Institute for Global Health


Cultural hierarchies in health

Project Summary


Biraderi is a form of identity-based grouping among South Asian communities which refers to an individual's occupation, kinship networks, or place of origin. It can also be used for social ranking into so-called "higher" and "lower" biraderi groups. Biraderi is common marker of identity among British Muslims, and is related to the broader concept of caste. In South Asia, caste status affects people's access to economic opportunity and health services, and forms part of the way children learn about themselves and society, with those of so-called "higher" castes often having better access and opportunity than those of so-called "lower" castes.

There is a wealth of research on how caste or identity-based grouping in South Asia predicts children's access to nutritious food in the crucial early years of life, but very little information on how biraderi is related to breastfeeding and children's diets among South Asian diaspora communities in the UK. There is also no clear way to organise data on biraderi groups to help researchers understand whether some children in the UK are at risk of poor nutrition because of the social or economic vulnerabilities that come with belonging to a so-called "lower" ranking group.Are nutritional patterns linked to identity-based ranking that are observed in South Asian countries re-created among British diaspora communities? What implications does that have for public health and inequalities in the UK? We will answer these questions by looking at data on British Pakistani women and their children who are born in the city of Bradford.

Aims and Objectives

Our study aims to understand whether biraderi is related to women's breastfeeding practices and their children's diets by re-using data already collected in the Born in Bradford (BiB) study.
We will achieve this aim through 4 objectives.

  1. We will consult a group of academic experts on biraderi and a community group of Muslim residents in Bradford on the best way to arrange or rank the 15 biraderi groups in the BiB study.
  2. We will create data summaries of breastfeeding rates and duration, and nutritional qualities of children's diets for each biraderi grouping identified by our academic and community groups.
  3. We will examine whether there are important differences in breastfeeding practices and children's diets between different biraderi groups (or ranks) after we have accounted for other factors such as education, income, and living conditions.
  4. We will compare our findings from Bradford to the wider research on how differences based on social and cultural identity are expressed in children's diets, and discuss whether community breastfeeding / nutrition services or social health initiatives need to account for differences based on biraderi.

Potential applications and benefits

Our study will be one of the first to examine biraderi-based differences in breastfeeding and children's diets among British South Asians, and we expect 4 potential applications and benefits.

  1. We will identify sub-groups within ethnic minorities in the UK who are at increased risk of poor nutrition in early life and would benefit from additional support to achieve the lifelong health and economic benefits of breastfeeding and healthy diets.
  2. Our expert and community consultation on grouping biraderi data will provide a framework for researchers who want to understand how biraderi is related to other health conditions across the life span.
  3. Internationally, there is a large community of researchers and policy makers who want to understand and reduce the effects of identity-based markers of social grouping on health, and our work will show an innovative method to involve community groups in the analysis and interpretation of such information.
  4. At a local level, Bradford is the UK City of Culture 2025, and our activities to share results with local communities will put the spotlight on children's nutrition and health in the city.

UKRI: Cultural Hierarchies in Health: Does inherited sociocultural position (biraderi) shape diet and nutrition among British Pakistani children?


Bhatia K, Intezar H, Akhtar P (2024) Cultural hierarchies in health: Does inherited sociocultural position (biraderi) shape diet and nutrition among British Pakistani children? Protocol for a mixed-methods study. PLoS ONE 19(6): e0305556. https://doi.org/10.1371/journal.pone.0305556