section two

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only.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

When you have completed this section, you should be able to:

compare and contrast the concepts of national identity, 'race' and ethnicity
explain the processes by which people develop their sense of 'national identity' and 'ethnicity' - and illustrate this with reference to your own sense of identity
discuss the impact of other aspects of your identity (including, for example, your gender, age, political views) on your ability to express your national identity or ethnicity

What do you currently know?

In Section 1, you have learnt about the ways in which history and patterns of migration have helped to shape the nature of contemporary multi-ethnic Britain. You should also have discovered that:

nearly all of us have family histories that include migration, whether within the United Kingdom or internationally
the factors that motivated those migrations are similar to those that continue to impel people to migrate today.

Which leads us back to the question posed in the Introduction to the module: 'If the process of migration is not alien to our personal experience, why is it so easy for current immigrants to be presented as threatening and alien?'

Many of the answers to this question are tied up with the notion of 'identity'. One of the ways in which we routinely confirm our identity is through social comparison with others:

comparison with other members of our own 'in-group' - to ensure that we are consistent with group norms, that we are 'one of us'
comparison with relevant 'outgroups' - to ensure that we are not like 'them'.

The comparisons - based on criteria that are particularly valued by us - allow us to define others not simply as 'different from us', but often as 'different and inferior to us'.

For those of us living and working in multi-national / multi-ethnic Britain, defining our 'identity' - laying claim to membership of what we imagine is a common community of people - is complicated. For example:

Hybrid identities such as Pakistani/British or Cypriot/English, or Muslim/Welsh - are a common feature of contemporary life, as we all seek to make sense of our own biography and experience
Often, hybrid identities are associated with past or recent immigration in the United Kingdom - and are consequently seen as being associated with minority ethnic identities. But, strong regional identities are equally powerful ways of fragmenting national affiliations - do you define yourself as English, Scottish, Welsh or as British? Or, as Geordies, Cornish or a Londoner? Along with the concept of diaspora the idea of hybridity has become very important in contemporary discussions of ethnic diversity. At its simplest it reminds us that we are all complex individuals with many facets to our identity. Often it is those aspects of our personal biography and make up that society treats as significant which are discussed in understanding issues of hybridity. Thus, in contemporary Britain it is apparent that gender is a major factor in shaping your life chances. Thus, in issues of discrimination, minority ethnic women may be referred to as suffering a double jeopardy.

But, it is important not to see different elements of our identity just adding together. As we make sense of selves these different elements interact complexly. Thus, for example, if you consider how someone's gender, ethnicity, class and disability may interact within a hybrid identity you can begin to comprehend the complexity. When these individual aspects of identity are mobilised as group identity politics; as in the women's movement, the disability movement or gay rights, then we can appreciate how important it is to understand the implications of hybridity. For example, the women's movement was criticised internally by Black women who perceived it to be white and middle class.

When we apply the notion of hybridity to any nation or any ethnic community it acts as a powerful warning against us expecting uniform behaviour from all the members of these categories.

Being resident in Britain does not necessarily mean that you are 'British'
The fact that someone is a British 'citizen' tells us little about her/his 'national identity'
When someone does claim a specific 'national identity', it tells us little about what this means for that individual

In this section, you are going to take a look at three different ways of creating 'Us' and 'Them':

National identity, which is closely involved in attempts to clarify "Who is 'one of us?" and "Who has a right to live here / to be a citizen?"
Race - ostensibly based on biological differences between the different 'races' - but in fact a politically influenced concept suggesting that "'They' are not just different from 'us' they are demonstrably inferior."
Ethnicity which is concerned with recognising those who have a culture 'like ours' and excluding those who are 'not like us' .

Read the following text

1. 'National Identity'

We are going to look at this from two angles:

National identity as a unifying force
National identity as a divisive force.

National Identity As A Unifying Force

There is now a considerable academic examination of nation building and the nature of nationalism. In Imagined Communities, Benedict Anderson (1991) explores the processes by which people develop a personal and cultural feeling of belonging to a nation. This is a very scholarly book, which discusses:

the role of religious faith
the development of shared and unifying languages
the construction of shared notions of time
the central role of the media.

But the essence of his analysis - which has caught the popular interest - is his notion of nationality as 'imagined communities'. And the emphasis lies upon both words: communities - as groupings of people with shared histories, territory and feelings of connectedness - and imagined as a clear statement of the historical and contemporary construction of this shared identity.

This idea of a constructed national identity - deeply rooted in the emotional ties between 'those who are like us' and the almost fictional definition of that 'us' - provides a strong challenge to anyone who would see their national identity as in some way an inevitable expression of an unambiguous shared history. It warns us that shared national truths may be highly suspect and that emotion, as well as reason, is a key component of national consciousness.

This idea of the active fabrication of national identities is further underlined by the wonderfully provocative title of a book by Hobsbawm and Ranger (1983): The Invention of Tradition. They echo Anderson's argument that nations, new as well as old, construct their identity around their sense of historical continuity; of being an old 'people' even if a new nation. With rich and amusing examples, they demonstrate how shared practices - of relatively recent construction - are transformed into part of a shared 'tradition'. The idea of a tradition has its power in the expectation that things could not be otherwise: "This is a tradition: its origins need not be enquired into and it cannot be changed". Chapter 2 of their book - in which, for example, it is argued that the kilt was:

. . . invented by an English Quaker industrialist", (and) saved from extinction by an English imperialist statesman" (p. 26)

provides powerful examples of the peculiar bases of some traditions in the fabrication of 'The Highland Tradition of Scotland'. And - given the current ambiguous status of the British royal family - Chapter 4 makes rewarding reading for monarchists and republicans alike.

The historical events of our past, then, are not handed down uninterpreted, but may be retained, retrieved or reinterpreted along the way. Historical 'facts' are:

contaminated by their process of transmission
further distorted by the fact that those who encounter this history - whether in reading, cinema or public spaces - bring their own agendas to it. We are all partisan in our consumption of history.

Patrick Wright (1985) has provided a wonderful insight into the contemporary English heritage industry. As part of his argument he suggests that:

. . . preservationism has certainly played its part in a nationalisation of history which enables the state to project an idealised image ... of its own order against a geographical and historical background of its own selection."

(Wright, 1985:49).

In other words, what we as a nation choose to preserve - and the stories we attach to what we have preserved - tell us a lot about our contemporary efforts to shape our national self image and shared feeling.

The United Kingdom is an interesting historical construction. There has been a tendency to see ourselves as a relatively homogeneous people with a shared history and identity but - as you have seen in Section 1 - this is far from the truth. In fact one commentator suggested that:

'The British are clearly among the most ethnically composite of the Europeans'

(Geipel, 1969:163).

(And that was a statement made prior to the extensive modern migration of the last three decades!)

You've already considered some of the ways in which Britain has become a multiethnic society through the various patterns of immigration discussed in the previous section. It also belongs to the category of multinational societies - for example:

as Linda Colley (1992) has shown, the emergence of a 'British identity' was built upon a partial suppression of distinctive Scots, Welsh, Irish and English identities as Protestant England struggled against Catholic mainland Europe. Indeed, the very success of building a 'British' identity was dependent upon the dominance of English power and wealth in their bringing of these countries under the control of a parliamentary system based in Westminster: what one author pointedly called "Internal Colonialism" (Hechter, 1975). (The tensions currently emerging - as Labour Party policy seeks to give limited political autonomy back to Scotland, Wales and Northern Ireland - show how the identity of the 'United' Kingdom has remained an awkward fusion of distinct identities.)
our historical heterogeneity is also a result of invasion, as in the case of Romans, Angles, Saxons and Normans.

This historical diversity, however, has partly been obscured in the 'social construction' of the 'British identity'. In responding to the many facets of ethnic diversity in the United Kingdom, our own distinctive 'imagined communities' may be very powerful. Our sense of 'national identity' impacts upon our sense of connectedness to those around us. It informs our acceptance of the 'truths' of British history and the virtues of the British tradition. It may weigh heavily upon our willingness to accept change. If a state's construction of a national identity is important in a multi-ethnic society; so too are our own identity claims and our positioning of ourselves in relation to the past and present.

EXERCISE 2.1
Reflection Activity
1. Do you have a national 'identity'? What are the traditions, values and behaviour that enable you to share and express your national identity?
2. List at least five ways in which you could recognise someone sharing your national identity.
3. The concept of hybridity reminds us that we all have multiple affiliations which we integrate complexly in forming our own sense of self:

what other identity labels might you apply to yourself - including, for example, those defining your age, gender, sexual preference, leisure pursuits and personality? (Ethnicity and 'race' you will come back to later.)

consider whether some of these are more important:
- to you
- - or -
- to other people
in what ways do these other labels link into, or challenge, your sense of national identity?

EXERCISE 2.2
Group Activity:

- Discuss what you think is the stereotype of the British held by other nations.
- Discuss how national identities become relevant in your work place.

Nation Building As A Divisive Process

National identities can have a strong impact on us - as imagined communities that bind individual identities together. However, they also:

define the boundaries between 'Us and 'Them'
provide 'truths' that legitimate the inclusion of 'Us and the exclusion of 'Them'
make 'our' rights self-evident and 'their' "bogus claims" illegitimate

So why does this happen? And why is it so easy to nurture and so powerful in its effects?

The contemporary social theorist Zygmunt Bauman (1990) offers useful insights into both questions, suggesting that the very mobility and complexity of the contemporary world is a challenge to:

the power of the state over its citizens
the certitude of individuals' confidence in their own identity (and fans their xenophobia)

Let's take a closer look at each of these in turn . . .

Threats To The Power Of The State

Bauman reminds us that, from its emergence, the logic of the nation state has been to promote homogeneity through defining and controlling the identity of members of the nation.

It has been stressed repeatedly in all analyses of modern states that they 'attempted to reduce or eliminate all loyalties and divisions within the country which might stand in the way of national unity'

(Schafer, 1955: 119)

National states promote 'nativism' and construe their subjects as 'natives'. They laud and enforce the ethnic, religious, linguistic, cultural homogeneity. They are engaged in incessant propaganda of shared attitudes. They construct joint historical memories and do their best to discredit or suppress such stubborn memories as cannot be squeezed into shared tradition. They preach the sense of common mission, common fate, common destiny. They breed, or at least legitimize and give tacit support to animosity towards everyone standing outside the holy union (Alter, 1989: 7ff.). In other words, national states promote uniformity. Nationalism is a religion of friendship; national state is the church which forces the prospective flock into submission. The state-enforced homogeneity is the practice of nationalist ideology.

(Bauman 1990:154)

Clearly, this is a process under strain given the current forces of globalisation and the reality of the diversity within the population living in the state:

We all have multiple loyalties, which may potentially weaken our acceptance of the legitimacy and power of the state. Through our participation in diverse groups we may experience our interests - as members of some groups - being challenged by the policies and agencies of the state
Our globalised consciousness, diasporic networks and hybrid identities provide other ways of imagining the possible rather than accepting the permissible. Such critical consciousness can be threatening to the state.

Through the concept of citizen the state recognises the legitimacy of an individual's presence within the territory of the state and acknowledges their formal entitlement to the benefits of citizenship; namely, a range of rights and participation within the institutions of the State. (See Bottomore 1992). In multinational states like Britain there is no formal requirement to be a member of a specific nation in order to be a British citizen. (This is in comparison to the past pattern in Germany where it was assumed that all citizens would be members of the 'volk'; the German nation (See Wrench and Solomos, 1993 or Koopmans and Statham, 2000). In practice, of course, we have seen how British (English) nationalism has at various times suggested that not all persons can become British. This has not only fed discriminatory immigration policies, but has also meant that in effect many minority ethnic British citizens have been effectively denied the full enjoyment of their citizenship rights. The in-group self-interest of a historically constructed nationalism is not easily compatible with the inclusive rights of citizenship in multinational and multi-ethnic countries.

Threats To Individuals' Confidence In Their Own Identity

It is not only the state that can find aspects of the contemporary world troubling. Remember that the unifying agendas of nationalism also offer the promise of protection, rights and territorial certainty for members of the nation - so conformity may have its rewards. One function of the state is to police our territorial boundaries and 'keep the Barbarians at bay'. However, Bauman (1990) suggests that, through migration, there is a new source of anxiety - the stranger in our midst. Someone who is not really 'one of us', but who lives among us: Aliens who were safely imaginable - perhaps even known - were safe curiosities as long as they lived outside our boundaries:

As an ex-imperial nation, Britain had very extensive exposure to differing peoples all over the world. This contact generated a degree of assumed familiarity with the identity and customs of territorially distant peoples. Through literature, painting, music and more recently the cinema, they were familiar to us
Tourism allowed for a safe, vicarious intellectual and emotional interest in 'the Orient', the 'Arab world', the 'Indian sub-continent' and the 'Native Peoples' of the known world
This phenomenon is still replicated in the diet of the Discovery Channel and National Geographic - presenting 'exotic' others who live elsewhere.

Now, though, the safety of distance has been dramatically breached. In very many instances, the 'strangers' - who are now the settled minority ethnic communities of Britain - are not unknown aliens. They are vaguely familiar, with:

identities as 'strangers' - which may trigger anxiety and resentment
'known' characteristics - which may be drawn upon to justify anxiety, confirm difference and legitimise avoidance.

As Bauman puts it:

The stranger undermines the spatial ordering of the world: the fought-after co-ordination between moral and topographical closeness, the staying together of friends and the remoteness of enemies. The stranger disturbs the resonance between physical and psychical distance - he (sic) is physically near while remaining spiritually remote. He brings into the inner circle of proximity the kind of difference and otherness that are anticipated and tolerated only at a distance - where they can be dismissed as irrelevant or repelled as inimical. The stranger represents an incongruous and hence resented 'synthesis of nearness and remoteness'

(Simmel, 1971:45 cited in Bauman, 1990:150)

A degree of xenophobia is hardly surprising, then, given the extensive history of British nationalism and its complementary invocation of a self-regarding sense of superiority. In addition, the presence of historically established stereotypes flesh out the diffuse antipathies of xenophobia - a concept discussed further below. This is by no means a uniquely British phenomenon.

So in contemporary Britain, (as in many other European countries), the assumed 'cultural homogeneity' - a core element of the operation of the nation state - can no longer be guaranteed. To class, gender and regional identities - which have for a long time been a challenge to this homogeneity - the diversity of new ethnic identities has been added. The current exploitation of nationalist sentiment in party politics, in relation to both devolution in the United Kingdom and relations with Europe, continues to sustain the everyday relevance of national identity and its associated imageries. As the United Kingdom is now certainly a multiethnic society, it may be that for the majority ethnic populations there will be a need for un-learning, as much as taking on board new learning, in order to operate fairly and efficiently in their contemporary environment.

Before you move on to take a look at 'race' and ethnicity, turn your mind to the next Exercise. This is also a good natural break time - give one set of concepts time to digest before you turn to another.

EXERCISE 2.3
Group Discussion
1. Discuss the links between being a British citizen and having a specific national identity: Barbadian, English, Indian, Irish, Pakistani, Scots, Welsh et cetera.
2. In what ways does your gender (or any of the other aspects of personal identity that you considered in the previous exercise) impact upon your ability to express your national identity?
3. Does your 'nation' have 'natural enemies' - other nations you love to mock?

- Why has this come about?
- How does it express itself?

EXERCISE 2.4
Group Activity
- Share your understanding of how it is possible for a group of people to have common British citizenship, but quite different hybrid national identities.
- Discuss whether the 'work culture' of your place of work has any particular predominant national identity.
- Examine the implications of this for delivering care to:
- all citizens
- non-citizens

2. Race

"As a way of categorising people, race is based upon a delusion because popular ideas about racial classification lack scientific validity and are moulded by political pressures rather than by the evidence from biology."

(Banton and Harwood 1975:8)

Belief in the existence of distinct 'races' provides a wonderfully efficient way of simplifying the world. The complexity of human thought and action can, seemingly, be reduced to an explanation in terms of someone's race.

There is a long history to this pattern of thought and it is all the more powerful in British culture because of its close association with the legitimisation of the oppressive and exploitative practices of the British Empire. And yet, this taken-for-granted assumption that there are clear distinctions between human beings, based on their membership of different racial categories, is one of the most dangerous cultural practices available to the contemporary world.

We don't have to have crew cuts and tattoos on our knuckles in order to employ the language of race. The emergence of extremist groups like the National Front and the British National Party in the 1970's provided a political context in which it became popular to equate racism with fascism. (Media assaults on 'racist thugs' are still common.) And yet, a national consensus that racism = extremism is dangerous, with the implication that 'we, the majority' are liberal and tolerant. However, racism starts with the use of race concepts - as soon as we seek to explain anything by reference to race, we have brought 'race' into our thinking and given it legitimacy.

The power of this 'race thinking' comes from:

its long historical presence in most cultures and its continuing linkage with the politics of nationalism. Our ideas about race have extensive historical roots, which guarantee their relevance to us - whether we are English, French or Japanese
the flexibility and ambiguity of the language of race. Like a super solvent it reaches the parts of our consciousness other ideas fail to touch
its ability to offer a certainty of identities in a world of rapid social change and global threats to the power of national governments to negotiate trade, information and culture within their own borders
the easy familiarity of its use. It doesn't stand out as a strange and totally distinct set of thought processes, because we are quite familiar with structuring the world into categories such as men/women, vegetarians/meat eaters, intelligent/dull, fat/thin or old-young. We are also familiar with attaching moral and social value to these distinctions. We're not likely to be startled, then, by a way of thinking that reduces human variation into a few distinct categories and which then places these categories into a hierarchy of worth.
the common mechanism of stereotyping - reducing the 'other' to a simplified set of references. (You can catch yourself out in this process when you use 'they' to refer to someone from a group other than your own - 'They always do this. They wouldn't want this.') Such stereotypes commonly serve to validate the 'hierarchy of worth' referred to in the previous point and are developed in a specific historical context. For example:
- as Walvin (1971) and Jordan (1969) have shown, British stereotypes of blackness were significantly developed during the era of slavery and imperial expansion. A belief in the moral and intellectual inferiority of the peoples of Africa was highly consistent with the treatment of fellow human beings as goods and chattels
- contemporary English stereotypes of the French were developed through centuries of conflict (Colley, 1992) and are sustained through contemporary competition within the European Union.

The logics of 'race thinking' are not unique to race thinking; but the substantive content, the idea of race and the beliefs associated with it are distinctive. As Omi and Winant have said (1986:64), racialisation is:

"the extension of racial meaning to a previous racially unclassified relationship, social practice or group ... it is an ideological process, an historically specific one."

You read in Section 1, the demographic reality of the post-war period was that Britain, needed to draw in a labour force for economic regeneration purposes. However, what the press constructed was a 'moral panic' about a crisis of "coloured immigration". The flow of migrant labour was discussed in the language of colour and 'race' - this was racialisation. The British public learnt to view this phenomenon, not as a major economic benefit to the country, but rather as a threat to British 'racial identity' and culture. The language of this account was that of natural disasters and extreme threat. It fed, and fed off, the party political competition to buy the anti-immigrant voter. The racialisation of British political discourse in that period was profound. (Hartmann and Husband, 1974) and:

established the acceptability of xenophobic nationalism, which has continued as a dangerous part of British politics, fuelled by Thatcherism and remaining an important element in the anti-European Union propaganda
confirmed 'race' as a real and unembarrassing concept in British life.

The power of 'race thinking' lies in just this assumed normality in using the language of race. But, as the academic literature amply demonstrates (Banton and Harwood 1975, Mason 1986) there is no scientific basis for the race categories that are employed. They are a social invention: but nonetheless powerful because they are believed to be real.

Ahmad (1993) provided a robust critique of the dangers of racialisation; that is, of explaining phenomenon by employing the language of race. He argued that:

"Racialization assumes that 'race' is the primary, natural and neutral means of categorisation, and that the groups are distinct also in behaviour, characteristics, which result from their 'race'...

Racialization takes place in terms of notions of cultures being static and homogeneous and having a biological basis. This is then extended to notions of cultures having direct relationship to attitudes, expectations and behaviour. 'Cultures' here take on a rigid and constraining shape, rather than being nurturing and sustaining forces. These culturalist assumptions ignore issues of power, deprivation and racism. They result in culturalist explanations and feed into culturalist health policy options."

(Ahmed 1993: 18-19)

As this quotation indicates, the dangers of radicalisation in health care provision is that it provides simplistic, and rigid, accounts of people's identities and characteristics which denies the complexity of hybrid identity we have reviewed above. It also, of course, defines the majority ethnic culture as the norm from which all others are likely to be inferior deviations.

EXERCISE 2.5
Reading and Reflective Activity
For this activity you will need to read and access the following article:
Husband C (1987) 'Introduction: 'Race', the continuity of a concept' in Husband, Charles (ed) Race in Britain: Continuity and Change. London: Hutchinson pp 11-23

1. Consider the presence of 'race thinking' in your environment:
(a) Are there occasions when you are comfortable with the use of 'race' categories?
(b) Do you consider yourself to be a member of a 'race'? If so, are you happy to have your behaviour and thinking explained by your racial characteristics?
(c) What, if any, are the linkages you make between nationalism and race thinking?

EXERCISE 2.6
Group Activity
Discuss your experience of 'race thinking' in contemporary Britain.
(The concept of 'racism' is discussed in Section 3.)

3. Ethnicity

You have just read about the ways in which multi-culturalism has become an issue - because of the co-existence, within states, of people claiming distinct ethnic identities.

The issue is not simply one of differing cultures. It is about the value that people attach to the differences and the strategies that they develop to sustain the continuity of 'their' ethnicity. You need to be familiar with the ways in which:

'cultural markers' are used to sustain definitions of ethnicity
ethnicity is situational and interactive
ethnicity has both personal and structural components.

Let's take a look at each of the highlighted topics in turn.

'Cultural Markers' Are Used To Sustain Definitions Of Ethnicity

A very simple definition of ethnicity is 'Cultures in contact'. We become aware of our ethnicity when we interact with members of a different culture - and ethnicity is about:

the negotiation of our ethnic identities
the collective identification and assertion of our significant characteristics or 'ethnic markers'.

Similar to the process of defining national identity, ethnicity is tied up with recognising 'those like us' and excluding 'those who are not like us' from inclusion in our identity group on the basis of these 'markers'. As Hylland Eriksen says:

"Ethnicity occurs when cultural differences are made relevant through interaction. It thus concerns what is socially relevant, not which cultural differences are 'actually there'. In an article on ethnic relations in Thailand, Michael Moerman (1965) has shown that many of his informants mention cultural particulars which they presume are characteristic of themselves but which they in fact share with neighbouring peoples. Indeed, a variety of criteria can be used as markers of cultural difference in interethnic situations - phenotype (appearance or 'race'), language, religion or even clothes. If any such marker is socially recognised as an indicator of an ethnic contrast, it matters little if the 'objective cultural differences' are negligible."

(Eriksen 1995:251)

Once again, we are looking at the social construction of difference. Identified markers of difference become important because they are vehicles for representing that difference; not because they are important in themselves. Are the linguistic differences between a Brummie and a Geordie accent really important in themselves? They are both regional English accents. But, as markers of identity they are very significant.

You might find it useful to think about the way in which the word 'ethnic' is used in everyday speech - for example, what images are conjured up by:

ethnic food
ethnic fashion?

For the first of these, you probably thought of a cuisine unlike your own, in which different spices are used, say, or cooking processes differ. What may be eaten with what can also seem odd - having maple syrup with your bacon, or refusing bacon at all. Such decisions are, in themselves, not remarkably important in relation to sustaining your good health, but they may be important to your ethnic identity.

For the second - fashion - you probably thought of very different colour combinations and styles of clothing from your own.

These images reveal an important truth about the routine popular discussion of ethnicity in contemporary Britain - and this is the assumption that 'Only other people are ethnic', whilst our own ethnic identity remains unstated. We are the taken-for-granted norm; and where the 'we' are the majority ethnic community this way of thinking can have very significant consequences.

In other words, in such circumstances the term 'ethnic minority' refers to both:

difference from the norm
marginal status in relation to the majority.

However, if ethnicity is a process of negotiated difference, it is vitally important to recognise that majorities are also ethnic. (The recent political devolution in Scotland and Wales has, for example, initiated a current anxious debate about what is Englishness: the majority population in England is engaged in re-evaluating its 'ethnic markers'.)

A failure to recognise your own culture as also 'ethnic' is the basis of a major conceptual error, namely ethnocentrism. Ethnocentrism means unthinkingly taking your own culture as an absolute: an unquestioned source of truths whereby to judge the world and others. As Hylland Eriksen says:

"This term (from Greek 'ethnos', meaning ' a people') means evaluating other people from one's own vantage point and describing them in one's own terms. One's own 'ethnos', including one's cultural values, is literally placed at the centre. Other people's would, within this frame of thought, necessarily appear as inferior imitations of oneself."

(Eriksen, 1995:11)

The great triumph of successful socialisation is that we wear our own culture so unselfconsciously. Our identity and our beliefs and values are, quite literally, normal: the norm. We receive reinforcement and support from other members of our group from our daily participation in this normality. Mavericks and rebellious youths may be stimulating but they are only to be tolerated within limits. They usefully remind us of the norm; by violating it. We routinely rehearse our own ethnicity by inhabiting its social structures and practicing its codes. It is hardly surprising, therefore, that we can easily fail to remain conscious of our ethnicity. However, an incapacity to recognise and respect other peoples' experience of inhabiting their ethnicity necessarily makes us rigid and judgmental in our response to their behaviour. When a particular ethnic identity has been tied into the definition of 'a nation', then we may see the social psychology of ethnocentrism magnified and made legitimate by the ideology and politics of nationalism.

Ethnocentrism is entirely inconsistent with an ability to provide holistic nursing care. Recognising that someone is different is not a sufficient basis for culturally sensitive care:

If that difference is understood through the language of 'race' then a racialised understanding of their difference can at best provide the basis for patronising tolerance
If that difference is understood through an ethnocentric recognition of their ethnicity, it is virtually inevitable that their values and needs will be seen as a deviation from the norm.
In contrast, nurses who start from a recognition of their own ethnicity as one amongst very many cultural solutions to living, willingly enter into contact with a client being aware of our difference. This is a recognition of difference which does not start from an assumption of the inferiority and weirdness of the patient's culture. This openness to the existence and integrity of other ethnicities is known as cultural relativism.

Cultural relativism doesn't require a denial of one's own values, or a total suspension of judgement about the other culture. But, it does demand a reflexive critical awareness of one's own ethnicity; and an openness to understanding the other ethnic community on their terms. It is a necessary learning of how and why their ethnicity makes sense to them. (You'll be coming back to the topic of cultural relativity in Section 5.)

If we are to be capable of cultural relativism we must have the basic tools for understanding the nature of ethnicity. In this task the anthropologist Fredrik Barth (1969) proved very helpful in criticising early anthropology's fascination with the cultural artifacts and practices of ethnic communities and emphasising, instead, the importance of examining the mechanisms whereby communities create and maintain the boundaries between them. He makes a useful distinction between the:

The assumed static cultural content of ethnic communities - that 'ain't they quaint' fascination with the 'cultural stuff' of other communities that we can still find in popular travelogues in print and on television
- and the -
dynamic social processes of sustaining ethnic identities - the social boundaries between groups and the ways in which these are constructed and policed. Such processes are at the dynamic heart of ethnicity; along with our markers of ethnic identity which serve to define these boundaries. These markers may include language, dress, diet and gesture.

It is important to note that there is always a complementary range of ethnic markers. This helps to:

minimise the risk that a genuine member of the ethnic group can have their claims to membership denied because they fail on one marker
ensure that no outsider can claim membership of the group because they satisfy one of the criteria
build flexibility into ethnic boundary maintenance. (New criteria can be developed and established markers can be allowed to fade without causing a sudden radical redefinition of the boundary. Each marker is part of an interactive whole.)

The integrity and workability of ethnic boundary maintenance comes not only from the effective interaction, in use, of the boundary markers, but also because these markers are themselves embedded in a valued collective history. Ethnic groups may be engaged in a process of negotiating their identity on a day to day basis, but they do so with a strong sense of continuity with their shared history. This history is likely to:

include origin myths, which identify the ancient roots of the current people
rehearse key events in their history - events which exemplify some of the enduring qualities and values that continue in their self definition
trace the long dynamics of conflict and resistance in relation to significant competitors.

Thus, this construction of a 'shared history' provides a coherent body of belief, which serves to legitimate the contemporary claims to a common culture. (A social construction, like the traditions that serve to bolster the imagined communities of nationhood.)

EXERCISE 2.7
Reflective Activity

1. What would you regard as being your ethnic identity?
2. List 4-5 'markers' of your ethnicity.
(a) Are they all equally important?
(b) Do they all have the same visibility in your daily life, or are some specific to special occasions?
3. What 'origin myths' and 'key historical events' help to embed these markers in your consciousness?

EXERCISE 2.8
Group Activity
- Share your understanding of how you experience the boundary markers of your own, and other ethnic groups, in your daily life.
- Try to identify ways in which particular boundary markers have changed over time.

And, remember our discussion of hybridity - are there different markers that link ethnicity with gender; age, or class?
Remember that ethnic communities contain diversity within themselves.

...Continue to Read on

Ethnicity Is Situational And Interactive

Ethnicity, as you have already seen, is the product of a dynamic collective process. As Hylland Eriksen says:

"... ethnicity is relational and processual : it is not a 'thing', but an aspect of a social process."

(Eriksen 1995:254)

Ethnicity is not imprinted within us - a social-genetic micro-chip which, once implanted, determines and makes sense of our behaviour. It is an ongoing process of identity building, which is achieved through our relations with others. However, we are all members of very many groups. We fulfil many social roles and, as we have seen, have many social identities - for example, as nurse, parent, mortgage owner, or member of a religious faith. Our gender, class, age, sexual preference and health status are also powerful determinants of our life experience. This reality has a number of important implications:

1. We need to understand the ways in which these different identities interact - for example:

very often, part of the internal cultural definition of an ethnic community will include strongly prescriptive norms about gender appropriate behaviour, which means that gendered identities and ethnic identities may be closely interwoven
in some circumstances, ethnicity and class are closely correlated because of the structural location of an ethnic population within a society. And, class may vary the modes of expression of ethnicity within a community.

The inter-relationships are always going to be specific to a particular ethnic community, in a specific location, at a specific time. We need to employ intellectual curiosity, openness and a willingness not to resolve the uncertainty and ambiguity present in any instance too rapidly. Complexity is normal when we seek to understand the implications of ethnic identities.

2. We are not permanently locked into negotiating our ethnicity - we do not persistently, in all places, at all times, perceive the world through the filter of our ethnic sensibilities. Like all our other significant identities, ethnicity can be made relevant by events in our social environment, or triggered by stimuli in our current activity. For example:

In watching a film we may suddenly feel resentment at a stereotypical presentation of a character we identify as a member of our ethnic community
In a conversation with a professional focus in a clinical setting, nurses may be discussing a case history when a casual aside dramatically makes everyone self-conscious about the ethnic diversity present in the group. One of the key issues in multiethnic societies is the implicit rules about who may make ethnicity relevant and when.

Thus, when we speak of ethnicity being situational we are merely noting that triggers in our environment may bring our ethnic identity into focus. When we are operating within our ethnic community very often our ethnicity is seemingly irrelevant; other distinctions within our community may hold our attention. When the process of radicalisation takes ethnic markers and converts them into the rigid criteria of racial categories then ethnicity may be frequently important; for both the racist and those stigmatised by them. And, in the work place where we are attempting to change routine working cultures to meet the demands of the UKCC, the Vital Connection or other policy initiatives, then there is likely to be a period where self-consciousness about ethnic identities is almost routine.

When members of minority ethnic communities experience behaviour in the workplace as being ethnically insensitive, they cannot assume that they will be granted a positive response by making the ethnic dynamic in the situation explicit. Nor can a member of a majority ethnic group proceed, on a day to day basis, with the assumption that the ethnic identities of workplace colleagues should always be made explicitly present in all interactions with them. We are all used to the daily routines of negotiating our own ethnicity - feeling it to be relevant or irrelevant from moment to moment. We have greater difficulty in being sensitive to others' engagement in exactly the same process. The micro-politics of negotiating ethnic identities are the practical core of transcultural communication in multiethnic societies.

Ethnicity Has Both Personal And Structural Components

We have become familiar in the last two decades and more with the development of 'identity politics' in a variety of forms. For example:

Gay pride has seen the active assertion of the legitimacy and vitality of homosexual relations and culture
In Grey Power we have seen the growth of identity claims for dignity and expression from the not-so-young
From the radical politics of Black Power in the 1960s onwards we have seen the growth of social movements based upon ethnic identities.

This reminds us that ethnicity is the product of collective political and institutional action in addition to being a product of individual subjective feeling. As Wallman (1986) has argued: Ethnicity is a necessary interaction of organisational infrastructure and 'consciousness of kind'. Let's take a closer look at this:

Having a strong sense of a distinct ethnic identity may be sustained by individuals regardless of where they live. They have a psychological 'consciousness of kind', a personal sense of their shared identity, which shapes their response to the world. Much of the comedy created around tourists is based on the fact that they take their identity (and culture) with them wherever they happen to be. But on a continuous day-to-day basis we can only truly live our ethnic identity if we can express it in action by, for example:

Buying and cooking our food in our way
Watching films and television that tell our history and show our culture in ways we find acceptable
Sending our children to be educated in schools in which our values and history are an integral part of the curriculum.

Similarly, members of an active ethnic community must be able to live their ethnicity - to express their beliefs, values and cultural practices in action - which entails having the necessary infrastructure of resources and institutions including:

shops that provide the appropriate raw materials, or clothes, or books or video cassettes or CDs. With the advent of video cassette technology, there has developed an infrastructure of corner shops that made available Bollywood films to South Asian communities in Britain. Now, with satellite television, Indian and Arab language television programmes, among many others, are available to meet the ethnically informed media preferences of particular communities.
structures that sustain religious practices in Mosques, or Synagogues or Gudwaras or Chapels
an educational framework which allows choices for people from particular ethnic communities. In Britain we are familiar with Catholic, Quaker and Jewish schools which are supported by the state; and we have seen over the last decade or more, the persistent struggle of Muslim communities to be allowed Islamic schools, to serve their own children.

In health care, too, the different cultural conceptions of health - and of appropriate treatment - have led to the emergence of a wide range of health care provision run by minority ethnic health care providers for specific minority ethnic communities.

Traditional practitioners in Chinese medicine have operated for a long time within their communities, as have hakkims within the South Asian communities. Now, in mental health and general health care provision, large minority health care organisations are to be found operating in the major cities of Britain. Increasingly, their 'traditional' practice is being transferred into mainstream (majority ethnic) health care where it has been called 'alternative' medicine. Acupuncture and Chinese herbal therapies, for example, are two of the models of practice that have become institutionally consolidated within Britain.

There is an ongoing struggle to provide a health care infrastructure appropriate to a multiethnic Britain. This includes:

making the mainstream services accessible and culturally safe for all potential users
providing a viable choice of access to ethnically specific health care services.

In the quest for building an organisational infrastructure - one that can reflect the values, and meet the needs, of distinct ethnic communities - there is a reality of competition for resources - both economic and political. Where some ethnic communities are minorities the pursuit of these resources can result in inter-ethnic competition and hostility. Where the legitimate pursuit of ethnic self-interest is understood through the language of 'race', it is very likely to be defined as a threat to the interests of the majority. Mutual respect for ethnic diversity is undermined by the superiority claims built into 'race thinking'.

The mobilisation of minority ethnic communities can, in such circumstances, be seen as both threatening and illegitimate to the dominant majority population. The idea of the 'victimisation of the majority' encapsulates exactly this sentiment. It is the unreasoned cry of a resentful majority that their interests are being neglected in the pursuit of minority ethnic self-expression.

Because, for the most part, the majority ethnic population fails to see itself as 'ethnic', it is not surprising that they fail to see that mainstream health provision is 'ethnically appropriate health care' - ethnically appropriate for them. And so, they see the demands of minority ethnic communities for ethnically appropriate health care as 'special pleading' and raising unique demands, rather than a demand for an infrastructure and a service that the majority ethnic community already enjoys.

Ethnocentrism, supported by 'race thinking' can make the resistance of the majority to the health care needs of minority ethnic communities seem reasonable. It is minority ethnic patients who from this perspective are being unreasonable. The dynamics of identity, of 'consciousness of kind', are focussed through the particular institutions and organisations in which ethnic interests are pursued. The health and care services are instances of such organisations. How people respond to the demands of ethnic communities is partially a consequence of their wider understanding of what is meant by multiculturalism - and you'll be returning to this topic in Sections 4 and 5.

It is not surprising that any attempt to provide a health care system that is appropriate to a multiethnic client population has the potential to generate anxiety, or even conflict. We have just discussed above the reality that ethnicity is not merely a psychological sense of identity: it is also dependent upon those institutional structures and political and economic resources that will enable individuals to live their ethnicity. It is exactly for this reason that models of transcultural nursing contain dimensions that reflect this organisational basis of ethnicity. Thus, for example, Giger and Davidhizar (1999) identify "social organization" as a key element in their model (see the Transcultural Health Care Practice: Foundation Module - Transcultural Health Care Practice for a further discussion of such models). Given that in contemporary Britain the demands made upon the health services far outstrip their capacity to respond, all demands upon the health system are problematic. When some individuals and communities are perceived as "not being really one of us" then it is simple for their demands to be seen as illegitimate, and to be resented. However, this arises from an ethnocentric, or racist, failure to recognize that the very great majority of minority ethnic clients are fellow citizens. All users of the health care system have an equal right to appropriate and adequate care. The Equal Opportunity Framework of the National Health Service Executive, The Vital Connection requires "a workforce that is able to deliver high quality services that are accessible, responsive and appropriate to meet the diverse needs of different groups and individuals".

Where members of minority ethnic communities are seen by majority ethnic health care staff as 'not one of us' then the legitimate expectations of minority ethnic clients are all too easily seen as unfair competition for scarce health care resources; or in other words that the majority community loses out to the special pleading of the minority community. This sense of the 'victimisation of the majority' is given a sense of legitimacy because of course in the overstretched NHS there is a realistic competition for resources between health care specialisms and different client interest groups. But there is not an equivalent prejudiced resentment when the particular needs of cardio-vascular patients or diabetic patients are promoted. Resentment against the health care needs of minority ethnic patients must be recognised for what it is; a prejudiced and often racist failure to regard fellow human beings, and citizens, as equal.

EXERCISE 2.9
Reflective Activity

1. In reflecting upon the situational dynamics of ethnicity can you recall recent events where you were made aware (self-conscious) of your ethnic identity?
(a) What were the circumstances?
(b) Specifically how was it triggered?
(c) How did the situation resolve itself?
2. In reflecting upon the structural basis of ethnicity can you identify infrastructures that enable you to express your ethnicity?
(a) What are these?
(b) Are there resources you lack to easily express your ethnicity? Why is this so?

EXERCISE 2.10
Group Activity

- Share your experiences of the importance of infrastructural resources in enabling you to live your ethnic identity.
- Share your experience of challenges in your work environment about the current resources available to ensure adequate health and social care for all ethnic communities.
- In addressing the needs of an ethnically diverse client population, is the workplace culture supportive of the ambitions of The Vital Connection?
- Where there is resistance - how is it expressed?
- How is it challenged?

What have you learned so far?

You have now developed your understanding of ethnicity and of its significance for the provision of appropriate health and social care. In the next section we will begin to address the question of how, as a country, we have defined the challenge of responding to ethnic diversity.