Discourses on im/migrants, ethnic minorities, and infectious disease: Fifty years of tuberculosis reporting in the United Kingdom

Penelope Scott,Hella Von Unger

doi:10.1177/09526951211015886

Penelope Scott, Hella Von Unger

Open Access

https://doi.org/10.1177/09526951211015886

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Abstract

Ethnicity and im/migrant classification systems and their constituent categories have a long history in the construction of public health knowledge on tuberculosis in the United Kingdom. This article critically examines the categories employed and the epidemiological discourses on TB, im/migrants, and ethnic minorities in health reporting between 1965 and 2015. We employ a Sociology of Knowledge Approach to Discourse Analysis to trace the continuities and changes in the categories used and in the discursive construction of im/migrants, ethnic minorities, and TB. These continuities and disjunctures are analysed within their socio-historical context to demonstrate the historical contingency of epidemiological knowledge production. We outline two historical phases in knowledge construction. The first coincides with the period of decolonisation, which witnessed a change in discursive identity ascriptions from ‘immigrants’ to ‘ethnic groups’ in health reporting as the ‘other’. The second commenced after 1991, when the adoption of the census ethnicity categories as a standard in the collection of population statistics entrenched ethnicity categories in health reporting. We argue the health reporting discourse reveals that the ‘new’ public health exhibits continuities with the ‘old’ by targeting the immigrant ‘other’ through biosecuritisation practices. We contend that these categories originated within a postcolonial paradigm and that increasing immigration and new forms of mobility are creating the preconditions for new discourses on identity construction that have implications for the current collaborative TB strategy.

Highlights

Ethnicity and im/migrant classification systems and their constituent categories have been integral to the construction of public health knowledge on tuberculosis in the United Kingdom since the post-Second World War period (Welshman, 2000)
Following the emergence of the new public health in the 1990s, with its emphasis on the role of environmental and socio-economic determinants in redressing social inequities (Tulchinsky and Varavikova, 2010, 2014), the discursive regime on im/migrants, ethnic minorities, and TB shifted to include statements regarding these groups as being ‘a risk’ to public health as well as being ‘at risk’ of contracting TB. We argue that this dual construction of risk is an inherent feature of the contemporary epidemiological discourse on TB in the new public health
Epidemiological categories in TB health reporting constitute a lens through which the socio-historical processes implicit in shaping the construction of knowledge about im/migrants, ethnic minorities, and TB can be examined

Summary

Introduction

Ethnicity and im/migrant classification systems (classifications) and their constituent categories have been integral to the construction of public health knowledge on tuberculosis in the United Kingdom since the post-Second World War period (Welshman, 2000). In the wake of declining TB rates, public health – as both a discourse and a set of practices – was central to managing a disease whose meaning has changed over time from a ‘social disease’ affecting large parts of the general population to an ‘immigrants’ disease’ (Kehr, 2012: 251). Epidemiology has had a defining biopolitical function in the production of public health knowledge by documenting patterns of the disease among the UK’s ethnically diverse population Central to this epidemiological task are the identification and categorisation of groups, as well as surveillance, record taking, and reporting back to a system of government agencies (Lupton, 1995). From a Foucauldian perspective, classifications in TB health reporting do organise knowledge about groups and infectious disease into the constituent categories These categories are discursive practices, the product of shifting and historically contingent configurations of power/knowledge that define the boundaries of what can be said about these groups.

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