section four

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Objectives

This section will encourage you to think about how policies aimed at addressing the challenge of our multi-ethnic demography are intimately linked to how we have created a specific 'definition of the problem'. When you have completed this section you should have the basic skills to look behind policies and practice in order to make explicit the assumptions that underpin them.

How we each respond to the requirements of multicultural policy is partially a consequence of how we frame our understanding of ethnic diversity:

If we continue to define minority ethnic colleagues and clients as 'immigrants', then we are unlikely to easily grant their demands as being fair and justified
If we explain continuing inequity in health care as due to 'their failure to adapt' then we are hardly likely to recognise discriminatory processes
If we regard discrimination as being the consequence of personal 'prejudice' rather than cultural or institutional racism then we will never adopt appropriate policies and procedures to deal with it.

The development of critiques of problem definitions has itself constituted a framework for new solutions. So, in this section, you are going to take a look at the approaches corresponding to each of the 'problem definitions' discussed in the previous section, that is:

The immigration problem approach
The cultural deficits approach
The personal prejudice approach
The cultural racism approach
The institutional racism approach.

1. The 'Immigration Problem' Approach

Different European states have responded to their ethnic diversity in different ways. But, despite many European countries now having large proportions of their minority ethnic communities who are second and third generation descendants of earlier immigrants, the language of immigration remains central to the political debate about ethnic diversity. For example:

Certain states, like Germany and Belgium have seemed committed to a view which resists the reality that they now have very substantial settled minority ethnic populations
Other countries, like Britain, the Netherlands and Sweden, have accepted the reality that they are now a multi-ethnic society, and have moved to develop internal policies to respond to this situation. (However, being aware that Britain is a multi-ethnic society is not necessarily the same as being explicitly aware of how we nationally and individually have come to make sense of that reality.)
However, even in this latter type, the 'Immigration Problem' mentality has been modified, rather than made obsolete. This view of the problem leads the state to maintain immigration policies to:
regulate the flow into the country
define the rights of those admitted previously and currently.

Recently in Europe, an increase in asylum-seekers has generated a refugee-based 'immigration problem' and, hence, immigration policies. However, the political rhetoric and moral climate generated by these policies inevitably impinge upon the formulation of multicultural policies within the country and the reception given to them.

Immigration policy cannot be separated from multicultural policy, except in the minds of bureaucrats, and the wishful thinking of politicians: The party political rhetoric, employed to justify the exclusion of asylum seekers and new immigrants, inevitably presents 'more of these people' as a threat. A basic assumption being offered in this argument is that Britain is a small island that is "full up". The language used to justify the continued exclusion of new immigrants is often 'discursively deracialised' - presenting the 'necessary exclusion' as entirely 'reasonable and inevitable'. (However, paradoxically, Western European countries are, in fact, deeply aware of their current and imminent need of more labour power.)

The nationalism invoked by this rhetoric is that of a homogenous Britain that shares the threat of further cultural dilution. The problem here is that this denies the demographic reality of multi-ethnic Britain. Many of those identified as a potential threat are members of ethnic communities that are already established and settled in Britain - they can hardly be expected to regard the entry of people sharing their culture and ethnic identity as a national calamity. Nor can they be expected to ignore the ethnocentric and racist logic that underpins this type of argument. British immigration policy and practice frequently exposes the racial anxieties at the heart of British nationalism.

This construction of 'immigration as a problem' can be challenged by a radical and honest rethinking of the basis of British identity. Devolution has already generated a new self consciousness about national identities in the United Kingdom. If the United Kingdom can recognise and accept its ethnic diversity, then ethnicity can be detached from loyalty to the country.

Federal states such as Switzerland demonstrate that ethnic diversity is not inconsistent with patriotism to the state. Citizenship provides a political and legal framework for binding the individual to the state; it provides a reciprocal package of rights and obligations.

Unlike some other European countries the great majority of the minority ethnic population in Britain are citizens. Discriminatory immigration policies cannot coexist comfortably with progressive ethnic relations policies in multicultural societies. Denigrating immigrants on the basis of their ethnicity must undermine any claims of the state to respect ethnic diversity among its population.

The robust nostalgic nationalism that so characterised Thatcherism sought to defend a notion of a homogenous British people. It was hardly surprising, therefore, that so much of its neo-conservative rhetoric invited us all to look backwards to discover ourselves. (Jessop, 1988). That vision of 'Britishness' (really 'Englishness') has far from vanished from the British political scene - there is ample evidence of those who continue to consider minority ethnic communities to be a problem: an unassiminable "enemy within".

Perhaps if we reflect that, within the lifetime of pensioners alive today, Britain still wondered if it was possible to give independence to its colonies and dependent countries, then we will have some understanding of the recency of the history that feeds this form of thinking. The public parade that marked our current monarch's coronation was in many ways little different from that which marked Queen Victoria's Jubilee in its being populated by the many representatives of her overseas territories.

However, times change. Contemporary culture is, de facto, multi-ethnic in ways so subtle and pervasive that we often fail to recognise it. In a multi-ethnic society of citizens, policies and imagery that are premised on defining people of different ethnicity as 'the problem' can only feed conflict. Such policies and politics require a denial of our shared reality that in other aspects of our life would attract mockery.

EXERCISE 4.1
Reflective Activity

1. Consider how the issue of asylum seeking is treated in the national and local media.
- Is immigration still associated with 'threat'?
2. Reflect upon how people in your neighbourhood and workplace use the word
'immigrant'.
- Are United Kingdom born citizens still being discussed as immigrants?
- What are the implications of this?

2. The 'Cultural Deficits' Approach

Where policy in multi-ethnic societies is informed by the perspective of 'disadvantage', minority ethnic people/communities become the focus of analysis - for example:

their unfamiliarity with the institutions and practices of the majority are typically approached through information programmes
their linguistic limitations - which impede their progress in education - are addressed through language training.

Should these programmes fail to achieve a remediation of the inequalities experienced by minority ethnic communities, this perspective can provide a complementary explanation from within the same culturalist logic: for example:

Continuing educational failure may be attributed to the fact that in 'their' culture there is no concept of play and hence children have no toys, and an intellectual deficit ensues
'They' do not encourage their children to succeed in education; or alternatively, they press their children too hard, and anxiety inhibits the children's educational success.

Bauman (1990) has suggested that the modern state first tried to homogenise its population. Where - through migration, federation or conquest - the state has become multi-ethnic, the initial response is to try to assimilate the new ethnic populations. That is, to persuade, educate and pressure the minority ethnic communities to adopt the values and culture of the majority ethnic community. This has included formally limiting their use of their community language, putting restrictions on their clothing and active educational initiatives to induct their children into the majority culture. At one level contemporary multiculturalism is a response to the earlier failure of such assimilationist policies. Ethnic identities are surprisingly robust. However, attempts to construct a consensus upon what our multicultural policies should be has not proved easy.

What was a positive transition - from the 'homogenising' language of immigration and immigrants to a view of the heterogeneity of the new, settled communities, within a multicultural society - has been hijacked and subverted. Ethnicity - conceived of as the self-conscious identity, history and culture of specific migrant groups - has become not just one important facet of their existence within the receiving society, it has too often been invoked as the only significant characteristic of 'these people'. This account of disadvantage fails to adequately address the location of minority ethnic communities in relation to:

access to power in the institutions of the state
the labour market (and their consequent material position in society).

From within this culturalist perspective it is the minority ethnic communities themselves who must be studied - in order to account for their success or failure to prosper in an 'open democratic society' - rather than the operation of the institutions of the state, or the provision of welfare, housing or education.

Let's just go back a bit though. It is not that newly settled minority ethnic individuals do not need structured information programmes, to inform them of the institutions and practices in their new country. Some European countries, notably Sweden, have invested considerable resources in developing extensive programmes of this sort; whilst other countries, like Britain, have adopted a very minimalist response and have seen schooling as the major vehicle for socialising new immigrants. Equally, training in the lingua franca of the new society is an important aid to empowering new minorities within the country of settlement.

However, the European experience has indicated that:

informing minority ethnic individuals of their rights is not the same as guaranteeing those rights
translating leaflets on the health service is not the same as ensuring that that service is capable of meeting the dietary and cultural sensibilities of the new client populations
enabling minority ethnic children to attend school - having learnt the lingua franca of that educational system - does not ensure that they are not then required to imbibe a curriculum which is ethnocentric - which, in its texts and through staff attitudes, denigrates their culture and history.

Perhaps surprisingly, for some, such an august body as the Council of Europe, within a major review of community relations policies, has been addressing the limitations of previous information-led programmes. It is examining the means whereby minority ethnic communities may be empowered, rather than merely assimilated. The willingness to consider such issues within a bureaucratic 'talking shop' cannot of course be translated directly into the policies of member states. However, the Council of Europe is but one of a number of regional or international bodies whose advisory statements, or indeed interstate agreements, constrain the freedom of national governments. Within the EC, general policy statements on the rights of migrant workers have moral, if not legislative, weight; and the European Convention of Human Rights has been employed by members of minority ethnic communities to challenge the actions of their state. Within the NHS we have also seen the development of formal policy statements on responding to ethnic diversity within the health care professions.

Recognition of the impact of cultural diversity within society is a necessary element in any multicultural policy. But, such recognition must be matched by appropriate action. To employ an active recognition of cultural diversity in order to blame the victim for their disadvantage is a perversion of such a policy, paralleling previous perversions for example:

the 'culture of poverty' which was used to explain the poor economic and educational attainment of peoples in the Developing World
the educational underachievement of the British working class, which has been linked to their cultural values.

Exercise 4.2 Reflective activity

Reflect upon how an appropriate recognition of ethnic differences can slip into an inappropriate use of 'their' culture in order to explain 'their' disadvantage. Think back to your thinking about the construction of "the other" and see if you can relate it to the process.

Collective values and practices, defined and sustained by ethnic communities, are relevant to an understanding of their participation in society. However, they are never sufficient, in themselves. As you learnt in Section 2, ethnicity involves both 'consciousness of kind' and an infrastructure of resources. The cultural deficits approach focuses the majority community's attention upon the culture of minority ethnic communities, rather than upon the operation of the institutions of the state and the behaviour of the majority themselves.

Contemporary initiatives in the European Union and in the United Kingdom, are seeking to promote a sensitive and sophisticated approach to cultural diversity.

Exercise 4.3 Group Activity

Discuss your experience of how culturalist explanations of minority ethnic health and social care needs have been encountered in your working environment.

3. The 'Prejudice' Approach

If prejudice is deemed to be based on 'faulty generalisation', then we may seek to counter these through educational programmes, which in itself is not a bad thing. If the prejudice is deemed to be rooted in the damaged psyche of a traumatised individual, then the policy options are somewhat different. Where the prejudice is extreme then, on past evidence, we may expect them to be labelled as being part of the 'unlovely ten per cent' of extremists that are found in virtually all attitude studies. As extremists they are by definition a minority, and consequently are often regarded as the inevitable emotional casualties of any civilised society. In policy terms, their existence should be monitored but largely ignored.

Where personal prejudice is seen as the problem in a workforce a number of policy responses are likely. One frequent response is to see this phenomenon as more or less inevitable: 'Prejudice is part of 'human nature', it's natural to be partial.' This perspective normalises prejudice and makes it less shocking and unacceptable.

A report commissioned for the Australian Government's Office of Multicultural Affairs in the late 1980's, by MacAllister and Moore (1989), produced a psychological account of prejudice, which presented it as a virtually inevitable facet of multicultural societies. They concluded that, while socio-psychological and social structural theories have some validity, the predominant factor is concerned with the personalities of individuals. Their emphasis on authoritarian and ethnocentric values raises the question of how these attitudes are formed in the first instance. Most studies interpret their origins in the context of Freudian theory and the interaction with group behaviour. MacCrone, for example, argues that:

'the greater the discipline of group life, its repercussions, privations and exactions either in the form of moral, religious, or economic sanction, the greater we can expect its aggressiveness to become at the expense of some other group or groups'

MacCrone (quoted in LeVine and Campbell, 1972: 117)

In other words, there must always be a group that is marginalised, against which frustration can be vented. This, of course, implies that the removal of one 'out' group will merely witness its replacement by another group, in a continuous cycle. From this perspective, prejudice is an enduring, and perhaps inevitable, feature of differentiation within human society. It has shown itself to be a pervasive influence, existing in societies at all levels of economic development.

While the results presented here have suggested that it is unlikely to be removed by the actions of government policy, nevertheless, a greater awareness of its causes can lead to a greater sensitivity in trying to remedy its consequences.

(McAllister and Moore, 1989: 37-8)

This pessimistic account has been severely criticised (e.g. Husband, 1991) since it leaves the only available policy option as being an attempt to minimise the consequences of prejudice. A psychological account of prejudice all too easily leaves the basis of discrimination resting upon the flawed nature of individuals. It distracts attention from those political processes that seek to promote and exploit hatred of the stranger. It focuses attention away from those ideologies and institutional structures which facilitate or promote discrimination.

In the 1970s and 1980s Britain saw a vogue for Race Awareness Training, which put people in touch with their prejudice. In both its conception and execution this response to racism was seriously flawed (Sivanandan, 1981, Gurnah, 1989). Prejudice does exist, and prejudiced individuals who dislike members of minority ethnic communities can readily be found in the health care professions: but responding to this phenomenon in solely psychological terms must be inadequate.

4. The 'Cultural Racism' Approach

You have seen, in Section 3, how it is possible to see discriminatory behaviour operating in the absence of any deep-seated personal hostility. Individuals express statements that are racist and offensive, without a sense of how offensive and distressing they are. The clue to understanding this is to review the ways in which 'race thinking' is generated and disseminated in our society, in which sets of interlocking ideas and values are packaged and made acceptable; in which racial ideologies are constructed and sustained.

A policy response to cultural racism cannot possibly be satisfied by focussing upon the individual. There is a long history to race thinking and the penetration of ideas of 'race' into, for example, notions of nationalism, of sexuality and of ethnicity, have provided multiple routes for 'race' to have apparent relevance in our lives and shared culture. The idea of 'race' has been exported around the world. It is not a mode of thought that is peculiar to contemporary Europe, or even contemporary Britain. Weimer (1999), for example, provides an account of race in Japanese thought. There is a wide acceptance of race thinking.

One of the first policy challenges of cultural racism is to find a way of revealing to individuals the racism present in their thought and behaviour. Where their modes of speech and styles of behaviour have an established acceptability, there is an easy resistance when they are challenged. The person presenting the challenge is frequently accused of being the one who is out of step. The charge of 'political correctness' is an example of such a strategy - the person confronting the norm is accused of being an extremist or 'an anti-racist zealot'. You have read about the technique of 'discursive deracialisation, which allows people to share a language where race can be discussed without being explicitly mentioned. This makes doubly difficult the task of revealing to people the racism embedded in their behaviour. Where this behaviour is the norm within a community of practice it is particularly resistant to change.

Professional socialisation and training must be one of the sites where this thinking and discourse must be challenged. Where race thinking and discriminatory practices are made professionally unacceptable, then there is a counterbalancing collective pressure to challenge existing practice.

In recent years, the NHS in general, and the nursing profession specifically, have adopted formal policy statements on the eradication of racism from professional practice. Increasingly, people entering the nursing profession are being made aware of the nature of racism and are being sensitised to ways in which racism may enter into communities of practice.

Awareness, of course, is not necessarily sufficient to guarantee changes in practice. Personal and professional hierarchies of power and institutional structures may work against processes of change. Cultural racism and institutional racism are highly interrelated

5. The 'Institutional Racism' Approach

The policy implications of identifying institutional racism as the basis of discrimination, are much more extensive and demanding than those which follow from a concern with prejudice.

The essence of institutional racism lies in its focus upon the structural properties of institutions and how these provide the environment within which identity politics are negotiated. The institutional racism approach, then, focuses attention on the everyday routines of an institution and the ways in which power operates, rather than on individual attitudes and intentions. Taking two examples:

A student nurse, on entering a practice placement, may be sensitive to forms of racist behaviour - and recognise it within her/his clinical setting - but decide not to challenge it, because of her/his position in the hierarchy. To confront mentors, assessors and experienced nurses, from the position of a student seeking to survive in a new environment, requires a good deal of resolve. The power relations within the 'community of practice' allow for a wide range of potential modes of punishment for a student wishing to challenge such behaviour.
Whilst health trusts are likely to have formal policies on equal opportunities and racism, the ways in which these are implemented, and continuously monitored, allow for considerable slippage between the policy statement and the actual practice. Sending staff on recruitment and selection courses is not the same as ensuring that they have the opportunity to implement what they have learnt or monitoring whether they have indeed implemented it. One large metropolitan authority, which had taken a high profile position on equal opportunities and challenging racism, was formally investigated by the Commission for Racial Equality for recurrent racial discrimination.

As the companion module, Race Equality Management, discusses at length, the institutional racism perspective requires a systematic strategy. Quite literally, it is whole systems that must be engaged in a process of reflexive review and change. It will be clear by now that racism has many forms and multiple causations. You have seen that people have very different views about racism and about the strategies required to challenge it. A core challenge of the idea of institutional racism is that we can think beyond the actions of individuals. We need to see how institutional structures, routine practices and work place cultures combine to reproduce inequality. Consequently, the actions we take to challenge institutional racism must also operate at the institutional level.

Exercise 4.4 Reflective Activity

1. Reflect upon whether examining institutional processes is something you are comfortable with - not everyone is.
2. Identify one or two instances where routine practices get in the way of making necessary changes in practice (in relation to any area of practice - not necessarily related to ethnic diversity).
(a) How is it that they inhibit change?
(b) What has been done, or can be done, to challenge the situation?

Exercise 4.5 Group activity

Share your experience of equal opportunity/anti-racist initiatives. They are not always handled either efficiently or sensitively.
- What sort of problem definitions and policy initiatives are most frequently visible in your communities of practice
- Identify the means whereby you could promote equal opportunities and culturally safe practice in your communities of practice.

Further Reading

Everyone should read:

The companion module Race Equality Management which will provide a coherent introduction to systematic strategies for promoting equitable practice.