ETHNICITY NOT RACE: A PUBLIC HEALTH PERSPECTIVE.
|Abstract:||This article presents an argument, from a public health perspective, against the use of the term `race' and for its replacement by the term `ethnicity'. Historically, the rise of the race concept in society was dependent on its undeserved status as an objective scientific and biological category and was associated with strategies of exclusion and political domination. Mainstream science played a key role in the rise of the race concept but has since largely abandoned it in face of evidence from population genetics. Similarly, the public health movement has historically been concerned with race/ethnicity as a determinant of unequal health status, but the race term has now all but disappeared from the Australian public health literature, where it has been replaced by the concept of ethnicity. Ethnicity is a complex social variable, with cultural and political dimensions, but no biological dimension. Adopting a public health perspective on ethnicity which recognises the fluid and contested nature of this socio-political variable, whilst seeking to make explicit its relevance and definitional limits, allows us to dispense with the race concept altogether, since race has no additional explanatory or strategic value above that of ethnicity. The race term is still commonly used, however, in general conversation and in the media. The persistence of the race concept and of racism is difficult to explain but may be related historically to the politics of nationalism, and in modern times to the politics of difference and identity that characterise the modern multicultural nation-state. Abandoning the terminology of race leaves racism without any logical basis, and may contribute to a process of social change, although it cannot be expected to eliminate the phenomenon of racism.|
Race discrimination (Analysis)
Public health (Services)
|Publication:||Name: Australian Journal of Social Issues Publisher: Australian Council of Social Service Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2000 Australian Council of Social Service ISSN: 0157-6321|
|Issue:||Date: Feb, 2000 Source Volume: 35 Source Issue: 1|
|Geographic:||Geographic Scope: Australia Geographic Code: 8AUST Australia|
Race, ethnicity and culture are issues of enduring importance not only in the social sciences, but also in public health. Public health is the organised effort of society to protect, promote and restore the public's health (Last, 1988) and equity of access to services and equality of health outcomes are key concerns. A recent listing of literature, dealing with racial and ethnic disparities in health care, that had been published in two American medical journals over a ten year period, filled 66 pages (Geiger, 1996). In this article, I attempt to briefly address the following questions: firstly, what concepts, and what distortions, hide behind the three words, `ethnicity', `race' and `culture'; and, secondly, can the public health community contribute some clear thinking to the `race' debate? In the first part of this paper, it will be argued that `race' has an undeserved status as an immutable biological variable and that mainstream science has now abandoned the concept it helped to promote. In the second part of the paper, I will draw on the public health literature to justify the abandonment of the term `race' and its replacement by the term `ethnicity' for academic purposes. In the final part, I will examine the possible effect such a change could have in the wider society as one tool to combat racism.
The `Race' Concept
`Race' is a word used frequently in general conversation and in the media. It is enshrined in legislation, such as the `Racial Discrimination Act' and appears in the titles of academic journals such as `Race and Class'. The race concept has been reified as a result of its widespread use in constructing boundaries that simultaneously include and exclude people and lead to `imagined communities' e.g. `White' Australia and `Asian' migrants (Pettman, 1992). The English word is derived from the Latin word `generare', which means `to beget'. It is defined in Last's Dictionary of Epidemiology (1988) as `persons who are relatively homogenous with respect to biologic inheritance'. The implication is that members are biologically similar to each other and different from the members of other racial groups.
There are a number of features that are consistently associated with use of the term `race' in the scientific literature, particularly in past years, but persisting up to the present time (Wolf, 1994). The first feature is the notion that if one could sort people out into physical types, one could impute their moral character. In other words, the sum of physical traits and temperament constitutes a stable bio-moral `essence'. The second feature is the creation of associated hierarchies where the people constructing the hierarchy generally find themselves in the highest stratum with the right to dominate others. The comments by West Australian senator, Ross Lightfoot, that `Aboriginal people in their native state are the lowest colour on the civilisation spectrum' (Price, 1997) are a contemporary expression of this historical hierarchy. The third feature follows from the first two, namely that commentaries based on racial classifications exhibit an ethnocentric bias, a lack of objectivity in analysis and an insensitivity to possible confounding social factors in interpretation. This has been well demonstrated with respect to phrenology and latterly with respect to IQ testing (Kohn, 1995; Gould, 1981).
Science, Race and History
Science has not been a disinterested observer as the ideology of race, founded on the notion of racial classification, spread. Rather, the power of the race concept, and its height of influence in the 19th and the first half of the 20th century was associated with the rise of Western science. To paraphrase Eric Wolf (1994) speaking about anthropology, science is both offspring and creator of the human condition and ideas about race in the 19th century not only arose from science, but served to orient its inquiries, particularly in the field of physical anthropology. For example, following the publication of Charles Darwin's `Origin of Species' in 1859, the principle of `survival of the fittest individuals' gave credence to what became known as Social Darwinism, or `survival of the fittest race'. It was argued that some races were better suited to survival than others and that unfortunate races, such as Australian Aborigines, were not suited to survival, and would die out as a result of this natural law. The link between race theories and physical anthropology was demonstrated in the Australian context by the battle between the Royal College of Surgeons and the Royal Society of Tasmania for the custody of the skull of William Lanney, the `last' Aboriginal Tasmanian male (Horton, 1994).
Social Darwinism acted as a justification for European colonial policies, including the colonial policies of the British in Australia, and it was Darwin's cousin, Francis Galton, who founded the study of eugenics or selective breeding, that was so influential in the first half of this century. At that time, prominent medical scientists sought to reframe the White Australia Policy (legislated through the 1901 Immigration Restriction Act) as an experiment in racial adaptation to new environmental conditions (Anderson, 1997). `Tropical races' were first deemed suitable as imported labour (e.g. the Pacific Islanders brought to work in the Queensland canefields) and later viewed as a potential reservoir for tropical diseases (e.g. indigenous Australians in Northern Australia) and subjected to laws designed to restrict their movement. The ranks of prominent eugenicists included highly influential Australian public health practitioners, such as John Howard Lidgett Cumpston, the first Director-General of the Federal Health Department which was established in 1921 (Lewis, 1989).
The race concept, however, has now been confronted by the phenomenon of genetic polymorphism and the science of population genetics (the study of gene behaviour in populations). Polymorphism refers to the existence of two or more different gene variations at the same place or locus in the human chromosome, giving rise to different physical characteristics. Jones (1981) has given a description of Latter's Index which used data on 18 polymorphic gene loci from 180 different human populations from six classically described racial groups (European, African, Indian, East Asian, New World and Oceania) to give a measure of the proportion of genes which two randomly chosen individuals had in common.
The differences between classically described racial groups (10% of all genetic variation) were only slightly greater than those which existed between nations (6% of all genetic variation) and both of these were small compared to the genetic differences within a local population (84% of all genetic variation). Jones concluded that the human species could not be divided into a number of discrete `racial' entities on the grounds either of genetics or physical appearances. Though, of course, there is genetic variation, there is no major genetic divergence between racial groups. Mankind is rather homogenous, which is what is implied by the term `species'.
I stress, the argument presented here is not that genetic or hereditary factors are always unimportant in the explanation of disease, but that no genetic or biological markers have ever been shown to reliably differentiate groups of human beings on `racial' grounds. Rejection of the `race' concept refers to ideas about classification, not variation (Kohn, 1995).
Ethnicity and Culture
So, what about the terms `ethnicity' and `culture'? Culture can be viewed as the `process of cumulative adaptation of a social group to a particular environment' (Shannon, 1994) or as a `set of beliefs and ideas that a group draws on to identify and manage the problems of their everyday lives' (Kelleher, 1996). An `ethnic group' refers to a culturally defined group which may include common geographic origin, language and religious faith as well as shared traditions, values, symbols, literature, music and food preferences (Polednak, 1989). Like race, the concept of ethnicity can be mobilised for political purposes (as we have seen in the former Yugoslavia), and the development of shared political values and traditions can, in turn, shape ethnic identification. So ethnicity is a socio-political variable defined on cultural and other criteria, whereas race is a socio-political variable masquerading as a biological variable (Witzig, 1996). Ethnicity does have its problems as an epidemiological variable (Senior & Bhopal, 1994), but these are the problems inherent in defining social variables. Ethnicity remains a meaningful and complex social variable with which we can potentially deal. However, continual reference to `race' as a biological rather than sociopolitical variable obscures the importance of other variables for which `race' is merely a proxy, such as income, education, housing and discrimination. Social disadvantage is thereby transformed into immutable biological difference (Osborne & Felt, 1992; Lillie-Blanton & LaVeist, 1996).
The Public Health Discourse on Ethnicity and Race
So what about the public health community in Australia and New Zealand? How do they talk, what terms do they use? I have taken the opportunity to review the first issue of the Australian (later Australian and New Zealand) Journal of Public Health for each of the years from 1992 to 1999. There were a total of 130 data-based articles, excluding editorials, opinion pieces, published orations and reviews. 55 articles (42%) had some mention of a variable relevant to ethnicity or race, compared to one United States series where the proportion was just over 50% (Ahdieh & Hahn, 1996). Ten of the 55 Australian articles dealt with indigenous groups only, six others dealt with other specifically named ethnic groups and five others described study populations that included indigenous and other ethnic groups together. Half of the articles (28 or 51%) included as a descriptor of the study population either the category `non-English speaking background' or `country of birth'. But to what underlying concept did the measured variables relate? In only three articles was the word `race' mentioned. Ethnicity was the presumed concept that underlay the variable in the other articles but the word appeared in only nineteen of those articles. Aside from the papers devoted to indigenous populations, the `ethnicity' variable was most often mentioned in describing the sample only to be forgotten in the analysis. It was rarely analysed as one factor among many. One can conclude that the term 'race' has all but disappeared from the Australian and New Zealand public health literature, in contrast to the American literature (Ahdieh & Hahn, 1996; Jones et al., 1991), but even in the American literature there is rarely ever an explicit definition of race given (Williams, 1994). The term `ethnicity' is also under-theorised; presumed related variables such as `country of birth' are mentioned without any attempt to explain or justify their relevance to the problem studied. In other words, the underlying hypothesis that triggered the decision to collect data on ethnicity is almost never stated (Osborne & Feit, 1992; Kaufman & Cooper, 1995).
Some public health professionals have argued that the concept of `race', although imprecise, may have some limited usefulness in physical anthropology, clinical medicine, epidemiology and public health, primarily as a way of generating explanatory hypotheses to be further tested and also as a means to target high-risk groups (Polednak, 1989; Feinleib, 1992). Most public health commentators have advised that race and ethnicity be better classified and defined. For example, Senior & Bhopal (1994) called for the abandonment of ethnicity as a synonym for race, but stopped short of calling for the abandonment of race itself. Guidelines on the use of ethnic, racial and cultural descriptors in published research (Anonymous, 1996) similarly stated that race has limited biological validity; they did not state it has no validity.
I argue more radically that the race word is redundant and should be dispensed with altogether. Although under-theorised in practice, the concept of ethnicity has the potential to generate explanatory hypotheses and serve to target high-risk groups. It is an explicitly socio-cultural variable, and should therefore be adopted in preference to `race' in both our everyday language and our systems of classification. Race as a concept or category does not have any additional explanatory or strategic value above that of ethnicity; when stripped of its biological basis, race becomes a socio-cultural variable indistinguishable from ethnicity.
Adopting and Adapting Ethnicity
The adoption of ethnicity as the preferred term in health and social research in particular, and academia in general, will be enhanced if the terms of its use are agreed upon. Academics need to standardise the means by which ethnic groups are categorised, whilst acknowledging the fluid boundaries and social construction of those categories, and the contested and sometimes contradictory nature of ethnicity itself. It is known that people often change their reported ethnicity between surveys, such as between the census and the post-enumeration survey taken six weeks later (Australian Bureau of Statistics, 1997). This phenomenon is also seen in the US (Hahn, 1992; McKenney & Bennett, 1994) and in the UK (Chaturvedi & McKeigue, 1994). This variability does not mean that the concept is not useful, rather that analysis and interpretation need to incorporate the context in which the data was collected.
In order to maximise the reliability of the categorisation, we should encourage people to self-identify as a member of an ethnic group rather than be identified by others on spurious grounds. In the special conditions of a national census, care is taken to standardise the question asked of respondents and special efforts made to train census interviewers. The collection of routine data is done much less well. For example, at the time of hospital admission, admission clerks often make assumptions about ethnicity based on visual observation, rather than allowing people the opportunity to self-identify (Morrow & Barraclough, 1991). Special programs to train admission clerks can address this problem.
To name or identify an ethnic group should not be an end in itself, however, but the beginning of an enquiry tied to a specific hypothesis. Ethnicity data should only be collected with a particular hypothesis or purpose in mind. For example the term Asian refers to such a heterogenous group of people that it is of little use in testing hypotheses or formulating health policy (Bhopal et al., 1991). When ethnicity data is collected, data on potential confounding factors such as social class, income or education should also be collected. Depending on the specific purpose of the collection, other variables may be relevant (e.g. diet, language or religion). For example, if improving access to services is the purpose, it would be relevant to collect information on language, and cultural and religious practices, as well as self-reported ethnicity. Exploring ethnicity in such a way would allow us to acknowledge and approach diversity in a meaningful manner, whilst not forgetting the impact of racism and social disadvantage.
I stress that it is possible, at least in academic circles, to effect a change in discourse. Williams (1994) pointed out that journal editors are in a powerful gatekeeping position because they can insist, as a matter of policy, that researchers justify the inclusion of an ethnicity/race variable and report the means by which it was assessed (either through self-report, proxy report, record review or direct observation). Bhopal et al. (1997) asked UK-based editors of a broad range of medical journals about their practices, opinions and intentions in relation to terminology in ethnicity and health research. Ten (36%) had considered the issue of terminology in relation to ethnic minorities, one (4%) had a written policy and five (18%) had an agreed but unwritten policy. Most recognised the importance of the issue and welcomed guidance to resolve the problem of inappropriate terminology in ethnicity and health research. Bhopal et al. (1997) recommended that the World Association of Medical Editors take the lead in drawing up authoritative guidelines for editors.
Why Race Persists
The argument presented here is not new. Indeed, UNESCO recommended against the usage of the term `race' as long ago as 1950. So why has the term `race' persisted in common usage?
First, because `people look different'. Skin colour looks like it should be a big deal, but it is in fact a minor physical characteristic.
Second, because it is a term loaded with social and metaphorical associations, which can be positive or negative, depending on the context. Just as it can be used to stereotype and discriminate, it can also signify, say for some Aboriginal people, their uniqueness and survival -- `I am proud of being a member of the Aboriginal race'. Lattas (1993) prefers the term `racism' to ethnicity since it `captures the way power and hatred are inscribed in bodies and the policing of bodies'. It is not clear what he specifically thinks of the term `race' though he adds disparagingly in a footnote `Academics like to use the term ethnicity because it carries the connotation of culture detached from bodies and biologies [...]'. Whilst acknowledging the short term symbolic and strategic impact of positive statements about identity, I would argue that it is counterproductive in the long term to propagate a terminology that is not scientifically or biologically rational and may symbolically underlie much `racial' hatred.
Third, race and racism are central to an understanding of Australian history and how the transformation to today's multi-ethnic and multicultural society has been managed (Castles et al., 1988). Pettman (1992) writes that just as the ideas of scientific racism were used to rationalise Aboriginal dispossession prior to and after Federation, so the Australian national political project has been `masculinist, racist and Anglo-supremacist' from the beginning. The reappearance of a chronic deep-seated racism in Australia should not, therefore, be a surprise in circumstances where people are looking to include, exclude or scapegoat others for whatever purpose.
Is a Change in Terminology a Strategy Worth Pursuing?
It is not possible to apportion the contribution that the belief in a biological basis for race makes to the widespread phenomenon of racism. As we have seen, there are complex social, political and cultural factors that contribute to the persistence of racism, which is embedded within medical systems (Esmail & Carnall, 1997) as well as in the wider culture. Racism is often the invisible and unmeasured variable that explains differences attributed to social class, poverty or `race' itself (Peterson et al., 1997).
However, the strong historical relationship described previously, between the development of the biological concept of `race' and the development of nation-states that see themselves as scientifically rational, at least admits the possibility that `race and racism' would lose some of its allure if seen to be scientifically invalid. The process of de-emphasising `race' may have started already if the Australian public health literature referred to above is any reflection. There is little evidence, however, of any parallel challenge to the `race' concept in the popular media. A cursory examination of the media coverage of the possibility of a `race election' in 1998 suggests that racism is portrayed as undesirable while the scientific status of `race' goes unchallenged.
A recent program run by the Australian Bureau of Statistics demonstrates the potential link between adopting ethnicity as a crucial public health variable, and challenging the societal assumptions that underpin its use. The Aboriginal and Torres Strait Islander Health Information Plan (AHMAC & AIHW, 1997) identified the need to collect more complete and accurate data on indigenous people entering hospital. A crucial barrier to such data is that hospital staff fail to ask the question `Are you of Aboriginal or Torres Strait Islander origin?' either because they assume the ethnicity of the client, or are embarrassed to ask. The campaign, targeted at both hospital staff and people attending hospitals, includes a poster showing three people of different physical appearance. The accompanying words say `Any of these people could be of Aboriginal or Torres Strait Islander origin. To find out we need to ask.' Overall, the campaign highlights the need for self-identification (a key component of ethnicity as opposed to race), and the potential to challenge and change attitudes in this sensitive area.
The possibility of language change contributing to a change in the dominant discourse and in the long term to a lessening of prejudice is one strategy for social change worth exploring. The women's movement has been strong in its emphasis on non-sexist terminology whilst not claiming that a change in terminology will, in itself, eliminate sexism. The abandonment of the race concept in the health and social research field, and in academia in general, will eventually have an influence on social commentators in the media, who if not academics themselves, certainly rely heavily on academic sources. Public attitudes may also then change over time, though the strength of attachment to the race concept should not be underestimated. Warwick Anderson (1997) has described his experience of being labelled a race traitor when describing, in a public gathering, the historical flexibility of the categorisation of race. His response was to point out that one could not betray something that did not exist. He also called for scientists to enter the national debate on race, and this article is a partial response to that call.
It has been argued in this article that `race' is not just a poorly defined concept, it is an anti-scientific one whose use is no longer justified. There are, of course, real ethnic and cultural differences and certain situations of extreme group disadvantage (e.g. Aboriginal and Torres Strait Islander people in Australia) that justify government policy that seeks to accommodate those differences and redress those disadvantages through improving access to education, housing and employment.
To continue to talk about `race' instead of about the more complex issues of ethnicity and culture and their relationship to identity (Jordan, 1985), harks back to an Australia when social policy (particularly in relation to Aboriginal affairs and migration) was constructed on the notion of `racial essences'. Humphrey McQueen (1994) has pointed out that `although talk about Aboriginal "blood" is nonsense, blood retains its place as a key metaphor in the rhetoric of prejudice'. In 1994, National Party leaders demanded that the official definition of Aboriginal person be narrowed. They wanted only `full bloods' and `half castes' to qualify for government benefits. Such attitudes survive, in part, because the concept of `race' survives. The public policy of multiculturalism that aims to manage `the consequences of cultural diversity in the interests of the individual and society as a whole' (Rice, 1997) would in fact be strengthened by a deeper appreciation of both ethnic diversity and human unity freed from artificial racial divisions.
Before I am accused of the dreaded `political correctness' (Morris-Suzuki, 1996), let me point out that this article is intended as a contribution to a hopefully thoughtful debate about the usefulness and limits of categorisation and the relationships that exist between language, attitudes and public policy. There is no wish to censor free speech, rather a desire that our speech be more exact and truer to the real-life circumstances and possibilities of the human condition. To become race and colour-blind, whilst remaining sensitive to ethnicity and culture seems to me to be a worthwhile goal.
We should not fool ourselves, however, that changing terminology is all that matters. `Ethnic cleansing' is as hateful as `racial cleansing'. `Essentialism' tied to any terminology is a real danger. We make no progress if we eliminate the ideology of racial essentialism, only to substitute an ideology of genetic, ethnic or cultural determinism.
Abandoning race as a concept leaves racism without a logical basis. This is not to say that racism will immediately disappear, since logic does not explain its persistence in the late twentieth century, but racism may diminish over time. Castles et al. (1990) offer a vision of Australia as a communal and inclusive society that transcends notions of the nation-state, nationalism and racism. The battle against racism in Australia will require a mix of strategies ranging from the personal to the political, and the strategy offered in this article is but one contribution.
I would particularly like to thank my friend, Sam Heard, for challenging my own understanding of `race' some years ago. Also Tess Lea, Peter Markey, Karen Martin, Kerry-Ann O'Grady, David Thomas and other friends and colleagues who have debated these issues with me over the last few years and who may still disagree with the viewpoint offered here. Thanks also to the anonymous reviewers who helped to clarify the argument presented.
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Dr Tarun Weeramanthri PhD FRACP FAFPHM, Community Physician, Disease Control, Territory Health Services, PO Box 40596, Casuarina NT 0811 Fax:08-8922-8310 E-mail: email@example.com
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