Social policy and health inequalities : the relevance of faith to chronic illness management in the Pakistani community

Two historical frameworks dominate European discourse about Muslim identity. First, the Enlightenment notion that religion is a private matter to be disassociated from public life, particularly from the scientific enterprise. Secondly, the Orientalist tradition of portraying Islam as inferior to Western culture and Muslims as people to be feared and controlled. These discursive practices have consequences for the everyday lives of Pakistani Muslims in the UK and for their healthcare and health. This thesis aims to assess the influence of Muslim identity on healthcare and health through a multifaceted methodology, which takes account of context and of other aspects of identity such as social class, ethnicity, gender and age. Findings show that dominant conceptualisations of Islam and Muslims corrupt the communication process between Pakistani people and health practitioners and expose Pakistani people to stereotypical ideas about their beliefs and practices. Furthermore, discussion of religious influences on selfcare is avoided by patients and practitioners alike. Consequently, Pakistani people receive inadequate support in decision-making about chronic illness management and are more likely to develop complications. This disadvantage is exacerbated by ethnicity and gender. These dynamics of healthcare reflect discrimination that is mirrored in almost all contexts in the wider UK society, affecting education, employment and civic participation. These areas affect health status, as does self-perception of social position and social relations. The disadvantage to which Muslim identity appears to expose individuals and groups suggests a possible explanation for higher levels of mortality and morbidity within this community compared to other minority ethnic communities. This thesis explores the implications of these findings for practice, policy, research and activism. It concludes that developing shared understanding and common ground needs to be a focus for policy and practice development. Policy support for Muslims to organise on the basis of faith identity is also needed if health inequalities within the Pakistani Muslim community arc to be effectively addressed.