Dying, Death and Bereavement in a British Hindu Community

British Medical Journal, Jan 2, 1999 by Paramjit S. Gill

Peeters, 17.99 [pounds sterling], pp 240 ISBN 90 6831 976 0

Rating: **, ***

As we celebrate the 50th anniversary of the founding of the NHS we should also reflect on the growth of Britain's black and ethnic minority population. These two elements of modern British society have not only grown up together but are also intimately related. During the late 1940s and '50s there was a major recruitment drive of doctors and nurses from Commonwealth countries to work in the "mother country." Some years later their dependants joined them, and during the 1960s events in Africa led to an influx of "Asian" migrants. The ethnic minorities now form 6% of the British population, and within this figure there is enormous cultural diversity.

Healthcare needs assessment is a relatively new term for an older concept and is defined pragmatically as the ability to benefit from health care. The Step by Step Guide takes us through the process of assessing needs; it covers difficult areas, such as defining ethnicity and "race," which the authors illustrate by defining their own ethnic group. The issue of ethnocentricity, when the view of the majority is used as the standard against which others are compared, is highlighted by the problems of standardising rates for specific ethnic groups. I enjoyed reading this guide, which states the objectives for each chapter and provides worked examples. As this is a basic introduction, it lacks details on specific ethnic groups and diseases, but the appendix provides further sources of help. Some of the material can be adapted for teaching at both undergraduate and postgraduate levels.

Whereas the Step by Step Guide provides an overview of minority ethnic groups, Dying, Death and Bereavement focuses on a specific minority group and subject. The book arose from the author's thesis and compares the beliefs and practices of death of British Hindus with their counterparts in India. The author collected data for this by spending three months in India. The focus of the book is individual Hindus, seen in the context of their family and community. The first part sets the context and provides a cross cultural perspective of death and bereavement. As Firth reminds us, "In a secular culture in which death is highly medicalised, there is a risk of seeking rational explanations for illness and death in terms of physical causes which can lead to separation of religion from the rest of life and a devaluation of religious experience and spirituality." So the Hindu model of a "good death" provides a useful philosophical approach to death, with new insights and understanding.

Rituals around death are explored in the second part, and the book concludes with an analysis of the social and psychological dimensions of death and mourning and implications for professionals in this country. The book also gives a lucid account of Hinduism and how British Hindus have adapted these "practices."

In the constantly changing NHS both these resources will be valuable to both commissioners and providers of services, as well as academics. Indeed, Dying, Death and Bereavement will also be of help to those wanting deeper insight, and it shows that the host community also needs to learn and adapt.

Paramjit S Gill, senior lecturer, Department of General Practice, University of Birmingham