Researching ethnic diversity in the British NHS: methodological and practical concerns

The collection of data on ethnic groupings has become an increasingly pervasive feature of contemporary health policy and research in the United Kingdom, with attention concentrating primarily on monitoring access to and utilization of services by different ethnic groups, together with epidemiological data on morbidity and mortality. At the same time, the collection of data on ethnic populations by census and health agencies has been the subject of a wide-ranging and contentious debate and there is a growing critique that challenges the collection and use of such data on political, methodological and practical grounds. This paper explores the nature of these debates as they apply to health research. Issues of validity and reliability arising from the application of pre-defined ethnic categories, such as those used within the National Health Service derived from the 1991 census, are considered and alternative approaches which utilize a range of variables such as language, religion and length of residency in a country suggested. Experiences derived from an ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds are used to illustrate some of the practical issues of researching ethnic diversity. Strategies for addressing some of the methodological and practical concerns are proposed.