Kamaldeep Bhui
The new science of cultural epidemiology to tackle ethnic health inequalities
Queen Mary University of London
bhopal provides important timely paper census categories ethnic groups recently revised explicit emphasis public health approaches managing ethnic inequalities health status providing effective interventions reduce inequalities shift policy addressing inequalities social inclusion broader equalities agenda race one component also relevant policy development paper challenges paper also proposes cultural histories recent experiences individuals groups ignored understanding inequalities bhopal argues shared understanding professionals public alike desirable necessary reduce inequalities achieving shared understanding topic often emotionally charged value neutral difficult premise paper racismfree social environment necessary backdrop making use routine data unlikely achievable ever refined forms individual structural prejudice racism existed societies far back human history unlikely disappear different approach racism prejudice part human condition inevitable also emerge intergroup tensions either face scarce resources simply relatively isolated groups interact isolation may cultural linguistic economic psychological geographical lack knowledge understanding alienation may used justify sorts wellintentioned treatment social structures generate sustain inequalities science although purports objective value neutral untarnished history examples scientific racism failures logic may still emerge therefore professional responsibility manage processes evident order minimize inequalities professionals also active improve literacy around discrimination prejudice investigate manifestations mechanisms inequalities racism health care debate evidence based challenge convenient ineffective policy responses therein lies challenge evidence takes many forms must provide clinical policy guidelines evidence strong practical evidence relate realworld situations rather remaining form complex statistical models numerous methodological limitations including residual confounding insufficient power investigate interactions poor definition ethnic groups factors may explain ethnic inequalities issue misclassification ethnic group remains important problem researchers although move improve precision ethnicity categorization balance utility ethnic misclassification major issue routine data well hypothesesdriven research matter many ethnic categories generated assumptions approximating ever complex ethnic identities process fundamentally imperfect new categories included census options ethnic coding still ascribed identities assumed meaningful category may never capture individuals experienced identity notion aspire minimize risk lowest risk group good one however acculturation influences health risks time important resident host population well migrant population process classifying people basis ethnicity alone neglects numerous variables including identity acculturation religiosity integration acceptance host values lifestyle cultural identity influences consumption patterns govern forms social support gender disadvantage access employment