Narratives of under-representation: older Pakistani women’s accounts of their health and social care experiences

This research project explores older Pakistani women’s narratives of their interactions with health and social care systems. Initially situated in social work practice, the study developed from my experience working in an intermediate care facility. The project was located in a town identified as one of the most deprived in England in 2016, and where 10% of the population self-identified as Pakistani according to 2010 Census data. Rather than remain located in a specific service, the project evolved to take a broader approach; narrative interviews were conducted with eight older Pakistani women. The open question ‘please tell me about an encounter you have had with health or social care’ elicited a spectrum of responses. Transcripts were analysed using dialogic performance analysis and each interview was developed into a case study incorporating extracts of the original transcripts. Four themes were then constructed through thematic analysis of the narratives from each case study. The themes expose the intersectional nature of oppression and disadvantage experienced in interactions with health and social care services. This indicates that social class plays a substantial role in whether racial abuse and/or discrimination has an impact on an individual’s identity. Social class was also important in generating boundaries of space and place, with increased capital playing a key role in expanding the boundaries of ‘safe spaces.’ Racism was experienced by all participants and was generalised across numerous different fields, leading in many cases to an expectation of poor care provision. The implications of these findings are two-fold; primarily, those who experience the most intersectional oppression are most likely to have their identity affected by racial abuse and/or discrimination, therefore affecting their future interactions. Additionally, those experiencing significant intersectional disadvantage are less likely to encounter the white population outside of health and social care interactions. It is therefore in these exchanges that the impact on identity is played out, with potential consequences for the health of these individuals. Secondly, racist behaviour is generalised from one professional to whole professional groups, and from one field to another, contributing to the development of a system of representation. This indicates that any steps taken to adapt or improve the accessibility of individual services will have limited, localised impact at most. To facilitate more equitable distribution of health and care services, the emphasis needs to be on addressing intersectional oppression and discrimination on a societal level, with a focus on the limiting impact of socio-economic disadvantage and dismantling of oppressive representational systems