Decolonising Health Inequalities: Uncovering the hidden factors behind biological models of Caribbean and African health outcomes in Greater Manchester

This thesis presents qualitative research conducted into an exploration of the hidden factors contributing to the disproportionate burden of disease for people of Caribbean and African descent in Greater Manchester. The study uncovers the hidden factors behind biological models of Caribbean and African health outcomes. It recognises the differences in morbidity and mortality between majority and minority Black groups and how the current evidence base constitutes consistent epidemiological findings of poor health across a range of health measures. The voices of Caribbean and African people were centralised through two phases of ethnographic data collection. Participants shared snapshots of their daily lives which captured their health and social interactions within the health system. This interdisciplinary piece of work is underpinned by several theories and frameworks and begins by presenting the social construction and post/decolonial legacy of race and its impact on Black people in the health market. It uses the sociological frameworks of Critical Race Theory (CRT) and Kimberlé Crenshaw and Patricia Hill Collins' iterations of intersectionality to explain how through health economic theory, gatekeepers' habitus and the unequal power relationships underpin institutional and systemic decision-making. Thematic analysis identified themes from the data that exposed external structural biases in the health market with concomitant internal pressures that have post-colonial origins. Findings revealed wide-ranging overarching themes, which were identified throughout the analytical process in phase 2 that had captured and developed themes from phase 1 of the study. Phase 2 themes included Significant Influences on Individuals’, ‘Discrimination’ and ‘the Mirror of Black Health’. I conclude that racial disparities in health endure primarily because the foundations upon which racial hierarchies were built are still present and used today. There has been a fundamental systemic and structural failure across government including public health practices to address the root causes that sustain the poor health of Black people. This study highlights how the deconstruction of race based and discriminatory practices can open possibilities for reconstruction to bring about more equitable solutions in practice-based outcomes. This will require a combination of post and decolonial scholarship, relationship building, health advocacy and political action to mount a sustained communities’ campaign for structural change within the health sector