3rd Quarterly, 2007 No.145

Discrimination and Health: a Study among Buraku Women

Timothy Harding, Faculty of Medicine, University of Geneva, Switzerland.
Summary of a lecture given at the BLHRRI on February 9, 2008

The reality of the discrimination faced by the Burakumin in Japan has been extensively documented. It is experienced in marriage, employment and in day to day experiences in school, the workplace and the community. This form of discrimination, based on historical divisions in the social class system and descent, exists in other countries, notably in India.

An association between discrimination and health problems has been clearly demonstrated in many groups facing discrimination; for example, black people in the U.S. and Roma populations in Eastern Europe. However, the causal mechanisms have not always been fully understood.

There is also an established link between poverty and ill-health, notably documented in the "Black Report" on inequalities in health in the United Kingdom. It is therefore possible that the association between discrimination and health problems is simply part of a wider phenomenon related to social class and poverty. However, some evidence from the United Kingdom suggests that discrimination effects health over and above the associated social and economic factors.

Therefore there is an important issue to be researched, concerning the potential incremental effect of discrimination per se on health.

Studies carried out in burakumin communities in the early 1980s, showed a higher prevalence of a wide variety of diseases than in the general Japanese population: overall twice as many "sickly persons" (23.2%) in Buraku communities than in the general population (12.6%). The difference was particularly pronounced for gastrointestinal disorders, liver disease, cardiovascular disorders and musculo-skeletal problems. These disorders were also associated with a higher rate of physical handicap.

There is some evidence that the health status of burakumin has improved as measures to combat discrimination and its effects bear their fruit.

The present study seeks to examine the possible links between discrimination and health among burakumin over the past half century. The study focussed on women because of their key role in child rearing. The importance of maternal and child care in promoting health in the community as a whole is well known.

85 women over the age of 65 were interviewed in Buraku communities in several prefectures: Osaka, Wakayama, Hyogo, Kochi, Ehime, and Fukuoka between August 2003 and February 2005. About half of the sample was contacted through the BLHRRI and the rest through informal contacts. The results were not influenced by the way in which contact was established, which argues against a sampling bias.

A semi-structured interview was conducted covering three periods of the life experience of these women: their childhood and adolescence, corresponding to the period before, during and shortly after the War, their period as young adults and middle age (for many of the sample the time of child bearing and rearing), and the period over the past 20 years when measures were taken to combat discrimination. The interviews sought to establish the realities of living conditions, employment, education, marriage, as well as factors concerning health: access to medical services, experiences of childhood mortality, accidents, disabilities, alcohol abuse, smoking...

The results showed:

  • Poor habitat during childhood - overcrowding, lack of clean water supply, dirty and dusty environment; improving progressively after 1975.
  • Lack of education with a high rate of illiteracy and lack of information about health promotion such as vaccination.
  • No overall malnutrition but in some communities, dietary habits and preferences for some unhealthy foods (high content of animal fats).

Surprisingly few problems of access to health care based directly on discriminatory attitudes among doctors, midwives and nurses; but, problems related to health insurance cover due to unstable employment.

High rates of work related accidents among close male relatives.

52% had at least one close male relative (husband, brother or brother-in-law) who had permanent work related disability.

High rates of reported alcohol abuse among close male relatives.

In three communities, there appeared to be a high rate of psychiatric hospitalisation among both men and women.

A significant number of the women's children had married non-burakumin partners.

Continuing experience and fear of discrimination at a psychological level.

For two sets of data a comparison with a control group of non-burakumin women of the same age group attending activity centres for elderly persons in Hyogo prefecture was carried out. Women were asked how many children and grandchildren they had and whether any had died before the age of five years. There was a highly significant excess mortality among children of burakumin women compared to children of non-burakumin women. However, there was no such difference for deaths before five years among grandchildren. Furthermore there was an excess mortality of close relatives of burakumin women before the age of 50 years compared with non-burakumin. The excess was mainly due to deaths by accident and suicide.

This study has methodological weaknesses, notably the lack of a control group of non-buraku women for much of the data (but not for the results summarised under point 10). However the results suggest that discrimination impacts negatively on health through several mechanisms: lack of education effecting preventive measures, work related accidents, alcohol abuse related to hard working conditions, dietary choices and psychological effects of discrimination. Environmental factors were important but conditions have improved. Negative attitudes of health professionals were rarely experienced.

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