Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
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Section II--Two Key Conceptual and Methodological Challenges5 The Life-Course Contribution to Ethnic Disparities in Health
Section II--Two Key Conceptual and Methodological Challenges5 The Life-Course Contribution to Ethnic Disparities in Health
Pages 143-170
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Section II Two Key Conceptual and Methodological Challenges
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. · Observation 2: Birthweight differences In a recent study of birthweights among U.S.-born blacks, African-born blacks, and U.S.-born whites in Illinois (1980-1995)
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As shown in Figures 5-1 and 5-2, the regions with the "best" Aboriginal health status are close to, or overlap with, the Upper Island/Central Coast 18.5 Central Van Island 17 Richmond 16.4 Vancouver 14.6 Capital 12.8 Fraser Valley 11.6 Provincial total 4.9 East and West Kootenay 10.5 North Interior 10.2 Burnaby 9.6 North West 8.7 Cariboo 8.7 Coast Garibaldi 8 South Okanagan Similkameen 7.6 Simon Fraser 7.3 Peace Liard 6.7 North Okanagan 6.6 South Fraser Valley 5.3 Thompson 4.9 0 5 10 15 20 Rate per 1,000 Live Births FIGURE 5-1 Infant mortality by health region for status: Indians, British Columbia, 1991-1999. SOURCE: British Columbia Vital Statistics Agency (2001)
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. This chapter contends that these observations, although diverse, form a consistent pattern that is comprehensible from a population health perspective and that can help to explain ethnic disparities in health status.
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According to this hypothesis, ethnic differences in health status emerge from the same sort of nature-nurture interactions that produce socioeconomic differences in health status across the life-course. To produce systematic differences in health status, ethnic differences must be associated with systematically different developmental experiences, and systematically dif
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The degree of local control of the civic environment in Aboriginal communities is a measure of their liberation from external domination by white society. Figure 5-3 shows that the "degree of liberation" has a doseresponse relationship to a key outcome of "healthy child development": teenage suicide.
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. Differential experiences are closely associated with systematic differences in the function of at least three important physiological control systems: the HPA axis (the hypothalamicpituitary-adrenal system, which controls cortisol secretion)
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. The hypothesis here is that early life experience profoundly shapes the ways these axes develop; that these body-regulatory and defense systems, in turn, experience the environment and respond to it in radically different ways in different individuals according to the differences in their early experiences; that these responses influence the lifelong health of the individual; and finally, that systematic differences in these responses across population groups in a society (whether defined by socioeconomic status, ethnicity, or geography)
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Having a down-regulated HPA axis is associated with better decision-making functions, quicker task learning, and a slower rate of loss of learning and memory functions. Thus, the frequently suckled baby rats acquire a lifelong advantage as a result of a systematic difference in early nurturant experience (Francis et al., 1999)
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. Pathways Finally, "pathways" refer to the ways in which individuals get onto well-worn life-course trajectories that carry with them a set of "health Men Women 25 25 20 20 Health Health 15 15 Poor Poor in in 10 10 5 5 Percentage Percentage 0 0 2 4 6 8 10 12 14 16 18 2 4 6 8 10 12 14 16 18 Lifetime Socioeconomic Status Score Lifetime Socioeconomic Status Score FIGURE 5-4 Poor health includes subjects who rated their health as fair at age 33 and cumulative socioeconomic circumstances (birth to age 33)
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4. Adult socioeconomic circumstances, also closely associated with educational attainment, have an impact on health in adult life (Drever and Whitehead, 1997; Evans, Barer, and Marmor, 1994; Kunst, Geurts, and van
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The example illustrated in Figure 5-5 uses this model, in a somewhat reduced form, to display findings from the 1958 British Birth Cohort study. In particular, it shows how experiences during the first 16 years of life Social network OR=n.s.
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The odds ratio of 5.03 suggests that those who have relatively rapid early growth, who were read to consistently, and who adjusted easily into school were one-fifth as likely to be in a state of fair or poor health by age 33 as those who grew slowly, were not read to consistently, and had trouble adjusting to school. The statistically independent cumulative and pathway effects were: cumulative socioeconomic status at age 0, 7, 11, and 16; socioemotional adjustment to school at ages 11 and 16; and end-of-school qualifications.
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. Similarity of the Determinants of Healthy Aging and Healthy Child Development Socioeconomic status, social integration, social support (Seeman and Crimmins, 2001)
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The leading hypothesis would be that adverse early experiences would lead, through biological embedding, to a high-risk allostatic load in mid-life and late life. OPPORTUNITIES FOR ETHNICITY TO AFFECT DEVELOPMENTAL TRAJECTORIES Latency and Ethnicity In theory, there are three ways that ethnic differences could translate into latent effects on health across the life-course.
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Second, there is the potential for ethnic differences in parenting style to make a difference in early cognitive and social development. It is well known, and reasonably well documented, that different ethnic groups tend to have different bonding and attachment styles with their newborns; different values and beliefs regarding when and how to talk with young children and read to them; and parenting styles that can vary from the interactive to the apathetic to the authoritarian.
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Insofar as these perceptions have been prejudicial to visible minorities, limiting their trajectories of income, education, and/or occupation, they can be taken to be relevant determinants of ethnic differences in health status, because adult socioeconomic status carries powerful health expectations with it. The second large factor is readiness for school.
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It should be reemphasized here that early life conditions affect social mobility through cognitive, social-emotional-behavioral, and physical readiness for school according to the pathway model. To the extent that ethnic differences in school readiness exist, and are related to early life experiences, there will be a social mobility effect (or, for that matter, a social immobility effect)
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As of this writing, a key issue in Canada is the role of Western diet in the epidemic of diabetes mellitus among the Aboriginal population. Traditional Aboriginal diets were largely absent of unrefined carbohydrates, so the leading hypothesis is that the increasing penetration of Western diet has created an invidious interaction between diet and genetically determined metabolic processes in Aboriginals that are easily overwhelmed by large carbohydrate loads.
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Moreover, the first two observations, protective early life factors and birthweight differences, given in this chapter could be accounted for by the fact that Caribbean and African blacks in the United States are voluntary migrants, whereas American-born blacks are either nonmigrants or, if ones' historical memory is long enough, forced migrants. As a "non-life-course" hypothesis, differential migration has the potential to conceal important information by avoiding the question of how migrants differ from the rest of the population and how these differences evolve over time.
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Although such genes may exist, and may be distributed in a nonrandom fashion among different ethnic groups, it is worth noting that during the 20th century the average life expectancy of the citizens of the world's 25 wealthiest countries rose by 30 years, irrespective of ethnic differences and without recourse to genetic change. There is no evidence that genetic mono-causation has played a significant role in explaining the differences in health status among different ethnic groups that exist today, and it is likely that the role of genetic mono-causation will remain marginal in the future.
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to study socioeconomic and neighborhood effects on child development. This data source, in particular, has been used to show how contextual factors have affected differential development among American black and white children.
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cooperation like that developed for the recent income inequality and mortality studies were established, it would be possible to subject this to rigorous empirical test, working backward to try to understand any systematic differences found. A similar attempt could be made with Canadian and American Aboriginal populations.
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British Columbia Vital Statistics Agency.
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. Birthweight, body-mass index in middle age, and incident coronary heart disease.
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. Occupational class and cause specific mortality in middle aged men in 11 European countries: Comparison of population based studies.
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. Socioeconomic status and health: How education, income, and occu pation contribute to risk factors for cardiovascular disease.
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