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Currently Skimming:

1 The Nature of Racial and Ethnic Differences
Pages 7-31

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From page 7...
... In 1994 the Committee on Population of the National Research Council held a workshop on health differences in late life. The papers from that workshop, published in 1997 in a volume entitled Racial and Ethnic Differences in the Health of Older Americans (National Research Council, 1997)
From page 8...
... The panel's specific mandate was to: · organize a 2-day workshop with leading researchers from a variety of disciplines and professional orientations to answer questions about the nature and extent of racial and ethnic differences in health in old age, the social and biological mechanisms involved, what studies would advance understanding of differences, and what opportunities exist for research on special populations or research in special areas such as the biology and genetics of aging; and · provide a short report summarizing the main lessons learned and providing recommendations for further work. The panel's summary of research findings, disciplinary issues, and possibilities for future research is covered in this volume.
From page 9...
... : white, black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. An additional distinction is made between Hispanics or Latinos and all others, this being designated as an "ethnic" distinction that crosscuts the racial classification.
From page 10...
... We do not distinguish Native Hawaiians and Pacific Islanders, treating them together with Asians when the data require this or leaving them out. We treat American Indians and Alaska Natives as a single group.
From page 11...
... The Hispanic proportion will almost triple in this period, going from 5.6 to 16.4 percent, and Asians will increase almost as fast. Blacks and American Indians and Alaska Natives will show more moderate growth, but still faster growth than whites because of differential fertility in the past, delayed improvements in mortality, and population momentum (U.S.
From page 12...
... Although the natives divided themselves into numerous racial and ethnic or tribal groups, for many purposes the colonists and their governments used a dichotomous distinction between themselves and the natives -- a lumping together of the American Indian and Alaska Native populations that is still used in government statistics. The forcible importation into the American colonies of Africans as slaves gave rise to a third enduring racial or ethnic category.
From page 13...
... Though such changes in self-identification need not affect individual health, they still affect average group health, in this case reducing any health disadvantage of American Indians and Alaska Natives relative to other groups. Such selection effects are considered further below.
From page 14...
... There is a strong, but not isomorphic, relationship between tribal enrollment and residence: most American Indians/Alaska Natives living on or near reservations are enrolled tribal members, but as much as 60 percent of the enrolled population lives off-reservation, in rural, suburban, and urban areas. Relatively few individuals who selfidentify as American Indian and Alaska Native but are nonenrolled in tribal registers reside in reservations.
From page 15...
... Mortality The black disadvantage in mortality is clear. As shown in Figures 1-1 and 1-2, the official death rates for black males and females are 30-50 percent higher than those of whites at ages 65-79.
From page 16...
... In some cases, this minority advantage stands up under scrutiny; in others, it does not, or may still be questionable, as data limitations have been less studied among other minorities than among blacks. Mortality rates for Hispanics appear to be biased downward, but corrected rates are still lower than those for whites.
From page 17...
... Somewhat more reliable data come from the IHS (1999) , which covers the 60 percent of American Indians and Alaska Natives living on federal reservations or in counties near them.
From page 18...
... . Older blacks have higher death rates than older whites from the two leading causes, heart diseases and neoplasms.
From page 19...
... , but is not as large, and it rests on weaker data. American Indians and Alaska Natives on reservations, however, have higher cause-specific death rates than American Indians and Alaska Natives more generally, and they are also at a disadvantage relative to whites for influenza and pneumonia.
From page 20...
... The rankings by racial and ethnic groups on this indicator are essentially the same as for self-rated health, except that American Indians and Alaska Natives are worse than blacks for some age and gender categories. In contrast to mortality rates, black and white morbidity indicators do not cross over at the oldest ages.
From page 21...
... Some comparisons can be made, though the picture gets increasingly clouded. The 1998 National Health Interview Survey compares three groups -- whites, blacks, and Hispanics -- on selected diseases and conditions (Pleis and Coles, 2002)
From page 22...
... Blacks report substantially more frequent diagnoses of diabetes. These comparisons are consistent with other data in which blacks do
From page 23...
... . Asians are not in the data for Table 1-3, but other data show they have lower prevalence than whites for heart disease, cancer, and cardiovascular disease (Kagawa-Singer et al., 1997; Whittemore, 1989; Ziegler et al., 1993)
From page 24...
... . Besides differences in broad disease categories, racial and ethnic differences exist in specific diseases.
From page 25...
... If such partitioning can be accomplished, it should be possible to refine the research agenda to focus on the most critical areas. The health disadvantages of blacks and American Indians and Alaska Natives appear to be the most troubling.
From page 26...
... The small size of the group, however -- 150,000 American Indians and Alaska Natives are aged 65 and older -- makes national samples less practical, though it should be feasible to study representative samples of those living on or near reservations. Similar attention may be needed to establish the health status of other selected subgroups.
From page 27...
... Research on the selection of immigrants by health status may help clarify some differences involving these groups. Socioeconomic factors obviously differentiate groups and play a role in health differences, but how much of a role, and in what ways do such factors contribute?
From page 28...
... Health is needed to earn income, and to enjoy it. Income is needed to ensure health, and people with lower incomes suffer from worse health and live shorter lives.
From page 29...
... These two arguments imply that black-white health differences and American Indian and Alaska Native-white health differences may be of particular concern. This is in part because blacks and American Indians and Alaska Natives have suffered, and in some cases continue to suffer, other deprivations that make their relatively poor health.
From page 30...
... If there is no "biological" reason why poor people should be sicker than rich people or why blacks or American Indians and Alaska Natives should be sicker than whites, Hispanics, or Asians, then Americans who are poor or black or from native populations are obvious targets for health interventions. Yet it is not clear whether such targeting is the most effective way, from a medical standpoint, of improving population health.
From page 31...
... Some health innovations that are clearly a good thing might exacerbate racial health differences. Thus evaluating health policies exclusively on the basis of their impact on racial and ethnic health differences would obviously be a mistake.


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