ABSTRACT
There is a debate about how we should characterise the differences between groups in contemporary societies such as England. It is clear to the eye of any observer on the street, in hospitals or in people’s homes that there are many differences between people in present-day England, but what differences should we pay attention to and how should we characterise those differences? As with all observation, what we see depends on the theoretical framework or sensitising notions we start with. But that is not to say that what we see depends purely on a technical decision about which theoretical concepts we decide to use to see with; there are also political considerations which influence the choice of concepts and the meanings we ascribe to them. For analytical purposes it is important to clarify what political perspectives attach to the words ‘race’ and ‘class’ on the one hand and culture and ethnicity on the other, but this is also important for practical purposes in relation to how we explain the links between these concepts and health. This chapter will argue that there is both theoretical validity and practical usefulness in using the concepts of culture and ethnicity in understanding differences in health. One broad way in which we can characterise the debate about how we should view the differences we can see is to say that the debate is between those who argue that there are broad similarities which are shared by all those people who are non-white and those who argue that there may be significant differences between the many ethnic groups within the whole range of non-white and white groups. Those who put forward the former view claim that because of the racism that non-white people experience, the position of all black people in
terms of their economic position, life chances and health is likely to be similar, and also poorer than the economic position, life chances and health of white people living in England (Kushnick 1988). Those who say that they see diversity and a range of ethnic groups do not deny that many of these ethnic groups experience racism and have the similar experiences of structural pressures, which affect their life chances, economic position and health, but they suggest that the culture of these groups may also be important in influencing how they respond to and manage their situation. They would also argue that ethnic groups are not necessarily defined by their colour. The attempt to equate ethnic minority status with being ‘black’ seems to stem from a crude Marxist position and a form of classification which glosses over many differences between groups in order to achieve a political unity around what is seen as a ‘real’ similarity of economic interest, as opposed to a concern with superficial differences of culture (Modood 1994). The view taken here will be similar to that expressed by Rex (1986) who describes his position as being Weberian. He argues that:
Class theory can and should be supplemented by the theory of ethnicity. At the same time, the theory of ethnicity should recognise that collective ethnic organization may lie dormant and only become activated by the emergence of shared interests.
