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EDITORIALS: Keith Lloyd Ethnicity, social inequality, and mental illness BMJ 1998; 316: 1763-1770 [Full text]

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Improving the health of minority ethnic communities must involve undergraduate education

Rhian Loudon   (15 June 1998)

ethnicity and social class adjustment

Carles Muntaner   (19 June 1998)

Improving the health of minority ethnic communities must involve undergraduate education 15 June 1998
Rhian Loudon, Clinical Research Fellow Birmingham University Send response to journal: Re: Improving the health of minority ethnic communities must involve undergraduate education	Dear Editor A recent editorial (1) discussed the prevalence and treatment of mental illness in the community among different ethnic groups, following a survey by the Policy Studies Institute(2). The author mentioned the government's commitment to improving the health of black and minority ethnic communities and the formation of health authority action zones. We believe that a vital component of assisting the development of appropriate and culturally sensitive services and consequently improving health, involves raising awareness of these issues in the undergraduate curriculum. In collaboration with Birmingham Health Authority and University of Birmingham Healthcare Trust (UBHT), the University of Birmingham Medical School is undertaking a Department of Health funded project to make medical education more responsive to community diversity, in particular ethnic diversity. Our aim is to develop an integrated strand of teaching through all years of the curriculum, operating in both community and hospital based specialities. The possibility of giving students a wider and more representative experience whilst studying in Birmingham has been highlighted in the preliminary findings of our project. As part of the behavioural science course, students visit a local family a minimum of 6 times over a 12 month period. A survey conducted this year of 1st year students revealed that only 15/118 families (13%) could have been described as coming from a minority ethnic background. In 1991 (3), 25% of the population of Birmingham defined itself as being from a minority ethnic group . Feedback of these figures to the local GP tutors may help ensure a broader experience for students next year. Yours sincerely, Rhian Loudon Clinical Research Fellow Sheila Greenfield Senior Lecturer Department of General Practice University of Birmingham Birmingham B15 2TT References 1. Lloyd K. Ethnicity, social inequality, and mental illness. BMJ 1998;316:1763-1770. 2. Nazroo JY. Ethnicity and mental health: findings from a community survey. London: Policy Studies Institute, 1997. 3. Office of Population Census and Surveys. 1991 Census.
ethnicity and social class adjustment 19 June 1998
Carles Muntaner, Assitant Professor School of Medicine, WVU and Mental Hygiene, JHU Send response to journal: Re: ethnicity and social class adjustment	I would like to make two comments regarding the important new data on ethnicity, social inequality and mental health described in Lloyd's editorial. My first point is that in addition to Ethnic categorization, mechanisms of discrimination are necessary to understand the relation between ethnicity and mental disorders (e.g., is it due to housing discrimination, lack of political representation, lack of access to education or labor markets or all of them?; see Muntaner et al., 1996, 1997). Unless we measure ethnic discrimination "per se", any residual Ethnic effect after adjustment is likely to be interpreted in hereditary terms, in particular among biomedical researchers (Muntaner et al., 1997a). A second and related issue is the potential for inadequate control for baseline confounders such as social status (Krieger et al., 1997). For example, when investigators adjust for education as a continous variable, the resulting models may misrepresent the true multivariate relationship, leading to incomplete adjustment and biased estimates (Greenland, 1989). Even assuming adequate social class adjustment, social class indicators are surrogates of baseline socioeconomic exposures (Alderman, 1993). References EW Alderman et al. Cautions in the use of antecedents as surrogates for confounders Am J Epidemiol 1993;137:1259-72. S Greenland. Modeling and variable selection in epidemiolgic studies. Am J Public Health 1989;79:340-9. N Krieger et al. Measuring social class in US public health research 1997:18:341-78. C. Muntaner, J. Nieto, P. O'Campo. The Bell Curve: on race class, and epidemiologic research. Am J Epidemiology 144 (6):531-536, 1996. C Muntaner, J Nieto, P O'Campo. Race, social class, and epidemiologic research. Journal of Public Health Policy 18(3):261-274, 1997a. C Muntaner, J Nieto, P O'Campo. Additional Clarification Re: On Race, Social Class, and Epidemiologic Research. Am J Epidemiology 146(7):607-608,1997b.