Understanding Racial and Ethnic Differences in Health in Late Life A Research Agenda (2004) / Chapter Skim
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Executive Summary
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population, blacks continue to experience significantly lower life expectancy than whites. Over the last 20 years, research on these issues has largely shifted away from straightforward descriptive studies to attempts to identify the underlying determinants of the observed differences in health status by race as a step towards developing an integrated model of causal processes.
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Both academic and popular understandings of racial and ethnic identities have not been fixed and the picture of racial and ethnic differences in health has been heavily influenced by how these understandings have changed over time and how data on race and ethnicity have been collected. To date, little of the research on racial and ethnic differences in health has been directed specifically towards the elderly, despite population projections that show that the population aged 65 and over is becoming increasingly diverse.
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Models of the effects of stress on health such as allostatic load, cardiovascular reactivity, psychoneuroimmunology, metabolic syndrome, and neurovisceral integration may have different predictive value among older persons of different racial and ethnic groups. Differences in health care access and quality are well documented, and they may affect health, but how much of the racial and ethnic health differences may be accounted for by such differences in health care is unclear.
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Understanding health differences in old age therefore requires understanding influences across the life course. Although deliberate interventions can affect individual health behaviors, interventions aimed at improving population health may exacerbate racial and ethnic differences, at least initially.
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· Research Need 6: Clarify the degree to which socioeconomic status accounts for racial and ethnic differences in health outcomes over the life course. · Research Need 7: Identify the mechanisms through which socioeconomic status produces racial and ethnic health differences in health among the elderly, and identify other factors that complicate its effects.
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· Research Need 15: Determine the reasons for differences in health care quality, focusing on the contributions of geographic variation, characteristics of health care institutions, provider behavior and stereotyping, and patient adherence to recommendations for care. · Research Need 16: Place particular emphasis on panel studies that follow cohorts in order to study differences in health among racial and ethnic groups over the life course.
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