Long-term ill-health and livelihoods among Pakistanis in the UK: Class, gender and household economies

A growing body of literature on health and social inequalities has identified Pakistanis as having a particularly heavy and premature burden of long-term ill-health compared with people from other ethnic backgrounds, and long-term sick Pakistanis are also a sub-population in the UK with disproportionately high rates of unemployment and inactivity. In this thesis, I argue that there is a need to turn fresh attention to the practical and material consequences of ill-health, and to the impact of ill-health on livelihoods. I make a case for shifting the focus of medical sociology and medical anthropology away from the subjective, psychological processes of coming to terms with, coping with and managing a long-term health condition, and onto the realm of overt behaviour and the everyday consequences of living with ill-health in specific historical contexts. I also make a case for examining how the experience and consequences of long-term ill-health are embedded in the local worlds of family, household and community, and how these are inflected by power relations. The thesis broadly documents the process of impoverishment engendered by ill-health, stressing how the economic impact of long-term ill-health is embedded in particular production and welfare regimes and differentiated by generation, class, education and gender among Pakistanis. Far from being a uniformly deprived and disadvantaged group located at the bottom of British society, I examine the significance of class relations and social mobility among Pakistanis, and show how long-term ill-health contributes to increasing economic polarisation within the community. Within certain material and cultural constraints, individuals and households also resisted the potentially ruinous consequences of long-term ill-health and impoverishment, and strived to maintain social status and membership in a moral community by engaging in strategic action via their interconnected means of production, consumption and reproduction, within a specific local regime of value. The thesis employs a mixed-methods approach combining statistical analysis of the Labour Force Survey with ethnographic material from East London. It is located analytically in Bourdieu's `theory of practice' (Bourdieu 1977), which offers a way to formulate the interface between structure and agency, and material and cultural factors as interweaving influences on the predicaments of long-term sick Pakistanis.