Introduction

The topic of Health and Ethnicity has become recognised increasingly as of relevance in modern m ulticultural societies. U ntil very recently the clinical a ttitu d e to diversity in m edical histories and conditions, due to ethnic differences, was generally viewed as due either to ‘racial5 attributes or to the problems of m igration across the globe, but there are serious problems with each of these simplifications. The problem with racial explanations is that they are based on the prem ise of biologically discrete races, which clinal patterns of gene frequencies show to be inaccurate. One of the difficulties with basing explanations on m igration is tha t in Britain it is still common to hear the term ‘m igran t5 used for people who have never m igrated but were born in the U n ited K ingdom , perhaps to p a ren ts w ith E nglish b irth c e r tif ic a te s . Such people m ay be asked w here th ey cam e from and ‘N ortham ptonshire5 is not the expected answer, but may be the reality. Yet, these descendants of earlier trans-global m igrants may show some of the same medical conditions as their m igrant forebears tha t may not be entirely genetic in aetiology. Little sensitivity was given to the complexity of the issue, for exam ple the genetic variation within and between sm aller subgroups of larger geographic categories, the many cultural differences from diet to m arriage preferences, and the psychological and socio-economic aspects that are so deeply intertw ined with ethnicity. W hen ‘cultu re5 was considered, it was generally by social anthropologists who were more likely to discuss health beliefs about diagnosis and remedy within the context of the whole cosmology of tha t social group than to explain how features resulting from these ideas might affect the biological condition. For these researchers, the ‘W estern5 biomedical sciences were frequently relegated to ju st another belief system, and the distinctive characteristic of W estern science, tha t it is always seeking to confirm or disprove earlier ideas, ignored. In this way those who could have provided useful insight into cultural factors affecting biology saw no point in doing so.W ithin the last 25 years, gradually increasing a ttention has been given to the topic, but it has been spread across different academic disciplines and so researched and reported in quite distinct styles with varying theoretical goals. Two roughly contem porary books, each well known in their relevant spheres,

illustrate the gap between two of the approaches. Social anthropologists and other social scientists were perhaps introduced to the topic by Helm an (1984), while the collection of papers edited by Cruickshank and Beevers (1989) was aimed at a more medical readership. Not only has this dichotomy continued but also there are significant sub-disciplinary and theoretical splits either side of the prim arily biomedical and the prim arily socio-cultural-political divide. The la tte r multiplicity, mostly within social anthropology, is well described by Sargent and Johnson (1996) in th e ir Handbook o f Medical Anthropology, where ‘anthropology’ refers only to social anthropology and the words ‘gene’, ‘genetics’, ‘m ultifactorial’ and ‘inheritance’ do not even appear in the subject index.It is in contrast to the above segregationist approach and in an a ttem pt to bridge the gaps caused by specialisation into sm aller and sm aller units of academic endeavour, that contributors to this volume were chosen. O f course, the editors and contributors do not and cannot aspire to present the whole picture or even unite the contributions into a seamless tapestry, but by the juxtaposition of chapters by specialists in quite different areas of knowledge, we hope to dem onstrate the diversity of angles significant to all who are in terested in any one of the perspectives. The book is generally aim ed at explaining the diversity in ‘biomedically’ m easurable health conditions due to determ inants and factors that can be called ‘ethnic’.However, the words, ‘health’ and ‘ethnicity’, are each fraught with semantic debate - a literature search on either would only show but a fraction of the library space taken up on each, but the next four chapters in this volume present viewpoints on these. M acbeth (C hapter 2) applies her enduring in terest in the definition of the ‘population’ to the concept of the ‘ethnic group’ and finds it equally impossible to define. She argues, nevertheless, that for the purposes of classifications viable for clinical practice, observation and research some working definitions are im portant. She contrasts the simple categorisation used in much medical literature with the complexity of factors affecting health which can justifiably be described as ‘ethnic’. There is a need, she argues, to research the factors themselves, or even a congruence of several factors, which may be obscured when a crude classification of ethnic or rac ia l group is used. B hopal (C h a p te r 3) acknow ledges how the classification of e thn ic groups based on concepts of race has becom e controversial, but he feels that if the concept of race is lost, acknowledgement of the effects of racism on disease patterns may be ignored. His chapter em phasises the value of sim ple c lassifica to ry groupings for m edical assessment, but identifies how differences in the basis of grouping can be useful for different conditions and purposes, w hether for clinical use or for achieving research-oriented objectives. Using the concept of ‘race’ can, he argues, be valuab le for some purposes a ltho ugh a new te rm such as ‘identifiable population’ may become useful in other circumstances. W hat is im portant for science is conformity of usage both at national and international levels.