Health, Illness and Ethnicity: Migration, Discrimination and Social Dislocation

Dublin 10-11, June 2011-03-25 Conference paper

Race, ethnicity and environment in the postcolonial metropole

Drawing on British examples, I will explore medical responses to postcolonial migrants and their ethnically marked descendants in the era of decolonisation and the Cold War. My larger project assesses such responses in relation to four conditions, each representing one or more specific models of disease causation (environmental, bacterial, nutritional and genetic). Here I will focus on tuberculosis and rickets, a pairing that will allow me to compare responses mediated largely by public health with those shaped principally by elite biomedical research. Both conditions were familiar to medical authorities in Britain, and both were readily curable. However, tuberculosis was a well-understood bacteriological condition which, although in decline by the 1950s, remained the focus of considerable public health activity within the majority as well as migrant minority communities. Its problematic association with migrant groups – first the ‘susceptible’ Irish, then the ‘suspect’ South Asians – and the distinctive ways in which these groups were treated by comparison with the majority population reveal institutional and political tensions within British medicine and government. Comparing Irish and South Asian at risk populations also highlights the ways in which race inflected responses to the twin markers of nativity and health status.

‘Normal’ (that is, nutritional) rickets by contrast had essentially disappeared from the majority community during WWII, not least because its treatment was well-understood, inexpensive and easy. However, the causes of rickets remained ill-defined – and only became better understood when a group of elite researchers came into contact with a new and apparently compliant pool of ‘clinical material’: immigrant and second generation sufferers of what was quickly termed ‘Asian rickets’. As the medical community debated the relative importance of diet and behaviour, environment and skin pigmentation in causing migrant susceptibility, they recapitulated colonial medical debates about the respective roles of culture and race in ‘native’ pathology. In much the same way, medical discussions of migrant tuberculosis reinvigorated its image as a ‘disease of civilisation’, while simultaneously reinforcing the well-established image of the infectious immigrant. Medical considerations of both diseases spliced older models of environmental risk and fragile racialised bodies with newer understandings of assimilation as a medical prophylaxis. Thus I will argue that close historical study of medical responses to ethnic minority communities in post-imperial Britain offers considerable traction on the question ‘what is ‘postcolonial’ about post-colonial medicine? It also reveals the bewildering frequency with which policy responses to immigrant and ethnic community health needs repeat unsuccessful – and even damaging -- models of intervention.

Dr Bivins was invited to contribute to the Afiya Trust's June round table discussion on public health and race equality. Her involvement was rooted in her work as convenor of the IDEA Collaboration, which brings together researchers and research usuers addressing issues of equality and disparity in health care and health research for ethnic minority populations un the UK and abroad.