The disproportionate mortality of COVID-19 and brutality of protective institutions has shifted anti-racism
discourses into the mainstream. 1 Increased reckoning over categorisations of people demonstrate that racial
categories, while imprecise, fluid, time and context-specific, embody hierarchical power. We interrogate 
categorisations used in the UK, South Africa and the USA; their origins and impact. We emphasise needing to 
recognise commonality of power structures globally,while acknowledging specificity in local contexts.
In identifying such commonality, we encourage use of the term ‘minoritised’ as a universal alternative

Deivanayagam, Thilagawathi Abi

Lasco, Gideon

Scafe, Suzanne

Selvarajah, Sujitha

University of the Western Cape Research Repository

 1Selvarajah S, et al. BMJ Global Health 2020;5:e004508. doi:10.1136/bmjgh-2020-004508Categorisation and MinoritisationSujitha Selvarajah   ,1 Thilagawathi Abi Deivanayagam,2 Gideon Lasco   ,3 Suzanne Scafe,4 Alexandre White,5 Wanga Zembe- Mkabile   ,6 Delan Devakumar1CommentaryTo cite: Selvarajah S, Deivanayagam TA, Lasco G, et al. Categorisation and Minoritisation. BMJ Global Health 2020;5:e004508. doi:10.1136/bmjgh-2020-004508Handling editor Seye AbimbolaReceived 19 November 2020Accepted 22 November 20201Institute for Global Health, University College London, London, UK2Department of Public Health and Policy, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK3Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines4School of Humanities, University of Brighton, Sussex, UK5Center for Medical Humanities and Social Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA6Health Systems Research Council, South African Medical Research Council, Tygerberg, Western Cape, South AfricaCorrespondence toDr Delan Devakumar;   d. devakumar@ ucl. ac. uk© Author(s) (or their employer(s)) 2020. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ.The disproportionate mortality of COVID-19 and brutality of protective institutions has shifted anti- racism discourses into the main-stream.1 Increased reckoning over categori-sations of people demonstrate that racial categories, while imprecise, fluid, time and context- specific, embody hierarchical power. We interrogate categorisations used in the UK, South Africa and the USA; their origins and impact. We emphasise needing to recog-nise commonality of power structures glob-ally, while acknowledging specificity in local contexts. In identifying such commonality, we encourage use of the term ‘minoritised’ as a universal alternative.HISTORICAL CONTEXTVarious historical and geographical contexts give rise to categorisations, consistently exposing the use of power in creating sepa-ration.The UK term BAME (Black, Asian and minority ethnic) reflects decades of cate-gorising groups of people referred to in the 1940s and 1950s as ‘coloured immi-grants’; ‘New Commonwealth immigrants’ or ‘African, Caribbean and Asian’ immigrants. This terminology, highlighted their perceived differences and non- White identity. From the 1960s to the early 1990s, ‘Black’ was used by some, as a political term to highlight the shared history of colonialism and political and cultural entanglement that brought African peoples, people from the Indian subconti-nent and Caribbean people of all heritages to Britain. BME (Black and minority ethnic), a governmental term, evolved to BAME in the 1990s when Asian was added, recognising the number of Asian people in the UK. The use of BAME contributes to obscure the colonial past and its impact on the lived experience of these groups.In South Africa, racial classification was an essential weapon of the apartheid arsenal. Categorising the South African population into racial groups can be traced to the colonial era in the mid- 1800s,2 but racial categories found their full expression under apartheid when promulgated in the Population Regis-tration Act of 1950. Under this law, four racial categories were formalised: White, Black, Coloured and Indian. From 1948 to 1991, racial classification was the foundation of all apartheid laws, determining where people could live, work, access healthcare and social services, be educated, travel and play. Even after the Act was repealed in 1991, the racial categories remain across many settings.The use of racialisation to assign rights and power is well established in the USA. Many have spoken of Whiteness as property, enabling freedom and rights.3 4 This has been enshrined in law, from slavery, to the one drop rule of Tennessee and Virginia’s Racial Integ-rity Acts, to the Jim Crow laws, whereby White-ness confers rights, power and privilege. The same values are evidenced today through the disproportionate incarceration and policing of Black Americans. The newer term BIPOC (Black, Indigenous and People of Colour) has gained recent popularity, being traced back to Twitter in 2013.5 While BAME highlights the two largest non- White groups in the UK, BIPOC emphasises the two groups who face the greatest discrimination and long history Summary box ► Categorisations are imprecise, time and context spe-cific and do not cross borders well, despite sharing global commonality in the power structures that govern them. ► Problems with current categorisations include: masking the centering of Whiteness, flattening or erasing difference and masking inequality, all of which make data interpretation and policy- making less effective for certain populations. ► Minoritised can be a more useful term as it de-scribes intersectional forms of discrimination, and acknowledges the active processes involved in differential allocations of power, resources and ul-timately health. ► Categorisations can be helpful in data collection and research but should be as specific and locally appro-priate as possible. on December 30, 2020 by guest. Protected by copyright.http://gh.bmj.com/BMJ Glob Health: first published as 10.1136/bmjgh-2020-004508 on 30 December 2020. Downloaded from 2 Selvarajah S, et al. BMJ Global Health 2020;5:e004508. doi:10.1136/bmjgh-2020-004508BMJ Global Healthof oppression in the US context: Black and Indigenous people. Many of the criticisms we explore below are applicable to both BAME and BIPOC, but a key differ-ence being that BIPOC, like ‘Women of Color’, was born primarily from multi- cultural and multi- racial movements working to dismantle the systems of oppression which create racial hierarchies. Women of Color in the words of Loretta Ross is ‘a solidarity definition, a commitment to work in collaboration with other oppressed women of color who have been minoritized’.5These categorisations are marked by contention, contradiction and contestation. We explore four themes arising from these discourses; (1) Whiteness and Euro-centrism, (2) homogenisation, (3) furthering divisions and (4) recognising power hierarchies. We then explore specificity and universality in our suggested alternative.1. WHITENESS AND EUROCENTRISMMany of these groupings centre Whiteness and create separation between White people and non- White people by drawing attention to perceived differences, while maintaining Whiteness as the ‘ordinary’. It is a recurring paradigm that the ‘norm’ in science, medicine and health is Whiteness or European. In health literature, ‘Asia(n)’ continues to be shorthand for the entire continent, or to specific parts (eg, East and Southeast Asia) based on the largely unchallenged assumption that, ‘due to the ethnic, genetic, environmental and cultural differences, clinical data of the Western populations may not be represent-ative of Asian countries’.5 6 The implicit assumption is that the ‘West’ is the default ‘reference population’ with which ‘Asians’ are compared—notwithstanding the fact that even with the most restrictive definitions, ‘Asians’ make up three fifths of the world’s population. Rejecting terms such as BAME and ethnic minority can be acts of decoloniality, decentring Whiteness and Eurocentrism.2. HOMOGENISATIONBAME and BIPOC are used and interpreted in multiple ways, for example some refer to the ‘BAME community’. Underlying this is the homogenising of all non- White British identities.7 This homogenisation is embodied in the pronunciation ‘baym’. These terms flatten important social and cultural differences between groups, while erasing the uneven power structures within which they are situated. Failing to recognise that discrimination faced by each group is unequal, masks inequality. For example, when organisations state a percentage of BAME or BIPOC representation, we fail to recognise systemic exclusion of certain groups.7 83. HETEROGENEITY: FURTHERING DIVISIONS AND DIFFERENCES IN OPINIONSuch categories can also further divisions among non- White groups. In South Africa, there is recognition of the ways in which the categories centre Whiteness, and sow and maintain divisions among the non- White categories of people (Blacks, Coloureds and Indians), pitting them against another, and maintaining racial hierarchies estab-lished during apartheid.Furthermore, there is no consensus about these terms, illustrating that not all who are grouped together think or feel the same. While there is rejection of these terms by many, in South Africa, there is a definite embracing of certain labels by some. Some see the categories as embodying the history and specific experiences of non- White people in South Africa. Adhikari,2 who makes a case for embracing the Coloured identity, stated ‘coloured identity is also very much the product of its bearers who, I would argue, were in the first instance primarily respon-sible for articulating the identity and subsequently deter-mining its form and content’. Thus, these terms do not cross borders with the term Coloured being pejorative in the USA and the UK, but embraced by some in South Africa.4. HIERARCHICAL POWER AT THE HEART OF CATEGORISATIONTerms like ethnic minority are not neutral phrases refer-ring to population size. Simplistic views like this ignore the central role of power. In South Africa, White people are a cultural majority despite being the numerical minority.9 Across the world, we see the minoritisation of people associated with Asia, a global majority. In recent infec-tious disease outbreaks from SARS to COVID-19, ‘Asians’ have been constructed in popular and state discourse as a dangerous, infectious ‘other’, imbued in discriminatory and xenophobic sentiment,10–14 echoing a much longer history of moral panic in the USA and elsewhere, around the ‘Yellow Peril’ . A similar dynamic was seen with terms ‘African’ or ‘West African’ during the Ebola outbreak in 2014,15 exposing categorisations of people as a function not of number but of power.SPECIFICITY FOR USEFUL CATEGORISATIONCategorisation in some form can help identify dispropor-tionate health burdens. Inappropriate use worsens stereo-typing as ‘the scientific use of a social category can be inter-preted as an endorsement of its validity’.16 For example, the UK census, and therefore health data, is disaggregated by Black African, Black Caribbean, Asian Bangladeshi, Asian Pakistani and Asian Other categories, providing confusion between skin colour, continents and countries. Moreover, they can reinforce colonialism’s ‘comparative paradigm’,15 which oversimplifies identities and contexts. This charac-terises global health today despite calls to decolonise it.15 16 For research and data collection purposes, we need accu-rate categories acknowledging complexity of identity, not originating from White or Eurocentric gazes and avoiding conflation of diverse groups or regions.UNIVERSALITY OF MINORITISING POWER STRUCTURESWe recommend the term minoritised, which emphasises active processes,17 shifting beyond binary discussion  on December 30, 2020 by guest. Protected by copyright.http://gh.bmj.com/BMJ Glob Health: first published as 10.1136/bmjgh-2020-004508 on 30 December 2020. Downloaded from Selvarajah S, et al. BMJ Global Health 2020;5:e004508. doi:10.1136/bmjgh-2020-004508 3BMJ Global Healthof minority versus majority.17 18 We build on existing explanations19 to define minoritised, as ‘individuals and populations, including numerical majorities, whose collective cultural, economic, political and social power has been eroded through the targeting of identity in active processes that sustain structures of hegemony.’ Power is emphasised as central to racism and inter-secting forms of discrimination. It highlights mainte-nance of structures which diminish minoritised people’s capability to lead healthy lives. It neither singles out nor creates groups, and adds more nuance than words like marginalised by connecting back to terms such as ethnic minority, thus acknowledging existing literature while resisting its coupling with dubious assumptions about ethnicity.In summary, we call for data collection and categori-sations to be accurate, contextually appropriate and not to reinforce existing power hierarchies. Name and recog-nise people, without reductive acronyms and amalgams. We call for the use of minoritised, for it will remain appli-cable across various manifestations of unjust power, as long as inequity and discrimination exist.Twitter Gideon Lasco @gideonlascoContributors DD and SS produced the first draft, with edits from TAD. SS then restructured the piece and asked for inputs from the other authors, including certain sections to be written by them before editing the commentary. All authors edited and critically revised the draft.Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors.Competing interests None declared.Patient consent for publication Not required.Provenance and peer review Not commissioned; internally peer reviewedOpen access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.ORCID iDsSujitha Selvarajah http:// orcid. org/ 0000- 0002- 5866- 2803Gideon Lasco http:// orcid. org/ 0000- 0002- 6402- 682XWanga Zembe- Mkabile http:// orcid. org/ 0000- 0003- 4106- 4513REFERENCES 1 Devakumar D, Selvarajah S, Shannon G, et al. Racism, the public health crisis we can no longer ignore. Lancet 2020;395:e112–3. 2 Adhikari M. Burdened by race: coloured identities in Southern Africa, 2009. 3 Mills CW. The racial contract, 2014. 4 Hooks B. Representing whiteness in the black imagination. Displacing Whiteness 1997:165–79. 5 Grady C. The meaning of the BIPOC acronym, as explained by linguists. Vox, 2020. Available: https://www. vox. com/ 2020/ 6/ 30/ 21300294/ bipoc- what- does- it- mean- critical- race- linguistics- jonathan- rosa- deandra- miles- hercules [Accessed 8 Nov 2020]. 6 Peng L, Yam PP- Y, Yang LS, et al. Neurocognitive impairment in Asian childhood cancer survivors: a systematic review. 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Potential impact of COVID-19- Related racial discrimination on the health of Asian Americans. Am J Public Health 2020;110:1624–7. 15 Smith- Morris C. Epidemiological placism in public health emergencies: Ebola in two Dallas neighborhoods. Soc Sci Med 2017;179:106–14. 16 Bhopal R, Donaldson L, White DL. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. Am J Public Health 1998;88:1303–7. 17 Gunaratnam Y. Researching ‘Race’ and Ethnicity: Methods, Knowledge and Power. SAGE, 2003. 18 Brah A. Cartographies of diaspora: contesting identities. Routledge, 2005. 19 Milner A, Jumbe S. Using the right words to address racial disparities in COVID-19. Lancet Public Health 2020;5:e419–20. on December 30, 2020 by guest. Protected by copyright.http://gh.bmj.com/BMJ Glob Health: first published as 10.1136/bmjgh-2020-004508 on 30 December 2020. Downloaded from 

Categorisation and minoritisation

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