This sub-section examines the argument that current sociological
understandings of illness and disability fail to account for the diversity of experience between ethnic and religious groups in Britain. It uses
existing literature to argue that experiences of illness and disability are culturally and religiously specific. Furthermore, these diverse beliefs may be at times incompatible with western medical beliefs espoused by health and social services. These arguments are particularly pertinent to research on care as it is possible that diverse perceptions and experiences of health and illness at the intersections of ethnicity and religiosity may shape how the performance of care is undertaken.
In a study carried out to mark the silver anniversary of the leading academic journal Sociology of Health and Illness, Armstrong (2003)
68 noted that themes such as the theoretical constructs for the field and issues of identity were particularly prevalent within the articles. This finding is significant when considering the societal changes that have taken place in the last twenty-five years. An increase in disease and infection prevention, combined with falling death and fertility rates has resulted in an ageing population more at risk of chronic illness and disability. Additionally, globalisation and improved mobility has led to increased cultural diversity within Britain. Consequently, some
researchers have argued that classical theoretical understandings of health and illness are dated and need to account for societal changes. Adhering to this viewpoint, Kelly and Field (1998) argue that:
[N]ot only have the social structures of contemporary western societies become more diffuse and fragmented but the experiences of chronic illness have also become more diverse (p. 11).
Kelly and Field (1998) present contemporary society as rapidly changing and unstable. They argue that a current theoretical
assumption of health and illness needs to be inclusive of these factors. Arguably, experiences of illness and disability will depend, at least in part on culture and identity. House (2002: 134) argues that racial-ethnic status has an important influence on ‘exposure to and experience of virtually all known psychosocial, and biomedical, risk factors of health’.
In a classic study of patient symptoms and complaints, Zola (1966) argued that experience of illness and pain is variable and dependent on
69 social factors such as gender and ethnicity. In his study, Zola found that when comparing Italian and Irish patients in an outpatient clinic:
Not only did the Irish more often than the Italians deny that pain was a feature of their illness but this difference held even for those patients with the same disorder (p. 623).
In conclusion Zola called for a re-examination of ‘rigid’ definitions of health, illness, normality and abnormality implemented by official treatment agencies (p.630). Supporting Zola’s findings, Turner (2001) points out that illness behaviour can be culturally specific:
[I]n the Islamic Middle East illness behaviour can be a method for legitimating behaviour which deviates from conventional societal expectations […] A woman who is sick by possession may reject the offer of marriage selected by her father(p. 52).
As such, experiences of illness and disability can be shaped by cultural and religious factors. Without an understanding of these factors,
healthcare services may not be able to sufficiently account for groups of people who do not adhere to western medical beliefs about health, illness and disability. Avoidance of medical services by Asian communities has also been explained by differences in cultural and religious beliefs about medication. Horne et al. (2004) found that
negative perceptions of medication and a resistance to being prescribed medication were more likely in Asian individuals in the study. In
70 conclusion they insist that variables such as household composition, generation and religion must be further investigated and its findings used to ‘improve the delivery of care’ (p.1312).
Existing literature suggests that ethnic minorities have also experienced cultural intolerance and misunderstanding within the healthcare system. In an ethnographic study of midwives, Bowler (1993) identifies four racial stereotypes that the midwives upheld when treating women descending from South Asia. These stereotypes were distinctly negative, and included the view that such women abused health care services, lacked a ‘normal maternal instinct’ and were difficult to communicate with due to language barriers (p.157). Referring specifically to chronic illness and disability, research has tended to suggest that discrimination and disadvantage are reinforced if the person is black or of South Asian descent (Ali et al., 2001). Such
barriers have wide implications on an individual’s life including an unwillingness to interact with health care services (Ahmad et al. 2000,
cited in Ali et al., 2001). In addition to this, integration into British society
for some disabled ethnic individuals including refugees and asylum seekers is virtually impossible as forced dependency and inaccessible buildings renders the individual immobile (Harris, 2003).
Cultural and religious differences in how illness and disability is
experienced, perceived and understood provide a valuable insight into how services may be accessed or not accessed by minority ethnic and
71 religious groups. Furthermore, external barriers such as institutional racism, language barriers and religious and cultural insensitivities may also reinforce a separation between Britain’s minority communities and access to health and social services.
The following sub-section further examines access to mainstream British services by ethnic groups from the perspective of upholding ethnic and religious identities.