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Terms and concepts

2018: Intercultural care and support

In this Appendix, we look a bit closer at race, highlighting the continued use of the term despite widespread criticism of the concept. We then provide a few more details about some of the common characteristics of minority ethnic groups, including the relationship between ethnicity and both vulnerability and power, as well nationality and religion, ending with a few words about other terms often used in connection with minority ethnic groups.

More about race

Race is a concept which categorises groups of people on the basis of biological differences (often including visible physical traits or characteristics), which it is claimed have been passed down from generation to generation (i.e. genetic differences). The concept of race is often associated with the belief that some races are inferior and even ‘less human’ than others, with devastating consequences for certain groups of people (e.g. discrimination, colonisation, slavery and genocide). According to Smedley and Smedley (2005), two main beliefs about race have persisted since the 20th century, namely race as consisting solely of human biogenetic variation (prevalent amongst scientists) and race consisting of a combination of physical and behavioural differences (a folk perception, also prevalent in some policies and laws). The concept of race has been challenged with opponents of this concept pointing out that so-called racial groups are not genetically discrete, measurable or scientifically meaningful and that there is more genetic diversity within ‘races’ than between them (Smedley and Smedley 2005, Mersha and Abebe 2015).

Nevertheless, the terms race and ethnicity (or racial group and ethnic group) are often considered and used as if they were interchangeable or, alternatively, included in lists of possible causes of discrimination separately but without defining either term. Despite terminology surrounding the concept of race being fraught with ambiguity and misuse, measures designed to offer protection against ‘racial’ discrimination often use the term in a way which does not seem to challenge the concept of race, merely stipulating that it should not be used as a basis for discrimination.

Article 1 of the UN International Convention on the Elimination of All Forms of Racial Discrimination, for example, merely states that ‘racial discrimination’ shall mean “any distinction, exclusion, restriction or preference based on race, colour, descent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other field of public life.” The EU Charter of Fundamental Rights prohibits discrimination on ‘any ground such as sex, race, colour, ethnic or social origin, genetic features, language, religion or belief, political or any other opinion, membership of a national minority, property, birth, disability, age or sexual orientation’. The Racial Equality Directive (2000/43/EC) prohibits discrimination on the grounds of “race or ethnic origin”.

The underlying meaning and explicit assumptions made when the term ‘race’ is currently used are not always clear. It seems that whilst the term is widely acknowledged as lacking any scientific or genetic basis, it is now increasingly being interpreted within a wider scope including issues related to cultural differences, as can be seen from the following quote:  

“A racist practice or rule is one that distinguishes, excludes, restricts or gives rise to a preference based on ‘race’, colour, descent, or national or ethnic origin. Racist practices and rules make it more difficult for members of some groups to attain the human rights, to which they are entitled. Racist practices or rules may be practiced by individuals (for example through name-calling, racist graffiti, excluding people or using violence against them), or by institutions (for example, though the application of rules or regulations which do not make allowance for cultural difference)” (National Council for Curriculum and Assessment 2005).

In the context of research, the two terms often appear side by side with no explanation about their meaning. Typical statements include:

  • Caregiversindicatedtheir age, gender and primary racial or ethnic group.
  • Participants were grouped into 5 racial/ethnic groups.

It is not always clear whether the two terms are really considered interchangeable. Researchers might sometimes feel that it is irrelevant (for the purpose of their studies) whether people identify with a particular group on the basis of race or ethnicity or are taking into consideration possible differences in the way that these terms are understood by participants. Whatever the reason, the two terms have different meanings and using them in this way may perpetuate the current ambiguities surrounding their use.

Mersha and Abebe (2015) question this tendency within research to use the two terms in this way. They point out that there are valid reasons in the context of healthcare for being aware of genetic differences between groups of people but that the concept of ‘race’ (based on observed differences in biology, physical appearance and behaviour) is not useful in establishing such differences[1]. They argue in favour of using ‘ancestry informative markers’ (AIMs). These are a “set of genetic variations for a particular DNA sequence that appear in different frequencies in populations from different regions of the world” (2015, p.4). They do, however, recognise that whilst genetic ancestry might describe genetic relatedness more accurately than race or ethnicity, the interaction of biological and social factors in relation to health must still be considered.

More about some of the common characteristics of minority ethnic groups

In each country, there is usually a group of people who share a common culture and language, and form the largest proportion of the population. These people usually speak the official language of the country and have ancestors who have lived there for generations. They are more likely, compared to people from other ethnic groups, to receive culturally appropriate services and support, which can be readily adapted to their individual needs and preferences, because these are more compatible with the standard cultural norm (e.g. in terms of food, language, cultural activities, pastimes, religion, traditions and festivals). In this sense, they differ from cultural groups who are the native inhabitants of a particular country (e.g. the native Indians in the United States and the Sami communities in Norway, Sweden, Finland and Russia) but who have become a minority ethnic group.

People who identify with other groups, which share a different culture, are often described as being from minority ethnic groups, ethnic minority groups or as being members of minority ethnic communities. Barth suggests that the shared cultural features are “an implication or result, rather than a primary or definitional characteristic of ethnic group organization” (Barth 1998, p.15). Some writers opt for the term ‘minority ethnic group’ in order to emphasise that everyone belongs to an ethnic group (which is an inherent assumption reflected in many official documents). Mohammed (2017), for example, states,

“I also use the term ‘minority ethnic’ in preference to ‘ethnic minority’ because it stresses the fact that everyone belongs to an ethnic group, rather than an ethnic group’s minority status” (2017, p.6).

Being asked to identify one’s ethnicity in an official document, for the purpose of research, when filling out official documents or when being offered services or support suggests that a person is expected to belong to an ethnic group, irrespective of whether they feel any kind of identification with a particular group. This seems to run counter to the concept of ethnicity as involving voluntary self-identification with a cultural group.

Power relations and vulnerability

The issue of power cannot be ignored as members of minority ethnic groups very often have a vulnerable status and lack of political power, with many having experienced racism and prejudice (Moodley 2005, APPGD 2013). Berdai Chaouni and De Donder (2018) describe the situation of Moroccan older people who migrated to Belgium in the 1960s and 1970s under a guest worker program and, counter to the expectations of the Belgian state and even their own plans, ended up staying in the host country. Many (approximately 70%) have no formal education and their socio-economic status resembles that of many minority ethnic groups in other European countries with a similar migratory history (Liversage & Jakobsen 2016, Berdai Chaouni and De Donder 2018; Goudsmit et al. 2018) such as the Windrush generation[2] in the UK (BBC 2018). In some countries (e.g. Finland and Ireland), traveller communities have been largely excluded from healthcare and schooling, often as a result of not having a fixed residence combined with structural discrimination such as difficulties registering with a general practitioner (GP) (KMPHO 2014, Jaakson 2018, Dementia Action Alliance 2018). The potentially vulnerable position of many people from minority ethnic groups threatens their right to be treated equally and this must be challenged in order to respect the moral principle of equity.  In a report on the global impact of dementia, Prince et al. (2015, p. 75) point out:

“The basic principle is that all people affected by the condition should be acknowledged as having equal status and value, and should be accorded equal access to diagnosis, and evidence-based treatment, care and support, regardless of age, gender, socioeconomic status, ethnicity, or (at a global level) country of residence.”

Nationality and terms reflecting national origins

Often the name attributed to a particular minority ethnic group reflects the geographical origin of the members of that group who originally migrated to the country (e.g. Asian or Polish). Descendants of those people may sometimes be assumed to be members of that ethnic group based on knowledge that their relatives identify with that group or on their physical appearance. An emphasis on geographical origin of ancestors may lead to assumptions being made about similarities between groups bearing the same name (e.g. people from Pakistani or Chinese communities) in different parts of Europe.

In the United Kingdom, for example, the terms ‘Black and Minority Ethnic’ (BME) and ‘Black, Asian and Minority Ethnic’ (BAME) are quite commonly used, especially in the context of research and service development. However, terms such as ‘Black’ and ‘Asian’ are applied to very different groups of people, with quite different cultures. This may sometimes result in assumptions being made that people have things in common when this is not the case and overlooking significant differences such as different languages, religious beliefs, shared histories and traditions. As Regan (2014) points out, a person may define themselves culturally as ‘Pakistani’, but in terms of religion as Pakistani Muslim, Pakistani Sikh, Pakistani Hindu or as having no religious affiliation. Also, a person may identify with a particular minority ethnic group for various reasons without necessarily have any migratory or national link.

Some people who acquire citizenship in another country and live there for lengthy periods of time never feel a sense of identification with the culture of the host country. This may, in part, be linked to different degrees of acculturation[3]. In other cases, a person may, at some point, cease to identify themselves as a migrant and the country of their ancestors as relevant to their identity. They may, nevertheless, feel that they belong to a particular minority ethnic group. This might partly explain why some people in the UK, for example, identify themselves as being British Asian, a member of the BAME community, Asian or simply British (the latter perhaps also reflecting a statement about nationality).

Conflating assumed geographical origin with ethnicity is also problematic because the same categories are sometimes used differently by different researchers and policy makers. For example, the term Asian is often used by US and European researchers in one way and by researchers in the UK in another way (i.e. excluding or including people identifying with the Indian community). Sometimes the terms used reflect a broad cultural group, sometimes a specific group or sub-group. According to Mohammed (2017 and 2018), the term ‘South Asian’ covers people from Pakistani, Sikh and Gujarati communities and from other South Asian subgroups including people with a cultural heritage from Afghanistan, Bangladesh, Bhutan, India, Maldives, Myanmar (Burma), Pakistan, Nepal and Sri Lanka. This is problematic bearing in mind that minority ethnic groups are not homogenous in that there are also distinct differences between and within different ethnic communities (e.g. with regard to religion, gender, class and language).  In Bristol alone, for example, over 100 languages are spoken (Baghirathan 2018). Rauf (2011) uses the term ‘communities within communities’ to explain these within-group differences

Within-group differences do not threaten or call into question the existence of a particular ethnic group. Each ethnic group defines the cultural features that are considered significant and these features set the boundaries, determining whether or not a person would consider themselves and be considered by others as belonging to that group. Other differences or similarities, which are not considered by the group as being significant, are ignored, played down or denied (Barth, 1998, p.14). However, the intergroup differences are important to bear in mind when developing services which are not only culturally sensitive but also respond to the needs and wishes of individuals.


A shared religion sometimes becomes the defining feature of an ethnic group or a characteristic that people who are not members of that religion focus on. A minority ethnic group may, for example, be referred to as the Muslim or Jewish community or as people from the Buddhist, Hindu, Muslim or Sikh faiths.  In some cases, however, references to religious groups have little to do with religion, as noted by the United States Holocaust Memorial Museum Organisation:

“The Nazis defined Jews as a “race.” Regarding the Jewish religion as irrelevant, the Nazis attributed a wide variety of negative stereotypes about Jews and “Jewish” behavior to an unchanging biologically determined heritage …….” (United States Holocaust Memorial Museum, undated).

As with nationality, there may be significant differences between people within religious groups. Indeed, the same religion may be interpreted and practised very differently from one community to the next. In some cases, religion may cut across other aspects of people’s cultural identity. For example, there may be people who would describe their ethnicity as being Asian, White or Black who all belong to the same church, mosque or temple and for whom religion is something that unites them. The sense of belonging and the different aspects of a person’s cultural identity that they wish to emphasise may fluctuate over time and according to the situation.

Associated terminology

Many studies of relevance to minority ethnic groups use the terms ‘migrant’ and ‘immigrant’. Some studies, especially from outside Europe (which we have not referred to in this report) also use the abbreviation ‘CALD’. Several different terms are used to refer to majority ethnic groups. This section ends with a brief reflection on the use of these terms.

The majority ethnic group

In the United States, the majority ethnic group is often referred to as White with other possible groups being described as Black, Hispanic and Asian (although these terms are not fixed and have gradually evolved over time). It is not clear how the White versus Hispanic terminology would work in Spain though or how best to describe the Irish or Eastern European communities in the UK. Tilki et al. (2010) point out that Irish people in the UK are one of the largest minority ethnic groups but often ignored or aggregated within the White or White other category. In a few studies about dementia amongst different ethnic groups in Europe, terms such as native-Danish have been used instead of White (e.g. Sagbakken, Spilker and Ingebretsen 2018). This seems to reflect an implicit assumption about the migratory background of the minority ethnic groups (emphasising immigrant status despite some members of the community having been born in the same country as the ‘native’ inhabitants) but helps avoid confusion between minority ethnic groups which might also be considered as White.

CALD (Cultural and linguistic diversity)

The concept of cultural and linguistic diversity (CALD for short) highlights the broad characteristics of culture and language as opposed to focusing on specific people and groups who find themselves in the minority. The expert working group decided not to use the CALD terminology in this report because is relatively unknown in many parts of Europe and it was felt that this might interfere with the effective dissemination of the findings of the project and in raising awareness about the database of good practices.

Migrant and immigrant

Another possible term, which could have been used instead of ‘minority ethnic group’, is ‘migrant’.  The concept of ‘migrant’ is quite unclear, often being associated with ethnic or religious minorities and with asylum seekers and refugees, and sometimes being used interchangeably with ‘immigrant’. The term ‘migrant’ also has implications for residency rights and immigration control. The following extract provides a good example of the lack of clarity (in the UK) surrounding the term:

“Yet there is no consensus on a single definition of a ‘migrant’. Migrants might be defined by foreign birth, by foreign citizenship, or by their movement into a new country to stay temporarily (sometimes for as little as a year) or to settle for the long-term. Some analyses of the impact of migration even include children who are UK-born or UK nationals, but whose parents are foreign-born or foreign-nationals, in the migrant population. None of these definitions are equivalent, and none fit precisely with ‘migrant’ defined as an individual who is subject to immigration controls. Moreover, in the UK ‘immigrant’ and ‘migrant’ (as well as ‘foreigner’) are commonly used interchangeably in public debate and even among research specialists, although dictionary definitions distinguish ‘immigrants’ – people who are or intend to be settled in their new country – from ‘migrants’ who are temporarily resident.  Additionally, in some scholarly and everyday usage, people who move internally within national boundaries are called migrants” (Andersen and Blinder 2017).

The EU Health Policy Platform paper on Migration and Health (PICUM and IRCT 2017) defines migrants on the basis of having crossed an international border regardless of their length of stay but adds that many people can be migrants and members of ethnic minorities but that members of the latter are not necessarily migrants. Many people identifying with a minority ethnic group were born in the country to which their parents or grand-parents moved but nevertheless encounter similar difficulties to those experienced by the latter (e.g. linked to cultural and linguistic issues and social exclusion or discrimination). This might include some second or third generation descendants of migrants (e.g. from Portugal living in Luxembourg, from the Caribbean living in the UK or from Somali living in the Netherlands).

It was decided, already at the stage of drafting a proposal for funding for this project, not to limit the scope to migrant populations. The reason for this was that issues related to accessing or providing intercultural care and support for people with dementia were not considered as being necessarily limited to official status as a migrant or immigrant or to people having lived in different countries at some point in their lives. Nevertheless, it is clear from the literature that most minority ethnic groups have some link in the near or distant past to migration even though many people identifying with a particular group have no personal experience of migration.



[1] The authors make a very clear distinction between race and ethnicity but repeatedly refer to them jointly in their article as ‘race/ethnicity’ in contrast to ‘ancestry’. 

[2] Windrush was the name of the ship (MV Empire Windrush) which arrived at Tilbury Docks, Essex, in June 1948, bringing workers from Jamaica, Trinidad and Tobago and other islands, in response to post-war labour shortages in the UK. In 1971 immigration laws were introduced which ended this invitation to fill labour shortages.

[3] See also the sub-section on migrant carers.



Last Updated: Thursday 11 February 2021


  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020) and from the Robert Bosch Stiftung. The content of the report represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
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