The problem with ‘BAME’ within a UK public health context– one size really doesn’t fit all 

It’s a term widely used by politicians, educators, and the media in the UK to describe Black, Asian and Minority Ethnic groups – but we need to be wary of using ‘BAME’, especially within a public health context. Dr Sandhya Duggal draws on her doctoral research to reflect on some of the key issues associated with the term ‘BAME’, with reference to the Indian Punajabi community. Her work highlights two key recommendations – the importance of recognising heterogeneity and multi-generational differences – something ‘BAME’ fails to acknowledge. 

More than 7.6 million people in the UK fall under the category of black, asian and ethnic minority, according to the most recent census data (Census, 2011). The latest acronym being used to describe this group is ‘BAME’, and is widely used across a variety of sectors, from politics, education and health. ‘BAME’ appears to have transitioned from ‘BME’ (black and minority ethnic group), a term that originated from ‘political blackness’, an idea that various ethnic groups united behind to fight against racial discrimination in the 1970s. Since then, arguments against its use have reached the mainstream, (see MP Priti PatelTrevor Phillips), with the main criticisms drawing on the notion that using one label to describe a diverse group of people dilutes their rich identity, reinforces stereotypes and promotes homogeneity. 

 ‘BAME’ homogenises health experiences

Public health research has long recognised the importance of the health experiences of ethnic minority groups, and its impact on health inequalities (Bhopal et al., 1991; Nazroo, 2003; Rudat, 1994). Not only is this evident in the research literature, but also in the introduction of cultural adaptations of health interventions (obesity, smoking cessation, type 2 Diabetes) in an attempt to increase engagement amongst those from ethnic minority backgrounds. 

However, the majority of research in this area still tends to homogenise ethnic minority groups by grouping together the health experiences of black (North African, South African, Caribbean etc.) and south Asian (Indian, Pakistani, Bengali etc.) people together – consequently overlooking some of the subtle cultural differences that exist between subgroups.  

Employing ‘BAME’ within this context assumes culture is universally experienced across ethnic minority groups, when in fact cultural diversity produces vast differences in lifestyle choices and health beliefs. 

This ultimately raises various questions about how culturally appropriate adapted interventions can be when they have been designed with broad groups in mind. And, what important nuances do policy makers and health care practitioners miss when they label in this way? 


My doctoral research

My research was born from the realisation that south Asian population continue to be underrepresented and incorrectly homogenised in the public health literature, especially in relation to T2D management. The large majority of the literature exploring cultural influences on self-management behaviours among the south Asian population tends to be ambiguous, and few studies have explored the cultural differences between individual groups. 

Subsequently, there isn’t a lot of detail about the specific heritage of certain sub-groups on health behaviours; what they eat, the religion they follow, the language they speak, and the customs they practise. As a result of this, British Indian Punjabi men remain neglected from the field, despite being one of the largest groups at risk of T2D. 

My PhD consisted of a qualitative study that examined the social and cultural factors which influence Indian Punjabi men’s health beliefs and risk perceptions of T2D. The findings revealed the cultural significance associated with hospitality and drinking alcohol, which emerged as important socio-cultural practices;

  • Practices and behaviours related to food and alcohol within social settings were identified as contributing to the poor health within the Indian Punjabi community. 

  • Food and alcohol possess a social function at gatherings and family events. This was largely associated with the cultural meanings and values these practices hold within the Indian Punjabi community. 

  • Food and drinking practices have an impact on personal identity, which demonstrates how deeply embedded they are within the cultural life world of the community. 

The findings also revealed generational differences between the first and second generation migrants. This was especially true in how the first generation spoke about the negative impact of migration on health, and the risky behaviours of the second generation during their time in higher education: 

  • The importance of place and shifting places becomes relevant in shaping how these men have come to understand the origins of health risk within the Indian Punjabi community today.

  •  Health risks were perceived to be deeply embedded within the diasporic narrative of those who journeyed from India, and later reinforced by the later migratory experiences in the UK. These explanations draw heavily on the socio-cultural forces at work which have shaped how health risks have come to be developed in two places. 

  • This reinforces the finding that place plays a significant role in understanding how health risks have come to be and are reinforced within the Indian Punjabi community. 

  • Similarly, place also played a role in how the second generation experienced health risks during their time at university. It becomes apparent that the second generation have replicated the drinking practices of their elders, but in a different place and time. 


BAME oversimplifies culture 

Employing ‘BAME’ as a term within a public health context should be done with caution – as the danger to oversimplify the application and understanding of ‘culture’ is all too easy. This broad-brush, and somewhat misguided, approach has led to a lack of exploration into the identification of the cultural nuances and subtle differences that exist between south Asian subgroups, which have become blurred and indistinct. This has led to some research contributing to the current misconception that all south Asians are unhealthy and suffer from chronic disease in the same way. The findings from my research show that the Indian Punjabi population are a unique group, because unlike other south Asian groups, they are not strongly influenced by their religion, but by their cultural identity. 

More research in this area will only increase awareness of heterogeneity amongst the south Asian population, and may begin to challenge some of the commonly held assumptions health practitioners and policy makers may have about this group. 

If not BAME, then what?

If public health interventions targeting ‘BAME are to be successful, they need to be attentive to their different lifestyles, customs and attitudes. Distinguishing between ethnic minority groups in public health research has the potential to reveal these differences. Clearly identifying south Asian groups may highlight the different cultural barriers they face, and reduce stereotyping and generalisations made across broad groups. Maybe it’s time to ditch ‘BAME’ and move towards a descriptor that’s more inclusive for everyone.