Ethnic Factors in Health and Disease

J. K. Cruickshank, D. G. Beevers

• Publisher: Butterworth-Heinemann
• Year: 2013
• Print ISBN: 9780723609162
• eBook ISBN: 9781483165417
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Ethnic Factors in Health and Disease discusses ethnicity from a medical perspective. The book is comprised of 35 chapters that are grouped into four sections. The text first covers the background issues concerning the relationship between ethnicity and health. The next part deals with topics related to epidemiology, such as the health of migrants and interethnic comparison of cardiovascular disease. Next, the book tackles the sociology of health; this part covers occupational status, housing, and racism. The last part discusses the specific medical aspects, including pregnancy, viral infections, and cardiovascular disease. The book will be of great use to medical researchers and practitioners. Professionals dealing with ethnicity, such as sociologists, anthropologists, and psychologists will also benefit from this book.

Foreword 1

It is neither novel nor profound to restate that there will always be differences between people and many of mankind’s blackest hours were as a result of the strife and intolerance which these differences provoked. One of the significant advances of modern times has been the growing conviction that it is more productive to use the diversity in a positive way to contribute to our wellbeing. Jamaica’s motto ‘Out of many, one people’ is a reflection of this desire to focus on the unity which overrides differences.

Ethnicity is one kind of patent difference, and although it is difficult to define it accurately, it does convey the idea of peculiar characteristics assigned to some group of persons who can be easily recognizable and can be differentiated from others. Ethnicity often conjures up the image of the exotic, whether in terms of music, food, dress or even style of cricket! These ethnic differences have been explored in several places, and the roots and origins of much of Caribbean expression and thinking have been fertile fields for musicologists, anthropologists and the ethnologists.

Only occasionally have health professionals examined systematically these ethnic differences, gone beyond the stage of phenomenology and attempted to seek explanations for the differences in disease expression which are found.

This book represents a truly splendid effort by professionals from several parts of the world, and who work in a wide range of health disciplines, to examine the differences in various aspects of health which exist between groups of persons distinguished by their ethnic origins.

It is refreshing to read in the same book fascinating accounts of the sociology of race and health alongside descriptions of the clinical aspects of various interesting diseases. The range of problems addressed is also impressive and although the majority of the authors or the topics have Caribbean connections, there are contributions and perspectives from many other parts of the world.

This book must surely be seen as a first step the intrepid editors have taken in an area which is intrinsically sensitive, but which has to be explored if health care workers in various parts of the world are to deepen their understanding of the significance of their observations not only in the ethnic minority, but also in the numerically dominant majority.

Area Director. George A.O. Alleyne

Health Programs Development, Pan American Health Organization

Formerly Professor of Medicine, University of West Indies

Foreword 2

Medicine does not stand still. New diseases emerge, old diseases fade away, methods of investigation and treatment change constantly. Dr Cruickshank and Dr Beevers have identified a new and important factor in the metamorphosis of medicine, that arises from the movement of populations and the opening up to scrutiny of areas of the world that have not hitherto been easily accessible. The ease of international travel and the (usually enforced) migration of large groups requires all of us to know more about diseases that were once rare in the developed world. Epidemiologists must revel in the new opportunities to study common diseases as they present and evolve in different parts of the world among people of different genetic and environmental backgrounds, and are now greatly assisted in this task by the specificity and certainty of new molecular markers of genetic identity.

In tackling this fascinating topic, the editors have brought together a large and impressive international team. The first quarter of the book provides a general background that highlights ethnic differences and some of the factors that account for them. The rest of the book examines specific topics: infection, blood disorders, psychiatric disease, nutrition (illustrating the particular interests of the editors that must have stimulated them to produce this book) and cardiovascular disease including hypertension and diabetes.

This is an important book. It serves to throw into prominence aspects of medicine that could illuminate some of our darkest areas of ignorance. It is also easy, indeed engrossing, to read.

President. Raymond Hoffenberg

Wolfson College, Oxford

Recently, President of the Royal College of Physicians, London

Preface

There can be few people in Europe or North America who are not aware of the ethnic diversity of modern society. Communication between ethnic groups is often poor, even without language barriers, and may lead to an unawareness or lack of interest in the lives, aspirations and worries of ethnically different people, living and working no distance away. The domination of the media tends to encourage the majority to put over its ideas to minorities; the reverse rarely occurs. Assimilation into the majority is unusual so that minority groups tend to retain their cultural, religious and hence ethnic identity, as well as their social and health problems. Ethnic diversity will remain a feature of modern society. In the USA, the black, white, Hispanic and Jewish communities have retained their identities after generations of living in close proximity. The ethnic angle to health and disease is not unique to any country but has not yet achieved the understanding or perhaps sympathy of doctors, health-care planners or even patients.

Ethnicity rather than race

We have intentionally used the term ‘ethnic’ in preference to ‘racial’ throughout the book. ‘Race’ and ‘racial’ not only have inflammatory connotations, but are sloppy terms implying a precision of classification between peoples that has no biological basis. We agree with Cooper [1] who has argued that the concept of ‘race’ has been based on appearance and degree of melanization (skin pigmentation) rather than on repeatable biological or genetic measures. He suggests the word now has little meaning. How do the Ashanti or Yoruba peoples of West Africa differ from Nilotics of southern Sudan or black Americans or Negrito aboriginal peoples of Melanesia? Are Poles as distinct from Anglo-Saxons as they appear to be from Chinese? More relevant to medical science, how many research workers have bothered to define the ‘racial’ groups they study? To our knowledge, only Miller (see Chapter 32) has categorized black or Indian groups, whom he studied in Trinidad, by grandparental origin rather than by immediate appearance as a surrogate for ‘race’. Hill (see Chapter 5) elegantly describes the limitations to genetic definition of different peoples and the lack of specific genetic markers to identify ‘races’. Rather, the frequency of particular genes may be greater in one area than another and differences within groups are much greater than between groups.

The term ‘ethnic’ also has a much more appropriate wider context. It includes individual factors shared by groups (which may be genetic) as well as the social, economic, dietary and personal habits that characterize whole societies. By means of experience and education, effort or invitation, people can alter their social class. However, their ethnic origin remains relatively unchanged and may continue to influence their health. Analysis of these factors can lead to advances in our understanding and treatment of disease, as illustrated in the chapters on changes in cancer incidence and cardiovascular disease with migration.

Research results and positive discussion of ethnic factors have clearly benefitted people affected by specific diseases, often after extended efforts by pressure groups. For example, the knowledge and management of sickle cell and thalassaemia syndromes has improved considerably in the last decade. The technical and practical benefits allowed patients and their relatives to become directly involved, as in the development and day-to-day running of community sickle cell centres. There is increasing awareness of appropriate therapy for hypertension in blacks; nutritional supplements are given to susceptible pregnant mothers and their children.

The benefits are not restricted to more effective delivery of health services. Monitoring the epidemic of diabetes among people of Indian and Afro-Caribbean origin is providing clues to its origin. Advances have also come from the study of the interaction between lipids and coagulation factors as a cause of coronary heart disease, with important clues from ethnic differences. The finding that the retrovirus HTLV-I is implicated in spastic paraparesis in Afro-Caribbean and Japanese communities has provided a model for the pathogenesis of multiple sclerosis. We believe these examples represent clinical epidemiology at its best - approaching disease in individuals with a population perspective and the appropriate methods.

An important challenge to doctors will be a change in attitude to being questioned. In particular in these special topics, the ‘informed-doctor-dispensing-to-ignorant-patient’ approach will have to give way to an appreciation that many ‘minority’ patients will know more of recent developments in their condition than their doctors.

Thus the topics in this book cover much of medicine and international health. They could have been even wider; there is no specific discussion of ethnicity and disease in the South Pacific, in Japanese migrants, native American Indians or South Africa. Some topics (e.g. AIDS) are intentionally omitted as they have their own burgeoning literature. To have included or distilled the results from all potential ‘ethnic’ areas would have made the book unfocused, but we hope that the expertise of the authors and the breadth they cover will provide a comprehensive outline of how ethnicity affects health and medical practice.

Features of the book are the international contributions from the Caribbean, USA and Singapore where ethnic factors are obvious facts of daily life. These should balance the British perspective and encourage collaboration between colleagues working in the countries of origin and destination of migrant peoples. Unfortunately, the enormous topic of ethnic diversity and health in the Indian subcontinent itself could not be included. We hope, however, that the basic philosophy of the topics chosen will prove relevant.

Our book is aimed at doctors, nurses and health workers and the intention has been to allow any interested person to understand the topics discussed. Perhaps some of the lessons learned over the past 20 years in chronic diseases and ho...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Foreword 1
• Foreword 2
• Preface
• Contributors
• Section I: Background issues
• Section II: Epidemiology
• Section III: Sociology
• Section IV: Specific medical aspects
• Index