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2 Perspectives on Racial and Ethnic Differences
Pages 32-45

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From page 32...
... The next nine chapters then focus on specific factors and summarize the current state of the evidence that they contribute to racial and ethnic differences; we offer recommendations about the needed research in each area. MAJOR FACTORS The roots of health differences, according to the summary of a 1992 national conference on behavioral and sociocultural perspectives on ethnicity and health, lie in five broad categories of factors (Anderson, 1995)
From page 33...
... also note the possibility that disease and disability may itself affect socioeconomic status. The rest of this section outlines the nine factors that are covered in Chapters 3-11.
From page 34...
... Mortality, morbidity, and disability Reported activity limitations Age-adjusted mortality rate Reported health status Life expectancy FIGURE 2-1 Factors in racial and ethnic differences in adult health. NOTES: Most factors have a longitudinal dimension, affecting (and sometimes being affected by)
From page 35...
... Possibly offsetting health risk behaviors may be positive factors: personal resources and social support may provide various ways of coping with unfavorable circumstances, such as avoiding physical or mental illness or mitigating its severity. For instance, religious involvement or a sense of personal control may contribute to psychological resilience and help avoid depression.
From page 36...
... In discussing all the factors, therefore, we do not focus narrowly on their operation in late life but more broadly on their operation over the life course, with implications for late-life differences. NATURE OF THE EVIDENCE As the study of racial and ethnic differences in health has moved away from descriptive studies towards trying to identify the underlying determinants of these differences, researchers have naturally become increasingly interested in developing models of causal processes.
From page 37...
... Furthermore, much of the empirical literature apparently relevant to understanding the determinants of racial and ethnic differences in health is not based on solid experimental data but rather it is based on associations among observable qualitative and quantitative data. Conversations on causality both within and across disciplines are not always easy (Bachrach and McNicoll, 2003; Moffitt, 2003)
From page 38...
... One may question whether any specific experimental treatment can duplicate actual experience, particularly the cumulation of experience over a lifetime, and whether the small samples typically available to experimenters can provide findings that generalize to often heterogeneous racial and ethnic groups. In addition, experimental subjects may be college students rather than older persons, making the applicability of findings to older populations uncertain.
From page 39...
... . Selection processes appear under various names in the literature, sometimes being referred to as unmeasured heterogeneity or drift and sometimes being labeled with reference to specific selection factors, as in "healthy migrant bias" (Abraido-Lanza et al., 1999)
From page 40...
... could lead to a selection effect if this choice is somehow related to one's health status. Aspects of residential location or neighborhood, it is argued (Morenoff and Lynch, 2004)
From page 41...
... In a cohort studied from birth (or preferably conception) to death, one need not treat selection effects separately but could, in principle, incorporate in the analysis the appropriate traits and the environmental factors that vary across groups.
From page 42...
... Similarly, the effect of health on socioeconomic status may be either a selection effect, if it takes place prior to the stage of life under study, or reciprocal causation, if it takes place during this stage. Implications All of these selection processes are produced by a similar mechanism in that the initial composition of a group is affected by prior health and mortality conditions.
From page 43...
... The larger the intergroup difference in the variance of unmeasured traits affecting mortality or health status, the larger will be the influence of heterogeneity. Selection effects may also wane, remain invariant, or increase over time, considerably complicating interpretations of trends in health differences (Goldman, 2001; Vaupel and Yashin, 1985)
From page 44...
... To understand immigrant selection, for instance, one needs to be able to compare movers and stayers in the origin population, possibly even comparing migrants with siblings, relatives, or in-laws. A transnational study design, though it involves logistical and financial obstacles, is therefore far more useful than a study design based only on the receiving population.
From page 45...
... Fixed traits are surely important, but they may be only a small subset of the relevant factors for health and mortality differences. Since little is known about the magnitude of errors caused by deviations from the assumption of invariance, it is difficult to evaluate whether choosing an incorrect model for selection may lead to more serious problems than ignoring it altogether.


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