Race and health research is mostly from the United States. It has found both current and historical racial differences in the frequency, treatments, and availability of treatments for several diseases. This can add up to significant group differences in variables such as life expectancy. Many explanations for such differences have been argued, including socioeconomic factors (e.g., education, employment, and income), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination) as well as to treatment (through lack of insurance, lack of hospitals in certain areas, etc.), among other environmental differences. Some diseases may also be influenced by genes which differ in frequency between groups, such as sickle-cell anemia, which occurs overwhelmingly among some black populations, although the significance in clinical medicine of race categories as a proxy for exact genotypes of individuals has been questioned.
Background
Race and racism
There is considerable debate about the usefulness of racial categories in studies of health. Likewise, the effects of racism on social mobility, segregation and psychological well-being being of ethnic minorities is an emerging topic of study in health research. David Williams writes that because race is, in his view, an unscientific, societally constructed taxonomy, racial or ethnic variations in health status result primarily from variations among races in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors and resources. Although race has only limited biological significance, the concept of race is socially meaningful in the study of health. Trevor A. Sheldon and Hilda Parker write that thought and care is needed before data are routinely categorized by race or before race is included as a variable in medical research. They write that the tendency to collect routine ethnic data and include ethnic variables in an ad hoc and uncritical way in the United Kingdom and other countries may help transform minorities into mere statistical categories and produce data and findings which reinforce stereotypes. David Williams writes that terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors. A. H. Goodman writes that using race as a proxy for genetic differences limits understandings of the complex interactions among political-economic processes, lived experiences, and human biologies. Thomas A. LaVeist writes that while no credible scientist believes that race has any biological or genetic basis, it does have profound social meaning, rooted in history but with contemporary consequences. Racial status is a risk marker for exposure to racism, which may be a primary etiological factor in race differences in morbidity and mortality.
In biomedical research conducted in the U.S., the 2000 US census definition of race is often applied. This grouping recognizes five races : black or African American, White (European American), Asian, native Hawaiian or other Pacific Islander, and American Indian or Alaska native. However, this definition is inconsistently applied across the range of studies that address race as a medical factor, making assessment of the utility of racial categorization in medicine more difficult.
From the perspective of genetics, human population structure is the result of patterns of mating. Francis Collins writes that increasing scientific evidence indicates that genetic variation can be used to make a reasonably accurate prediction of geographic origins of an individual, at least if that individual's grandparents all came from the same part of the world. Migration between countries in the last two centuries, with consequent racial admixture has caused some to question the significance of this notion of race to medicine.
In multiracial societies such as the United States, racial groups differ greatly in regard to social and cultural correlates such as economic status and access to healthcare. These factors are believed to explain most if not all of the differential health care outcomes among races. An open area of investigation is whether genetic differences still show evidence of presences after social and cultural correlates are taken into account.
Health
Health is measured through variable such as life expectancy, and incidence of diseases. The undeniable existence of health disparities indicate that there is a correlation between self-identified race or ethnicity and health or disease in some cases. But the relationship among these factors is complex and poorly understood. Some researchers suggest that to unravel the real causes of health disparities, research must move beyond weakly correlated variables, such as self-identified race or ethnicity, towards an understanding of the more proximate environmental and genetic factors.
Health disparities
Main article: Health disparitiesHealth disparities refer to gaps in the quality of health and health care across racial and ethnic groups. The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care."
In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to European Americans, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Among the disease-specific examples of racial and ethnic disparities in the United States is the cancer incidence rate among African Americans, which is 10 % higher than among European Americans. In addition, adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.
In the United States
See also: Health care in the United StatesThe twentieth century witnessed a great expansion of the upper bounds of the human life span. At the beginning of the century, average life expectancy in the United States was 47 years. By century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although longevity in the U.S. population has increased substantially, race disparities in longevity have been persistent. African American life expectancy at birth is persistently five to seven years lower than European Americans. Crime plays a significant role in this racial gap in life expectancy. A report from the U.S. Department of Justice states "In 2005, homicide victimization rates for blacks were 6 times higher than the rates for whites" and "94% of black victims were killed by blacks."
Princeton Survey Research Associates found that in 1999 most whites were unaware that race and ethnicity may affect the quality and ease of access to health care. U.S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos (Vega and Amaro 1994). Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U.S. population (Mahoney and Michalek 1998). European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics (Hummer et al. 2004). In the United States, African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death (Hummer et al. 2004).
The vast majority of studies focus on the black-white contrast, but a rapidly growing literature describes variations in health status among America's increasingly diverse racial populations. Where people live, combined with race and income, play a huge role in whether they may die young. A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education. A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. Still, sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years) The differences were reduced when the data were controlled for education.
History
Disparities in health and life span among blacks and whites in the US have existed since the period of slavery. David R. Williams and Chiquita Collins write that, although racial taxonomies are socially constructed and arbitrary, race is still one of the major bases of division in American life. Throughout US history racial disparities in health have been pervasive. Clayton and Byrd write that there have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865-1872) was linked to Freedmen's Bureau legislation and the second (1965-1975) was a part of the Black Civil Rights Movement. Both had dramatic and positive effects on black health status and outcome, but were discontinued. Although African-American health status an
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