Miseducation and Racism

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Comment And Opinion
Community Health Centers in US Inner Cities: Additional Commentary By Aneez Esmail, University of Manchester

Blacks and the 2008 Elections: A Preliminary Analysis
By David A. Bositis, The Joint Center for Political and Economic Activities

Miseducation and Racism

by Marika Sherwood, c0-founder of the Black and Asian Studies Association (BASA)

Creating a Safe Learning Space for the Discussion of Multicultural Issues in the Classroom by Katherine M. Helm, Lewis University

Ethnicity and Race in a Changing World: A Review Journal

Comment and Opinion
Community Health Centers in US Inner Cities: From Cultural Competency to Community Competency Additional Commentary Aneez Esmail, Professor of General Practice, University of Manchester

It would seem strange that the first issue of a journal devoted to the study of issues around ethnicity and race should give prominence to an article which challenges the idea of multiculturalism and cultural diversity in responding to the challenges of delivering healthcare. However, because of the relationship between race and inequality it is right that consideration is given to questioning the effectiveness of one of the main policy responses to health inequalities and the way that they impact on different racial and ethnic groups. Multiculturalism as a policy response to racism has certainly been the dominant ideology used by the Government and its public institutions to tackle the significant racial and ethnic disparities that were highlighted in Britain in the early 1980s. and which have persisted to this day. The policy is based on a misguided assumption that targeting resources which focus on ethnicity and culture can mitigate the effects of racism which as Sivanandan has pointed out has been ‘woven, over centuries of colonialism and slavery, into the structures of society and into the instruments and institutions of government, local and central’. It was only with the publication of the McPherson report into the murder of Stephen Lawrence that some public institutions began to acknowledge the role of institutional racism. The corollary of multiculturalism for healthcare was the development of cultural competency as a policy response to health inequalities identified in racial and ethnic minorities. In the UK, its genesis can be traced back to the election of Margaret Thatcher and its attempt to suppress the findings of The Black Report on Inequalities in Health . Commissioned by a Labour Government in 1977 and published by a Conservative Government in 1980 on a Bank Holiday weekend, the Black report was a rare example of an attempt to explain trends in inequalities in health and relate these to policies intended to promote as well as restore health. The thrust of the recommendations in that seminal report were concerned with improving the material conditions of life of poorer groups, coupled with a re-orientation of health and personal social services towards public health. What became apparent through the nearly twenty years of Conservative government between 1979-97 was the disappearance of health inequalities from the lexicon of explanations for differing healthcare outcomes. Instead policy interventions were targeted at areas such as quality improvement within medicine and an emphasis on commercialisation and entrepreneurial medicine. Cultural competency as a policy response therefore found favour in many circles because it created the façade of tackling inequalities through measures of quality improvement, targeting under-represented groups and focusing on issues of culture and personal health rather than societal inequalities. The reason why such policies have failed are best exemplified by Bertolt Brecht’s 1938 poem when he castigates the doctor for asking the worker to put on weight. In his commentary, Jennings is, if anything, being generous to the proponents of cultural competency when he says that the effect was ‘limited and incomplete...
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