Where are you really from?

These days I have been thinking a lot about identity. My PhD explored how ethnicity affects physical activity  and identity and ethnicity is something that I have been confronted with throughout my life. Donald Trump’s decision to stop whole swathes of people from entering the United States based on a single aspect of their identity has brought my thoughts on this topic into sharper focus.

Where are you from? I am asked this question on a fairly regular basis. To the person asking the question, it seems like a very simple one, but to answer a question like that can require a whole set of judgments and calculations on the respondent’s part. Depending on what you want to know, I am from a lot of different places.

I have lived in Oxford for a few years, but I grew up in Greater Manchester. I was born in England and have lived here my entire life, but my parents are originally from India. I have been to India almost every year of my life, and I used to have a card declaring I am a ‘person of Indian origin’ which is a long-term visa for India, but I am a British citizen.

So where am I from? Usually I answer Manchester – that is where I have spent the majority of my life. This can create either disappointment, confusion or occasionally annoyance – “No, where are you really from?”  What this person usually meant to ask, but didn’t quite articulate is ‘what is your ethnic background’ or ‘where is your family from?’. Some of these people are just looking for friends in an unfamiliar society, some are simply curious, but there are others want to make a judgement on your background which they can’t do accurately without that nugget of information. I have to admit, the latter category is most often the older generation, but it still still a question I am asked around once a year by someone. But the clarification of ‘really from’ is telling. It gives the impression that the fact I was born in have lived in this country for my entire existence, has little or no bearing on who I am – even a child will tell you that this does not make any sense.

Incidentally, when I travel to India where physically I blend in, many people see me as ‘English’ or a ‘foreigner’, so the other thing to note here is that ethnicity is not a fixed aspect of our identity. It depends on where we are and who we are talking to.

This is complex area with more questions than answers. How does a person’s ethnicity affect their behaviour? Is being of Indian origin more important than being a woman? Or more important than my age? Or having a PhD? How do all these things interact and what is more important? When it comes to physical activity, I found in my PhD that what is important depends on other factors. Often gender had the biggest impact on whether someone was physically active or not, but religion, neighbourhood and schooling all mattered a lot too.

But if we look at another behaviour or condition, then different factors will become more important. Your diet and  mental health will be affected by the factors I have listed too, but  differently for diet and for mental health. And yes, I have to say it, your propensity to perform terrorist acts is not influenced by a single factor either.

I want to keep this blog about health, but this is so relevant that I just have to say something on the matter, even if Mr Trump will never read this. The reasons a person commits a terrorist act simply cannot be and is not due to one aspect of their identity (in today’s case it is religion). If something as everyday as diet and physical activity is affected by a multitude of factors that build up over a lifetime, how can a decision as momentous and horrific as a terrorist act be decided by something a single part of a person’s identity? Donald Trump and all his fans, I am here to tell you that knowing only that a person is from a particular country or following a particular religion will never predict what they are going to do. Why are they so angry? Why are they so vulnerable to these ideas? It may not win you an election, but I think answering those questions is more likely to prevent future attacks, not just from foreigners, but also from people who have grown up and lived on your own soil.

Anyway, I digress quite significantly.

I have lived with the complexity of how ethnic identity influences health my whole life – and whether you know it or not, you have too. The question of who we are is not only relevant to people who look a little different to the majority – we all have an ethnic group, just as we all have a gender or age.

There are different ways to define ethnicity, but it essentially refers to groups that have shared cultural practices and shared ancestry. A crucial point is also that we define our own identification with an ethnic group. Skin colour often creeps into this definition, which like gender and age, is a visible aspect of our identity that people will always make assumptions about. Our names and sometimes clothes are also public signs of some aspect of our identity, often signalling a country of origin or a religion.

In health studies, we may measure a person’s current address to get an idea of the type of neighbourhood they live in, a person’s ethnicity to get an idea of where their family is from, along with a range of other characteristics, such as age and sex. We might also ask questions about religion or educational level. We then run statistical analyses to figure out what the most important factors are, when all the other things we’ve measured are taken into account.

We know ethnicity is a complicated thing, but it is poorly measured in health studies. In the UK, it is simply a combination of skin colour and geographic ancestry. The ethnic group “Black Caribbean” illustrates this well. Yes, there are variations in health by ethnic group as we currently measure it, but what is that actually telling you? We can statistically ‘adjust’ for someone’s reported religion, income, education, occupation and gender to figure out if ethnic group still matters in the face of these things, but what if we find that it still does? Usually, socioeconomic status, neighbourhood and religion contribute to some of the reason why ethnicity affects physical activity, but they don’t account for the whole reason.

When we have taken things like income into account, ethnic differences in health could be due to specific cultural practices, attitudes, beliefs or genetics. But these things vary hugely within ethnic groups.By being born and educated in the UK, some of my ideas, attitudes and behaviours differ significantly from my parents’. The physical environment I have grown up in and live in now is also vastly different to that of my parents. And because some ethnic groups tend to live in particular areas, perhaps there is also a difference in these things not only within ethnic groups, but between ethnic groups.

We are a world obsessed by how we are different. When it comes to health, understanding why those differences exist is vital. Not just to help those who are suffering most, but also to learn from those who are suffering the least. But knowing what is the same is also key to improving the health of populations. And in the end, people of different ethnic groups will have many things in common, like gender, neighbourhood, age or education. There are some fundamental requirements for good physical and mental health that all human beings need. I think we could argue that making sure that everyone has access to these things, regardless of ethnic group would be a logical step in reducing inequalities in health. Because, as discussed, ethnicity is a complicated thing. It can change between location and matters more in some circumstances than others, just like our religions, genders and ages do.

So next time you are wondering where someone is from or what their ethnicity is, whether it is because you are curious or because you are trying to understand population patterns in health, remember that those things are only one aspect of who they are. We are the sum of everyone we have ever met, and our ethnic backgrounds only contribute to part of that sum.

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