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1 Introduction--Barney Cohen
Pages 1-22

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From page 1...
... . But throughout the second half of the century, advances in medicine-particularly in relation to the treatment of heart disease and stroke -- along with healthier lifestyles, improvements in access to health care, and better general overall health before reaching age 65 combined to result in continued improvements in life expectancy (Fried, 2000)
From page 2...
... , a surprise to many given their far lower average socioeconomic position and their generally poor level of health care coverage. Furthermore, the available data from death certificates suggest that, if taken at face value, both the American Indian and Alaskan Native populations and the Asian and Pacific Islander populations enjoy relatively lower age-adjusted death rates than non-Hispanic whites.
From page 3...
... A further reason for concern over racial and ethnic differences in health is that as a nation, the United States is becoming increasingly diverse. Currently, Hispanics, non-Hispanic blacks, Asians, and American Indians constitute 27 percent of the population, with blacks being the largest ethnic minority group.
From page 4...
... Inevitably, the empirical basis for certain conclusions is stronger than for others. For example, while enough large high-quality longitudinal data sets are now available to be able to link socioeconomic resources confidently to observed racial and ethnic differences in health, few data have been collected on the cumulative effects over time of perceived racism on health (Chapter 9, this volume, Chapter 13, this volume)
From page 5...
... also find that excess black mortality, relative to whites, is concentrated among the younger elderly population, with negligible differences beyond age 80. The authors show that education and income differences across groups continue to play an important role, explaining the overall worse health of non-Hispanic blacks, Native Americans, and, to a lesser degree, Hispanics in old age.
From page 6...
... The authors argue that because no research has been able to convincingly overcome the overwhelming influence of cultural and educational experience on cognitive test performance, the true extent of cross-cultural differences in cognitive impairment, dementia, or Alzheimer's remains an open question. Not surprisingly, therefore, researchers are still a long way from understanding how, controlling for education, observed differences can be explained by biological risk factors such as cerebrovascular disease, differential exposure to environmental risk factors,
From page 7...
... Hertzman sets out various mechanisms through which early experiences can affect adult health status, distinguishing among latency, pathway, and cumulative effects. Hertzman's chapter implies an urgent need for much better data in order to understand how various life-course factors (e.g., socioeconomic position over the life cycle, family history, migration history, work history, cumulative stress, child and early adult health experience)
From page 8...
... With immigration a driving force in accounting for the future growth of the American population, scholarly and policy-related interest in immigration and health, and how the two are related, is perhaps greater today than ever before. A recurrent finding in the immigrant health literature is that Mexican and non-Mexican Hispanics experience better health, lower adult mortality rates, and lower infant mortality than African Americans and non-Hispanic whites and that the health of immigrants appears to deteriorate with duration of stay in the United States (Chapter 6, this volume)
From page 9...
... Group differences in health are the product of both biology and individual choice, the former modified in some cases by environmentally sensitive gene expression and the latter strongly influenced by economic, social, and cultural conditions. While the volume itself aspires to be comprehensive in its coverage of the major health risks, individual papers introduce concepts and insights from quite different disciplines, not all of which have been fully integrated.
From page 10...
... But, given that most of the major diseases differing in frequency among the standard racial classifications appear to be diseases of complex etiology, involving a complex genetic basis and a strong environmental component influencing how this inherited susceptibility is expressed, and given that the environmental milieu of different racial and ethnic groups is quite different in many important respects, the challenge of disentangling the role of genetic factors from other possible explanatory variables appears hard to overstate (Neel, 1997)
From page 11...
... . Controlling for socioeconomic status eliminates a significant proportion -- but not all -- of the observed racial differences in chronic health between blacks and non-Hispanic whites, but not between Hispanics and non-Hispanic whites (Hayward et al., 2000)
From page 12...
... Multilevel studies consistently show that poor neighborhoods with concentrated poverty are associated with significantly elevated risks of poor health and overall mortality, even after
From page 13...
... Behavioral Risk Factors An enormous amount of research over the past 20 years or so has confirmed the link between certain diseases and health outcomes and various health-damaging and health-promoting behaviors. Smoking, for example, is now known to be a major risk factor for several forms of cancer, chronic bronchitis, emphysema, and cardiovascular disease, while alcoholism is an important risk factor for numerous health outcomes, including cirrhosis of the liver and pancreatitis (U.S.
From page 14...
... Stress is a known risk factor for hypertension, and the significantly higher prevalence of hypertension in blacks has led some researchers to theorize that there may be an important link between a negative psychological environment, cumulative stress, and hypertension and some of the observed racial differences in health. Important new attempts to understand the relationship between environmental and behavioral challenges and stressors, health, and disease have introduced the concepts of allostasis and allostatic load (see Chapter 13, this volume)
From page 15...
... . In addition, there is always the possibility that the causality runs in the other direction, namely that poor health status leads to higher perceived stress (Kington and Nickens, 2001)
From page 16...
... . Hispanics in particular are relatively underserved with respect to health coverage, partly because of their relatively low socioeconomic status and partly due to other contributing factors related to their degree of acculturation, language barriers, immigration status, and types of jobs in which they are engaged (Suárez, 2000)
From page 17...
... Chandra and Skinner demonstrate that regional variation in the utilization of health care, and in outcomes, potentially can account for a substantial part of the observed racial and ethnic disparities in health. This implies a different set of policy prescriptions than if the underlying source of racial differences in health were primarily due to differences in treatment within hospitals or communities or differences in the self-management of disease (Goldman and Smith, 2002; Institute of Medicine, 2003)
From page 18...
... Although both papers document slightly different patterns of racial and ethnic disparities in health than occur in the United States, they both suggest the centrality of particular casual factors including socioeconomic status, culture, racism, and, for immigrants, generation (i.e., first versus second or third) and period of migration (i.e., length of stay in country)
From page 19...
... Even if there is no way to weigh their relative importance, there is fairly broad agreement among the disciplines that the list of major causes is fairly self-contained: socioeconomic status, education, health risk behavior, psychosocial factors including stress, access to and quality of health care, culture, genetic factors, and environmental and occupational risk factors (Kington and Nickens, 2001)
From page 20...
... . The 1990 census count of American Indians: What do the numbers really mean?
From page 21...
... . Contri bution of job control and other risk factors to social variations in coronary heart disease incidence.
From page 22...
... , Chang ing numbers, changing needs: American Indian demography and public health (pp.


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