Ethnicity culture and healthcare need

Services aimed at minority ethnic populations are all too often developed on the basis of conspicuous morbidity than on any real understanding of the diversity of ethnic minority communities and their wider health needs. Thus while much has been written about ethnicity and psychiatric morbidity, the literature remains largely focused on African-Caribbeans and Asians, with other groups being rarely discussed. The Irish, for example, comprise the largest ethnic community by migration in many London boroughs yet their needs are seldom explicitly addressed despite evidence of high rates of suicide and unexplained death that is many times in excess of the indigenous population.'!.) Increasing morbidity among African immigrants has attracted much commentary but only piecemeal approaches to service delivery, as have the growing numbers of asylum seekers and refugees across Europe.

A proper consideration of the health-care needs of minority populations ought to take account of the interaction of ethnicity and culture with the myriad of wider social determinants of illness and help seeking—gender, family structure, socio-economic status, housing conditions, and employment as well as expectations of health care. But most discussions of service provision bypass this complexity and focus instead on crude ethnic categorizations based largely on skin colour and associated assumptions of immigration and stereotypes of alien cultural practices.

Members of minority ethnic communities generally do worse that the majority population across a broad range of measures of social disadvantage, with higher levels of poverty and material deprivation overall. There is no doubt that social disadvantage and racial prejudice are pivotal in determining the mental health of minority populations though there is little reflection of this fact in modern mental health services that have largely withdrawn from involvement in the provision of social care. While recognition of shared vulnerability across ethnic groups is important, so too is the recognition of the special needs of subgroups. The impact of migration, alienation, and issues of attachment for children and adolescents from minority ethnic groups is seldom acknowledged in service design. African-Caribbean patients, for example, report significantly higher rates of separation from parents in early life and the highest rate of young people living alone, both risk factors for mental ill health. At the other extreme of life, demographic trends mean that the numbers of minority ethnic elders are increasing while contrary to the stereotypical view of family self-help, expectations are changing towards increased demand for assistance from statutory services. The seeming inability of service providers to recognize similar and differing needs is part of the racism that minority ethnic people encounter and a major contributor to the under-utilization of mental health services.

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