now self-identify as mixed race. Inter-ethnic unions comprise around 2.7% of all unions in the USA and 1.3% in Britain and are increasing. The impact of these changes on the ethnic/racial diversity of Britain and North America and the demand from persons of mixed race to describe their ‘full’ identity requires a response from government and Census agencies that classify the population by race/ethnicity. Most current terminology to describe the mixed race population is contested and there is limited agreement on how it should be included in classifications. Research studies show that the self-understandings of persons of mixed race may incorporate a range of identities, some biracial and others a single group like ‘black’, although the options available in the USA may still be limited by the legacy of the hypodescent policy. The solutions offered by classifications in the 2000/2001 round of censuses include a subdivided ‘mixed’ category in England and Wales and provision to select one or more categories in the USA. This marks an end to the official conceptualisation of ‘pure’ races that has been so pervasive in the past and, for the first time, offers mixed race identity options to those of mixed heritage. Classifications need to satisfactorily allow for hybridised identities representing allegiances to multiple groups as opposed to a method that implies an outcome from two putatively ‘pure’ categories, the latter being the method chosen in the England and Wales Census.

Approaches to Developing an Improved Cross-National Understanding of Concepts and Terms Relating to Ethnicity and Race

Investigators from the fields of comparative social and epidemiological research have identified the need for an improved cross-national understanding of the concepts and terms relating to ethnicity and race. Suggestions have included the harmonization in surveys of variables like ethnicity and religion in a comparative European context and an internationally applicable and agreed glossary of terms relating to ethnicity and race. Pleas have been entered for work towards such goals, involving statistical offices and institutions in the European Union and bodies like the World Health Organization and International Epidemiological Association. This article examines how the conceptual bases of this terminology, issues of geographical specificity and the problem of which terms merit recognition impact on these goals. Different approaches to improving our understanding of this terminology in a cross-national context are explored. Given that the meanings of concepts and terms in the field of ethnicity and race invariably can only be understood in their national context of use–which is frequently layered, manifold, subtle and complex–an approach that explores the connotative reach of the different concepts and terms within this context is needed. Functional equivalence is more likely to be achieved by harmonization than the systematization of such knowledge through the economical form of a glossary of synthetic analytical terminology. However, given the socially and psychologically driven nature of ethnicity as a ‘global’ concept, harmonization may only be successful when limited to its multiple dimensions.

Why poor quality of ethnicity data should not preclude its use for identifying disparities in health and healthcare

Background: Data of quality are needed to identify ethnic disparities in health and healthcare and to meet the challenges in governance of race relations. Yet concerns over completeness, accuracy and timeliness have been long-standing and inhibitive with respect to the analytical use of the data. Aims: To identify incompleteness of ethnicity data across routine health and healthcare datasets and to investigate the utility of analytical strategies for using data that is of suboptimal quality. Methods: An analysis by government office regions of ethnicity data incompleteness in routine datasets and a comprehensive review and evaluation of the literature on appropriate analytical strategies to address the use of such data. Results: There is only limited availability of ethnically coded routine datasets on health and healthcare, with substantial variability in valid ethnic coding: although a few have high levels of completeness, the majority are poor (notably hospital episode statistics, drug treatment data and non-medical workforce). In addition, there is also a more than twofold regional difference in quality. Organisational factors seem to be the main contributor to the differentials, and these are amenable—yet, in practice, difficult—to change. This article discusses the strengths and limitations of a variety of analytical strategies for using data of suboptimal quality and explores how they may answer important unresolved questions in relation to ethnic inequalities. Conclusions: Only by using the data, even when of suboptimal quality, and remaining close to it can healthcare organisations drive up quality.

Is the standardised term 'Black African' useful in demographic and health research in the United Kingdom?

Objective. The main objective of this paper is to review the literature on the term ‘Black African’ with respect to a number of themes: its use in the census and official data collections; the acceptability of a colour-based term; the heterogeneity concealed within the ‘Black African’ collectivity; the invisibility of distinct populations; the concealment of disparities in health, health care, and determinants; the capture of ‘Black Africans’ in other countries; and a set of possible alternatives for classifying this population. Design. Structured searches were undertaken on a wide range of government and other grey literature sources and on two biomedical databases (Medline and EMBASE), using combinations of search terms for the collectivity and specific national origin groups. Results. Analyses of the data show that the term ‘Black African’ conceals substantial heterogeneity with respect to national origins, religion, and language. It includes many who have come to the UK since the 1960s from former colonies but also sizeable groups arriving as refugees and asylum seekers from a wide range of African countries. Moreover, its boundaries are fuzzy, especially with regard to those originating in Horn of Africa countries. Marked variations are found in the (albeit limited) available disaggregated data on health and the determinants of inequalities. Conclusions. Given the substantial increase in the size of the group, the extent to which such heterogeneity can continue to be tolerated in a single term must be questioned. The ‘Black African’ collectivity merits categorisation that addresses this issue and the proposed regional subdivisions in the Scotland 2006 Census Test currently offer the best solution.

The new 2001 Census question set on cultural characteristics: is it useful for the monitoring of the health status of people from ethnic groups in Britain?

The health of minority ethnic groups has been accorded a priority position in the British governments strategy to improve the populations health, including the provision of the necessary information to address inequalities. The independent Acheson Inquiry has also called for improvements in the capacity to monitor inequalities in health of ethnic groups which requires the use of appropriate ethnic group categories. The new 2001 Census question set includes a substantially revised ethnic group question and a new question on religion which address some of the shortcomings in the 1991 Census question. However, the token breakdown of the white group and its unsatisfactory capture of those of Irish origin, the use of Indian subcontinent groups that ignore ethno-religious differences and have little saliency amongst those being described, and the omission in Scotland of a subdivided white group and the religion question, are important deficiencies. The use of a few pan-ethnic racial groups in the proposed census tables is a major drawback. It is important that these changes are widely debated.

Language ability: a neglected dimension in the profiling of populations and health service users

Britain is becoming an increasingly diverse society in ethnic, cultural, and linguistic terms. Race equality as a matter of governance has gained momentum through legal developments and prioritization in policies. However, ethnic inequalities in health and healthcare are marked and persistent and language has been identifi ed as a key barrier to accessing services and effective communication. There is, for example, currently substantial under use of NHS Direct, Englands telephonic health and information service, by non English-speaking callers. It is surprising, therefore, that there are no offi cial sources of comprehensive information for the UK population on main spoken languages and competency in English. While such questions are routinely asked in national population censuses in the USA and Old Commonwealth countries, in the UK these are conspicuously absent from the decennial censuses, most of the major Government social surveys, nearly all NHS core datasets, and ethnic monitoring in primary care. The NHS Resource Allocation Weighted Capitation Formula now uses data on language diffi culty 10-15 years out of date. The upcoming 2011 Census offers an important opportunity for NHS organizations to secure the comprehensive national and small area data required to establish the need for language support services, including bilingual support and interpreting and translation provision.

The challenges of measuring the ethno-cultural diversity of Britain in the new millennium

During the next 50 years the ethnic diversity of Britain will increase in response to growing intermarriage, differential rates of natural increase, and continuing migration flows, especially of refugees. While religion is assuming a greater importance in the social identities of some minority ethnic groups, in others it is being displaced by an ethnic focus. In the upcoming decades the increasing sovereignty that people attach to self-identifiers and the demand for finer distinctions to accommodate hybridisation and generational changes will present substantial challenges to statistical agencies. New conceptual approaches are needed to capture this diversity and give service providers the robust data required to promote equal opportunities.

Suicide amongst Irish Migrants in Britain: A Review of the Identity and Integration Hypothesis

Background: Studies have consistently reported higher rates of suicide amongst Irish migrants in Britain than in the population as a whole. Leavey offers a hypothetical model to explain such rates that incorporates lack of social cohesion and integration meshed with the inability to establish an authentic identity and other contributory factors. Material: Systematic review methodologies are used to examine the central tenets of this explanatory framework. Some of the macro-level ecological associations in the model are critically evaluated in the context of findings from the 1991 Census and government social and household panel surveys. Discussion: The evidence base suggests that statements on social isolation and reluctance to use health care services are questionable and Irish migration is shown to be much more heterogeneous than the model suggests. Only small positive, and as yet unreplicated, associations have been established between identity and health behaviour in a non-representative sample and evidence is lacking of Irish stoicism and anti-Irish racism as putative risk factors. Epidemiological studies show that adjusting suicide rates for social class explains virtually none of the excess in Irish migrants, although higher risks for unmarried persons are reported. Explanations in the literature for higher rates of migrant suicide are discussed. Conclusions: Studies based on individual-level analysis and record linkage are urgently needed to explain the high rates.

Answer Formats in British Census and Survey Ethnicity Questions: Does Open Response Better Capture ‘Superdiversity’?

During a period of unprecedented ethnicity data collection in Britain, an almost universal characteristic of this practice has been the mandated use of the decennial census ethnicity classifications. In Canada and the USA a greater plurality of methods has included open response, now recommended for the 2020 US Census. As the ethnic diversity of Britain has increased, driven by immigration dynamics and population mixing leading to ‘superdiversity’, the census is no longer able to capture the new populations. The validity and utility of unprompted open response is examined in several ‘mixed race’ datasets. It is argued that open response can be a modus operandi for large-scale ethnicity data collection and that the lack of consistency in recording of such responses need not necessarily be viewed as a drawback. Open response offers substantial insights into the country’s superdiversity in a way that ethnicity categorization alone cannot.