Book Review
Health and social research in multi-ethnic societies
James Y Nazroo (ed)
ISBN: 0-415-39366-3; 2006; xii+218 pages; London and New York: Routledge Taylor and Francis Group;
Elizabeth Reid
Visiting Fellow, Gender Relations Centre, RSPAS,
Canberra ACT
Research on ethnicity raises methodological issues which are complex and often difficult to resolve. This crafted, and informative book, explores the methodological challenges which arise in conducting research into people's health and health care in a multi-ethnic environment. It is primarily a practical guide for those wishing to carry out such research in the UK. However, its analyses and case studies are more broadly applicable to the planning, conducting, analysing and evaluation of similar research elsewhere. Its interest also reaches beyond researchers to the users and funders of research, and to development practitioners in general.
How ethnicity is understood will affect the way research is undertaken and analysed, and the policy and programmatic responses. Importantly, the book argues that ethnicity is not pre-determined, objective or absolute; nor is it grounded in genes or historical or linguistic ancestors. Rather, as is argued consistently throughout the book, it is a product of social relationships: people choose the characteristics with which to define themselves. These may or may not include ideas of colour, language, history or ancestry. The experience of being a member of a particular ethnic group will also be affected by an individual's other social identities, including gender, age, social class, etc. Further, each ethnic group contains individuals who vary according to language, cultural traditions, religion, skin colour, migration history and pre- and post-migration geographic and social location. For some people, ethnicity will be a fundamental part of how they see themselves and how they interact. For others, ethnicity will have little or no salience.
This conceptual stance has important consequences for the classification and measurement of ethnicity. As a fluid concept, dependent on context, the construction of classification systems will be mediated by considerations of conformity and comparability on the one hand, and the need for definitions of ethnicity to reflect the purpose of the study and the hypothesis under discussion on the other.
The book critically considers the UK Office of National Statistics' decision to adopt self-defined ethnicity with a harmonised question that captures a number of aspects of ethnicity (nationality, country of birth, geographic origin, skin colour), to form a single classification, and limits individuals to selecting only one category from the alternatives provided (White, Mixed, Asian or Asian British, Black or Black British, and Chinese or other ethnic group). This critique will not have direct relevance to Australia where, although self-defined ethnicity has also been adopted, different approaches to classification and different aspects of ethnicity have been used. The book offers critiques of the ONS approach and construction of ethnic groups, most importantly, for an outside reader, reminding us such classifications are simply that: they do not carry explanations and should not be relied on alone. In arguing for a fluid understanding of ethnicity, the authors are committed to measures of ethnicity that will vary across time, context and according to other socio-economic characteristics.
Any research on ethnicity needs to be clear about this concept; but as the book cogently argues, this is only the starting point for a discussion of the methodological issues such research raises. The authors examine an extensive range of concerns relevant to undertaking both qualitative and quantitative research on ethnicity and to also secondary data analysis for ethnicity research. The discussion of the latter raises important matters although the data sets discussed are UK specific. Issues covered include research governance, including the inclusion of users and the researched communities in research; research funding; ethical issues, including informed consent in multiethnic communities; culturally competent research; measuring ethnic identity; data collection issues, including ethnic and language matching; computer assisted interviewing; translating; data analysis and validation; and the reporting and dissemination of research findings. Most topics are addressed by more than one contributor, thus gaining a diversity of perspectives.
The ethical issues which arise in health and social research on multiethnic societies are discussed in a number of chapters. The UK Department of Health guidelines, Key Elements of a Quality Research Culture, call for ‘respect for participants' dignity, rights, safety and well being and the valuing of diversity within society'. There are important questions about compliance with such guidelines in research in multiethnic societies. Issues discussed include the exclusion of ‘non-English speakers' from clinical trials and social research, procedures for informed consent in the absence of a common language, the non-reflexive value judgements that researchers bring to their work, research on ethnic communities that is never published or disseminated, and the lack of relevance of questions asked by bureaucratised research ethics committees. Such exclusions, errors and omissions may ultimately impair access to effective and appropriate treatment and care.
There is a rich discussion of the cultural appropriateness of many research practices and applications. Examples include one-on-one health visits where family or community ties are strong, or a preoccupation with the effect of cultural practices such as consanguineous marriages in explaining morbidity to the neglect of larger structural factors. The literature on ethnic matching and translation in data collection and analysis is well covered.
The multifaceted understanding of ethnicity which suffuses the analysis of the book stresses the fluidity of the concept and highlights the contexts ‘within which ethnicity, gender and socio-economic position intersect differently to shape individual and collective experience'. Such conceptual fluidity, however, can create boundary problems. For example, in the phrase just quoted and more generally in the book, gender is placed outside of ethnicity. Race, religion and inequality cross this border with greater facility, sometimes forming part of the understanding of ethnicity, sometimes intersecting with it. In this the framing, the book displays its historical and political origins in the struggles against racism.
An understanding of ethnicity that allows for variance across time, context and according to other socio-economic characteristics can accommodate the emergence of new perspectives and practices around ethnicity. Ethnicity as a mobilizing force and as a defamatory labelling characterises our times. Examples might be the use of ‘Pakistani' or of ‘Arab' in the rhetoric of the war on terror, or their use in the coverage of a recent rape trial and beach disturbances in Sydney. The emergence of ethnicity as a political symbol is flagged in the book but not explored. However, the book does provide important guidance on how to carry out research where ethnicity is salient, whatever that context might be.
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