Race, Ethnicity, and Health

A Public Health Reader

Thomas A. LaVeist, Lydia A. Isaac, Thomas A. LaVeist, Lydia A. Isaac

• Publisher: Jossey-Bass
• Year: 2012
• ISBN:
  9781118086988
• Topic: Medicine
• Subtopic: Public Health, Administration & Care
• Edition: 2

Race, Ethnicity and Health, Second Edition, is a critical selection of hallmark articles that address health disparities in America. It effectively documents the need for equal treatment and equal health status for minorities. Intended as a resource for faculty and students in public health as well as the social sciences, it will be also be valuable to public health administrators and frontline staff who serve diverse racial and ethnic populations.The book bringstogether the best peer reviewed research literature from the leading scholars and faculty in this growing field, providing a historical and political context for the study of health, race, and ethnicity, with key findings on disparities in access, use, and quality. This volume also examines the role of health care providers in health disparities and discusses the issue of matching patients and doctors by race.

New chapters cover: reflections on demographic changes in the US based on the current census; metrics and nomenclature for disparities; theories of genetic basis for disparities; the built environment; residential segregation; environmental health; occupational health; health disparities in integrated communities; Latino health; Asian populations; stress and health; physician/patient relationships; hospital treatment of minorities; the slavery hypertension hypothesis; geographic disparities; and intervention design.

CHAPTER 1
DEFINING HEALTH AND HEALTH CARE DISPARITIES AND EXAMINING DISPARITIES ACROSS THE LIFE SPAN

Lydia A. Isaac

For an enlarged, clearer view of the tables and figures in this chapter, please visit www.wiley.com/go/laveist_tables_and_figures.

These images are best viewed from a personal computer.

Undertaking the study of race, ethnicity, and health necessitates an understanding of the major terms used to describe and explain the relationship among these phenomena. In the United States the term most often used is racial and ethnic health disparities. Yet there is no clear definition of this term nor is there uniformity on how to measure these disparities. Moreover, this term is used almost exclusively in the United States. Globally, the terms health inequalities and health inequities are more common. The goal of this chapter is to explore the different terms and definitions used to denote the concept of racial and ethnic disparities in health and to provide a brief overview of the health disparities experienced by racial and ethnic minorities in the United States.

History of Health Disparities

The concept that racial and ethnic minorities and the white majority have different health experiences has been well established (McKeown, Record, & Turner, 1975). Disparities experienced by African Americans received significant national attention in 1985 when the U.S. Department of Health and Human Services released the Report of the Secretary’s Task Force on Black and Minority Health, also known as the Malone-Heckler report, which substantively documented racial and ethnic health disparities (Byrd & Clayton, 2000). The importance of this landmark report was its capacity to marshal substantive data to describe the stark and growing gulf in health status between African Americans and whites. Compiling a similar report for other groups was not possible at the time due to limits in methodology and data collection and the lack of data on other racial and ethnic minorities. Nonetheless, given the historical significance of the African American experience in the United States, most notably the group’s history of systematic exploitation and socioeconomic underdevelopment, exploring the health status of this particular group provides an appropriate lens for examining the concept of racial and ethnic disparities in health.

Even with the evidence of the Malone-Heckler report the popular use of the term health disparities did not appear until the 1990s. Although the exact origins of the term are not known, Adler and Rehkopf (2008) have pointed out, in their search of the peer-reviewed literature, that the term health disparities appears only once in the 1980s, thirty times in the 1990s, and in four hundred articles from 2000 to 2004. Clearly the importance and use of the term have steadily increased in recent years—even as the meaning of health disparities has remained poorly defined.

Health Disparity Versus Health Inequality Versus Health Inequity

Complicating the meaning of health disparity are the multiple and interchangeable usages of several similar terms. The term health disparity, as noted, is used mostly in the United States; the corresponding term health inequality is mainly used in Europe. Some scholars argue that neither term is appropriate, and some maintain that health inequity or other variations of these terms are preferable. There is no national consensus, and even within the literature there is no clear, standard definition for any of these terms. Table 1.1 summarizes the definitions of health disparities, health inequalities, and health equity used by government entities and agencies and academic researchers. Table 1.2 exhibits definitions of health care disparities and health care equity.

Table 1.1. Definitions of Health Disparities, Health Inequalities, and Health Equity

Source: Adapted from Braveman, 2006; Carter-Pokras & Baquet, 2002.

Agency or Other Author	Definition
Health disparities
The Secretary’s Task Force on Black and Minority Health, 1985 (U.S. Department of Health and Human Services,1985)	“. . . the statistical technique of ‘excess deaths’; that is, the difference between the number of deaths observed in minority populations and the number of deaths which would have been expected if the minority population had the same age and sex-specific death rate as the nonminority population.”
Minority Health and Health Disparities Research and Education Act	“A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.”
Centers for Disease Control and Prevention (2000)	Health disparities as discussed in Healthy People 2010 include “differences . . . by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.”
National Institutes of Health, 1999 (2007)	“Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”
National Institutes of Health, 2003 (2007)	“Health Disparities Research (HD) includes basic, clinical and social sciences studies that focus on identifying, understanding, preventing, diagnosing, and treating health conditions such as diseases, disorders, and other conditions that are unique to, more serious, or more prevalent in subpopulations in socioeconomically disadvantaged (i.e., low education level, live in poverty) and medically underserved, rural, and urban communities.”
National Cancer Institute (2008)	Defined “as adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States. These population groups may be characterized by age, disability, education, ethnicity, gender, geographic location, income, or race. People who are poor, lack health insurance, and are medically underserved (have limited or no access to effective health care)—regardless of ethnic and racial background—often bear a greater burden of disease than the general population.”
Centers for Disease Control and Prevention (2011)	A “particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
U.S. Department of Health and Human Services, Office of Minority Health, National Partnership for Action (2011)	“A particular type of health difference that is closely linked with social or economic disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social and/or economic obstacles to health and/or a clean environment based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation; geographic location; or other characteristics historically linked to discrimination or exclusion.”
Flaskerud (2002)	The “gap between the health of socio-economically advantaged and disadvantaged populations.”
Adelson (2005)	The “indicators of a relative disproportionate burden of disease on a particular population.”
Fink (2009)	The “difference in a measurement of a health variable between an individual or a group with specific defining characteristics disproportionate to a defined measure for another individual or group when other variables have been controlled (genetics, sociocultural beliefs and values, personal choice, and other variation from the normative measure).”
Health inequalities
Whitehead (1991)	“Health inequalities are differences i...