RECOGNISING AND ACCEPTING DIFFERENCES IN THE VARIOUS HUMAN RACES IS NOT RACIST. AS WELL AS WE HAVE EXPLORED ON THIS SITE, IS THE INFLUENCE OF CULTURES ON BEHAVIOUR. SOME ARTICLES ON THE NET ARE PURELY RACIST. OTHERS ARE CAREFUL IN EXPLORING THE DIFFERENCES WHILE PROMOTING THE SAME RIGHTS, WHILE HAVING A "DIFFERENT SKIN"...

Racism is a form of prejudice that assumes that the members of racial categories have distinctive characteristics and that these differences result in some racial groups being inferior to others. Racism generally includes negative emotional reactions to members of the group, acceptance of negative stereotypes, and racial discrimination against individuals; in some cases it leads to violence.

Discrimination refers to the differential treatment of the members of different ethnic, religious, national, or other groups. Discrimination is usually the behavioral manifestation of prejudice and therefore involves negative, hostile, and injurious treatment of members of rejected groups.

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MEANWHILE DUE TO CULTURAL DIFFERENCES (FOOD/CUSTOMS) AND SOMETIMES GENETICS RACES HAVE DIFFERENT REACTIVITIES TO SOME DISEASES — SUCH AS SMALL POX AND DIABETES....

Poor health comes eventually for most people in late life. But does it start earlier, last longer, and appear more common for some racial and ethnic groups than for others? If so, what are the causes of those differences and what can interventions do to affect them? This report examines these questions.

Racial and ethnic differences in late-life health may impose societal costs, and they rub against the American grain. They suggest possible inequity in life histories and opportunities, perhaps from exposure to unhealthy environments (e.g., Faber and Krieg, 2002), or in access to or the adequacy of medical care (Institute of Medicine, 2002).

Not all health differences necessarily involve inequity, however. Some may be due to life-styles freely chosen, especially in younger years, or to attitudes toward treatment. It is important therefore to understand the roots and mechanisms of health differences and to consider ways to reverse them, or at least to alleviate further damage, with the objective of providing all individuals the opportunity for the fullest possible exercise of their capacities in late life.

In 1994 the Committee on Population of the National Research Council held a workshop on health differences in late life. The papers from that workshop, published in 1997 in a volume entitled Racial and Ethnic Differences in the Health of Older Americans (National Research Council, 1997), summarized existing data on racial and ethnic differences in mortality, morbidity, disability, and dementia and discussed the role of such factors as socioeconomic status, health behaviors, the social environment, the use of medical care, and genes.

Recognizing the need for continuing research, as well as the increasing diversity of the U.S. population, the National Institute on Aging (which sponsored the 1994 workshop) commissioned a new panel to update the work and develop research recommendations. The panel's specific mandate was to:

• organize a 2-day workshop with leading researchers from a variety of disciplines and professional orientations to answer questions about the nature and extent of racial and ethnic differences in health in old age, the social and biological mechanisms involved, what studies would advance understanding of differences, and what opportunities exist for research on special populations or research in special areas such as the biology and genetics of aging; and
• provide a short report summarizing the main lessons learned and providing recommendations for further work.

The panel's summary of research findings, disciplinary issues, and possibilities for future research is covered in this volume. The commissioned papers, which were presented at the panel's workshop in Washington, DC in 2002, appear in a companion volume (National Research Council, 2004; see the table of contents in the Appendix).

In addressing its charge, the panel was forced to confront a large and burgeoning theoretical and empirical literature that involves researchers from virtually all the medical, social, and behavioral sciences. The panel's initial intention was to produce a short report of the state of knowledge, but it rapidly became apparent that current research provides no simple answers. What is currently known about the origins of racial and ethnic differences in health points in many different directions. This fundamental finding spurred the panel to produce a more comprehensive and complex report than was originally requested, detailing what is currently known about apparent health differences and the role and operation of each of the major risk factors involved. This work was seen as an important prerequisite for identifying the kind of research that might advance this field.

This report and the companion volume of papers update work reported on in the papers from an earlier Committee on Population Workshop (National Research Council, 1997). Many of the issues discussed in this volume are similar to those raised in the earlier one, but seen through different lenses and with different emphases.

In this chapter we consider why we focus on racial and ethnic groups and what groups we distinguish. We then characterize the health differences in late life that have been reported among racial and ethnic groups. These differences reveal a complicated picture that requires careful scrutiny. Chapters 2 through 11 explore the possible causes of health differences, including the social, environmental, psychological, and biological factors that may be at the root of racial and ethnic advantage or disadvantage in health. Chapter 12 asks whether and how action can deal with health differences and what the effects might be.

We refer throughout this report to differences rather than disparities, because the latter term has recently acquired a connotation of injustice, which is not always appropriate for the differences we consider, notably but not only when a minority population is actually in better health than the majority population. Although our focus is on late life, we offer some information on group differences more broadly, as context and in the absence of data on late life.

Race is a potent social reality and an important and enduring component of personal identity. In censuses and most surveys, a designation of race is selected by individual respondents from officially specified categories. This self-identification does not mean that race is without objective basis, since it is roughly consistent with ancestral origins. Yet because of the complications of migration histories and intermarriage, as well as the vagaries of self-identification and social categorization, racial classifications diverge from strict classification by descent.

Ethnicity is similar in concept to race. But while races have often been distinguished on the basis of physical characteristics, especially skin color, ethnic distinctions generally focus on such cultural characteristics as language, history, religion, and customs (Montague, 1942). However, physical and cultural characteristics are often conflated in the identification of racial and ethnic groups. What begins as an ethnic or cultural distinction often becomes racialized, and racial groups are often identified, in the public mind, with reference to customs and behavior. We generally refer here to racial and ethnic groups, without making any sharp distinction between these terms.

Five races are currently distinguished in official U.S. government statistics (Office of Management and Budget, 1997): white, black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. An additional distinction is made between Hispanics or Latinos and all others, this being designated as an “ethnic” distinction that crosscuts the racial classification. The 2000 census followed this classification—but also allowed multiple choices—and individuals selected their own identification as they had since the 1970 census. (Such self-identification has been used in censuses since 1970, though with different categories; before that, interviewers classified respondents.)

Self-identification sometimes gives people options, depending on the context. Racial and ethnic identities vary as a function of social and psychological factors that may alter their salience (Yancey et al., 1976). For instance, with the decline of stigma and greater emphasis on the rights of indigenous peoples, the number of people who say they are American Indians or Alaska Natives has increased over time far faster than would be possible from natural increase (Harris and Sim, 2002). A questionnaire provides sample categories that also can affect individuals' choices. English was the largest ethnic group in the 1980 U.S. census, but the size of this group declined by 34 percent when it was not listed as an example in 1990 (Waters, 2000: 1730).

As self-identification has become the norm, pressure has grown to allow multiple and interracial identification, which was done in the 2000 census. When asked to choose one race, more than 80 percent of multiracial individuals will do so (Sondik et al., 2000), but given the option of multiple identities, some people choose more than one, with more educated people being more likely to do so (Lieberson and Waters, 1993). Again, this depends on context. For instance, adolescents choose multiracial identities on surveys more often at school than at home (Harris and Sim, 2002). In the 2000 census, 2.4 percent of the population chose more than one race (U.S. Census Bureau, 2002b).

The categories used by the U.S. Office of Management and Budget (OMB) are a small part of the possible racial and ethnic distinctions that might be made among Americans. An encyclopedia of immigrant groups (Levinson and Ember, 1997) provides profiles of 161 groups, from Acadians to Zoroastrians, and this does not include native groups, such as the more than 550 American Indian tribal groups recognized by the Bureau of Indian Affairs. There are of course almost an infinite number of physical and cultural characteristics that could be used to define racial and ethnic groups, and the major groups are defined with reference to a very small subset of these.

In this report we generally follow the OMB classification, with minor modifications (at least partly to accommodate earlier data and studies). We treat Hispanics as a distinct group and all other groups referred to in this report explicitly exclude Hispanics. We do not distinguish Native Hawaiians and Pacific Islanders, treating them together with Asians when the data require this or leaving them out. We treat American Indians and Alaska Natives as a single group. We do not identify Alaska Natives separately since they account for only 0.03 percent of the combined group and are not distinguished (and are probably not represented) in any of the studies we covered. The five racial and ethnic groups we consider, therefore, are Hispanics, whites, blacks, Asians, and American Indians and Alaska Natives. Because of the paucity of data, we do not consider multiracial groups.

Table 1-1 shows the numbers of individuals aged 65 years or older in each of the major groups. In 2000, whites were 83.5 percent of this age group, a substantially larger proportion than their 71.4 percent in the general population. Part of the reason for the difference is the number of younger immigrants, mostly nonwhite, which reduces the proportion of whites at younger ages. The foreign-born population in the United States has become increasingly younger since the 1960s (He, 2002). Nevertheless, in the older population, the foreign born were a substantial, if not dominant, proportion in some groups in 2000. Fully 50 percent of Hispanics 65 years and older were foreign born, as well as 84 percent of Asians and Pacific Islanders (U.S. Census Bureau, 2001).

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Picturing Race in the British National Health Service, 1948-1988

In 1970, Harold Evans, the respected editor of Britain’s best-selling Sunday broadsheet the Sunday Times from 1967 to 1981, roundly reproached his fellow journalists for their reporting of ‘race’. Writing for the resolutely middle-brow The Listener magazine (published from 1929 to 1991 by the British Broadcasting Corporation [BBC] since 1929 to accompany and amplify the national broadcaster’s educational and cultural mission), Evans asserted that ‘the way race is reported can uniquely affect the reality of the subject itself’. In the matter of race, he observed, the newspapers did far more than fulfil their ‘traditional’ role as a ‘mirror of society’. Instead, ‘stealthily in Britain, the malformed seeds of prejudice have been watered by a rain of false statistics and stories’.1 Evans, famously a supporter of US-style campaigning investigative journalism, applied similar techniques to excoriate his fellow journalists. Focusing closely on the language in which stories about non-white migrants and racialized ethnic minorities were reported, he condemned rhetoric portraying migrants as ‘pouring in’ and Britain as being ‘overrun’.

Evans also drew attention to the striking inconsistency with which information about (perceived) race or ethnicity was reported. As the ‘most spectacular’ evidence of such dangerous ‘selectivity’ he pointed to the conservative broadsheet, the Daily Telegraph. On 1 March 1969, that paper headlined a coroner’s criticisms of a doctor prominently identified by the Telegraph as ‘Pakistani-born’. Yet only inches below, the paper ignored the Asian ethnicity of another doctor (Dr. Hassam Gareeboo) whose heroics saved an infant’s life.2

Using another medical story—press coverage of 1961–2 outbreak of smallpox traced to a number of migrants from Pakistan—Evans highlighted the influential role played by press photography in shaping interpretation of the news. Referring to work by the sociologist Eric Butterworth, Evans walked his readers through the exploitation of the outbreaks by an anti-immigration regional newspaper. The Yorkshire Post, he claimed, deliberately fostered the impression of ‘a conflict of interest’ between ‘immigrants’ (in fact, British subjects moving entirely legally to the UK from its colonies and Commonwealth) and the local population, not least by portraying a smiling, recently arrived Pakistani migrant next to an unsupported claim that ‘Pakistani smallpox papers can be forged’ to generate the impression that ‘immigrants did not care about the risks to which they exposed local people’.3

It is not a coincidence that when Evans turned his attention to the reporting of race in Britain, stories with medical subjects sprang to mind. While the impact of ‘coloured’ immigration on access to housing and employment featured most strongly in popular expressions of discontent, health was not far behind. The advent of the National Health Service (NHS) in 1948 coincided almost exactly with the post- war mass movement to Britain of once-colonial populations from the ‘New Commonwealth’ and thus with the emergence of what became known as the ‘colour problem’. Moreover, concern about the supposed or presumed health impacts of mass migration was strengthened by (sporadic and often self-contradictory) official endorsement.4 As Evans asserted in his rebuke, discussions of ‘immigration’—discussions which rarely differentiated between migrating British subjects and immigrat- ing aliens—in post-war Britain routinely employed highly provocative language, accompanied by images intended to inflame. And while racialized migrants were present in large numbers in a variety of industries and were notably visible in public transport services by the 1960s,5 it was their work in the NHS that was most frequently visualized in the press. This article argues that in relation to both the NHS and non-white immigration, such visual material often revealed assumptions and expectations that were either too uncomfortable or too thoroughly normalized to be made otherwise explicit.

Evans’ attention to news photography and the suggestive associ- ations created between images and texts on the terrain of the printed page was fleeting if insightful. He devoted far more attention to the rhetoric of race than to its visual representation. Until the last decade, mainstream historical scholarship on race and immigration in post-war Britain has been similarly transfixed by text.6 Only with the emergence of a body of scholarship examining the impacts of empire on the British home nations themselves and the growth of interdisciplinary research on visual cultures, has the balance begun to shift towards increasing attention to visual representations, particularly in cinematography and the broadcast media.7 Less attention has been paid to the images, photographic and editorial, that accompanied press coverage of ‘race relations’ and immigration, a lacuna which this article will begin to redress. Even in recent innovative work exploring the creation and interpretation of a welfare state that was both ‘post-war’ and ‘post- colonial’, linguistic representations of race, ethnicity, empire and decolonization retain their largely unchallenged centrality.8

Moreover, relatively few historians have examined British racial discourses through the lens of specifically medical events, institutions and phenomena.9 Yet as Evans’ commentary indicates, such events and sites both prompted and stimulated debates about the very fabric of identity in post-imperial Britain. Here, I will argue that close scrutiny of visual representations of racialized minorities in the NHS can shed new light on British attitudes towards race, ethnicity and belonging in the post-war period. While some images of this intersection are propa- gandist, candid, opportunistic, or even accidental, particularly in photojournalism and the broadcast media, others are explicitly humorous, ironic, or satirical, most notably a rich seam of editorial cartoons. The latter in particular explicitly use images of racialized bodies and situations in the NHS to comment on and critique social attitudes towards immigration in a welfare state.

This article will use visual representations of white and non-white figures in the context of the NHS to explore perceptions of race and ethnicity, and attitudes towards racism in post-war Britain.10 In an initial discussion of the wider British context, it considers the value of editorial cartoons and news photography as tools offering traction on implicit or assumed truths about the NHS. Subsequent sections examine depictions—initially photographic, then in editorial cartoons and for comparison in broadcast and newsreel footage—of non-white nurses, doctors and, largely in absentia, patients. These establish the import- ance of the NHS as a site in which racial and ethnic inclusion and British diversity could be recognized and portrayed. Little explored by historians, these sources allow consideration of the roles played by both humour and visuality in shaping and expressing responses to human difference understood through the lens of ‘race’. In representing or obscuring racialized figures at work in an institution often regarded as embodying core national values, editorial cartoons and the editorial selection of photographic images deployed visibility itself very deliberately to encode, interpret and challenge attitudes towards such difference in the wider society. The contemporary conflation of skin colour and cultural identity made such work possible, and is correspondingly at the heart of the analysis below. Close reading of specific images also sheds new light on the NHS as an institution imbued with meaning in and for British culture.

Imagining the NHS: The Value of the Visual

Since 1948, the language of the British NHS has been both possessive and inclusive. Pamphlets, films and other propaganda introduced the service to the population as ‘your’ NHS, and stressed that it was available to ‘everyone—rich or poor, man, woman or child’.11 In doing so, documentary sources and political rhetoric reflect and support the ideals of universalism and ‘equalitarianism’ so often associated with the immediately post-war period.12

However, if the language of the early NHS encompassed citizens, residents and visitors alike in its remit of care, early press and publicity images of the NHS painted a different picture. Whether produced by the national print media, the Ministry of Works, or the BBC, photographs of the NHS in its early years almost uniformly portrayed white and apparently indigenous British patients, staff and families.13 In these pictures, patients and users of the new services visually represented the established ‘vulnerable’ and ‘deserving’ categories familiar to the British public from interwar and wartime campaigns: infants, women, children, workers and increasingly from the mid-1950s, the elderly. Thus visual sources, unlike the contemporary rhetorical and textual evocations of the NHS, very clearly indicate that the possessive community implied by the repeated phrases ‘your NHS’ and ‘our NHS’ was assumed and intended to be a homogenous ‘British public’ that even in 1948 certainly did not exist.14

So who was ‘British’ in this period? In law, from 1948 to 1962, British colonial subjects, citizens of its former colonies and Dominions, and those born on the soil of the four ‘Home’ nations shared the status of British subjects, with equal legal rights and privileges.15 Contemporary data suggested a British population of approximately 30,000 non-white residents in 1945; historians have estimated the size of this largely settled population at 75,400 by 1951.16 Although rarely included in such figures at the time, the diversity of Britain’s wartime and immediately post-war population was greatly increased by the presence of US and colonial servicemen and women.17 Between 1948 and 1962, they were joined by some 500,000 primary migrants principally from Poland, the Caribbean and South Asia, but also the Middle East, Africa, and Europe (Irish migrant numbers were not officially recorded).18 All migrants from Britain’s colonies and former colonies were entitled to family reunification, and many took up that right. By 1961, London alone reported a population of 242,000 ‘New Commonwealth’ residents.19 Yet neither the exotically ‘colonial’ subjects frequently depicted in other contexts, nor Britain’s small but long-established ethnic communities played any significant visible role in official portrayals of the new NHS in its first decade.20

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SOME CARTOONS WERE PARTICULARLY RACIST:

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