In defence of ‘race’ and ethnicity as analytical variables in epidemiological research

1. In defence of ‘race’ and ethnicity as analytical variables in epidemiological research George TH Ellison St George’s – University of London

2. Overview

3. Overview • What do ‘race’ and ethnicity actually mean? • What are the problems with ‘race’ and ethnicity? • Should we use ‘race’ and ethnicity? If so, when? • How should we measure ‘race’ and ethnicity?

4. Overview • What do ‘race’ and ethnicity actually mean? • What are the problems with ‘race’ and ethnicity? • Should we use ‘race’ and ethnicity? If so, when? • How should we measure ‘race’ and ethnicity?

5. Overview • What do ‘race’ and ethnicity actually mean? • What are the problems with ‘race’ and ethnicity? • Should we use ‘race’ and ethnicity? If so, when? • How should we measure ‘race’ and ethnicity?

6. Overview • What do ‘race’ and ethnicity actually mean? • What are the problems with ‘race’ and ethnicity? • Should we use ‘race’ and ethnicity? If so, when? • How should we measure ‘race’ and ethnicity?

7. Where do the concepts of ‘race’ and ethnicity come from?

8. Where do the concepts of ‘race’ and ethnicity come from? • ‘Race’ – is traditionally used by biologists as a synonym for ‘subspecies’ (isolated populations of a species that contain individuals who are genetically more closely related to one another than to the rest of the species). • Ethnicity – is traditionally used by anthropologists to classify human populations on the basis of shared ancestry, culture and customs.

9. Where do the concepts of ‘race’ and ethnicity come from? • ‘Race’ – is traditionally used by biologists as a synonym for ‘subspecies’ (isolated populations of a species that contain individuals who are genetically more closely related to one another than to the rest of the species). • Ethnicity – is traditionally used by anthropologists to classify human populations on the basis of shared ancestry, heritage, culture and customs.

10. Are ‘race’ or ethnicity genetic variables?

11. Are ‘race’ or ethnicity genetic variables? • ‘Race’ – captures little of the modest geographical and sociocultural gradients in genetic variation and there are no genetically discrete human ‘races’. But, ironically… • Ethnicity – is routinely measured using aspects of appearance, ancestry and/or culture which are linked to phenotypic, geographical and reproductive factors which reflect/are responsible for genetic variation.

12. Are ‘race’ or ethnicity genetic variables? • ‘Race’ – captures little of the modest geographical and sociocultural gradients in genetic variation and there are no genetically discrete human ‘races’. Yet, ironically… • Ethnicity – is routinely measured using aspects of appearance, ancestry and/or culture which are linked to phenotypic, geographical and reproductive factors which reflect/are responsible for genetic variation.

13. Are ‘race’ or ethnicity genetic variables? • ‘Race’ – captures little of the modest geographical and sociocultural gradients in genetic variation and there are no genetically discrete human ‘races’. Yet, ironically… • Ethnicity – is routinely measured using aspects of appearance, ancestry and/or culture which are linked to phenotypic, geographical and reproductive factors which reflect or are responsible for genetic variation.

14. What have the concepts of ‘race’ and ethnicity come to mean?

15. What have the concepts of ‘race’ and ethnicity come to mean? • ‘Race’ – is seen as a socially-constructed and arbitrary classification based on discredited theories of innate genetic difference between human populations. • Ethnicity – has become conflated with ‘race’ and is increasingly used as a (sanitised) synonym for ‘race’, hence the biosocial term ‘race/ethnicity’.

16. What have the concepts of ‘race’ and ethnicity come to mean? • ‘Race’ – is seen as a socially-constructed and arbitrary classification based on discredited theories of innate genetic difference between human populations. • Ethnicity – has become conflated with ‘race’ and is increasingly used as a (sanitised) synonym for ‘race’, hence the biosocial term ‘race/ethnicity’.

17. Why have ‘race’ and ethnicity been criticised as analytical variables?

18. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability

19. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability Validity

20. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability Validity Sensitivity

21. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability • There is little consensus on how ‘race’ or ethnicity should be defined or measured. • ‘Race’ and ethnicity are fluid, subjective and context-specific characteristics that are therefore inherently unstable.

22. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability • There is little consensus on how ‘race’ or ethnicity should be defined or measured. • ‘Race’ and ethnicity are fluid, subjective and context-specific characteristics that are therefore inherently unstable.

24. Why have ‘race’ and ethnicity been criticised as analytical variables? Reliability • There is little consensus on how ‘race’ or ethnicity should be defined or measured. • ‘Race’ and ethnicity are fluid, subjective and context-specific characteristics that are (therefore) inherently unstable.

25. Why have ‘race’ and ethnicity been criticised as analytical variables? Validity • ‘Racial’ and ethnic categories rarely reflect genetically or socioculturally discrete and homogeneous populations. • ‘Racial’ and ethnic categories are rarely viewed as the consequences of the structures which make classification possible.

26. Why have ‘race’ and ethnicity been criticised as analytical variables? Validity • ‘Racial’ and ethnic categories rarely reflect genetically or socioculturally discrete and homogeneous populations. • ‘Racial’ and ethnic categories are rarely viewed as the consequences of the structures which make classification possible.

28. Why have ‘race’ and ethnicity been criticised as analytical variables? Validity • ‘Racial’ and ethnic categories rarely reflect genetically or socioculturally discrete and homogeneous populations. • ‘Racial’ and ethnic categories are rarely viewed as the consequences of the structural forces which make classification possible.

29. Why have ‘race’ and ethnicity been criticised as analytical variables? Sensitivity • ‘Race’ and ethnicity tend to essentialise any differences observed as intrinsically genetic or sociocultural rather than the consequence of extrinsic structural forces. • Using ‘race’ and ethnicity as if they were precise markers of difference tends to generalise, stereotype and stigmatise.

30. Why have ‘race’ and ethnicity been criticised as analytical variables? Sensitivity • ‘Race’ and ethnicity tend to essentialise any differences observed as intrinsically genetic or sociocultural rather than the consequence of extrinsic structural forces. • Using ‘race’ and ethnicity as if they were precise markers of difference tends to generalise, stereotype and stigmatise.

32. Why have ‘race’ and ethnicity been criticised as analytical variables? Sensitivity • ‘Race’ and ethnicity tend to essentialise any differences observed as intrinsically genetic or sociocultural rather than the consequence of extrinsic structural forces. • Using ‘race’ and ethnicity as if they were precise markers of difference tends to generalise, stereotype and stigmatise.

33. When should we use ‘race’ and ethnicity in epidemiology?

34. When should we use ‘race’ and ethnicity in epidemiology? Reliability Some definitions of ‘race’ and ethnicity can be reliably measured in some populations, in some contexts, at some times. Validity The characteristics used to classify ‘race’ and ethnicity (appearance, ancestry and culture) can be correlated with determinants of health status: genes; behaviour; and class.

35. When should we use ‘race’ and ethnicity in epidemiology? Reliability Some definitions of ‘race’ and ethnicity can be reliably measured in some populations, in some contexts, at some times. Validity The characteristics used to classify ‘race’ and ethnicity (culture, appearance and ancestry) can be correlated with determinants of health status: culture; class; and genes.

36. Race/ethnicity Health When should we use ‘race’ and ethnicity in epidemiology? Taken from: Nazroo (1997) The Health of Britain’s Ethnic Minorities.

37. Culture Race/ethnicity Class Health Genetics When should we use ‘race’ and ethnicity in epidemiology? Taken from: Nazroo (1997) The Health of Britain’s Ethnic Minorities.

38. Culture Discrimination Access to services Race/ethnicity Class Health Migration Genetics When should we use ‘race’ and ethnicity in epidemiology? Taken from: Nazroo (1997) The Health of Britain’s Ethnic Minorities.

39. When should we use ‘race’ and ethnicity in epidemiology? Reliability Some definitions of ‘race’ and ethnicity can be reliably measured in some populations, in some contexts, at some times. Validity The characteristics used to classify ‘race’ and ethnicity (appearance, ancestry and culture) can be correlated with determinants of health status: culture; class; and genes. Sensitivity ‘Race’ and ethnicity are crucial markers of the tendency to generalise, stereotype and stigmatise.

41. Three ‘tests’ when using ‘race’

42. Three ‘tests’ when using ‘race’ • Reliability – Can it be reliably measured? • Validity – Is it the most reliable proxy? • Sensitivity – Is it acceptable?

43. Three ‘tests’ when using ‘race’ • Reliability – Can it be reliably measured? • Validity – Is it the most reliable proxy? • Sensitivity – Is it acceptable?

44. Three ‘tests’ when using ‘race’ • Reliability – Can it be reliably measured? • Validity – Is it the most reliable proxy? • Sensitivity – Is it acceptable?