status are associated with socioeconomic status. For example, at age 45, individuals with family incomes above $25,000 can expect to live from 3 to 7 years longer than those with family incomes below $10,000 (National Center for Health Statistics, 1998b). Also, the death rate from chronic disease for individuals ages 23 to 64 with less than 12 years of education is more than twice as high as that for comparable individuals with more than 12 years of education (National Center for Health Statistics, 1998b). Nonelderly adults living in poverty-stricken areas experience a significantly higher risk of mortality from all causes (Waitzman and Smith, 1998).

Although the health status of all U.S. racial and ethnic groups has improved steadily, disparities in major health indicators between white and non-white groups are growing. In general, African Americans, American Indians, and Hispanics are dramatically disadvantaged relative to whites in terms of most health indices, whereas Asian Americans appear to be as healthy, if not healthier, than whites in terms of some indices. These overall group differences, however, mask important differences in the health statuses of subgroups. Americans of Southeast Asian descent, for example, suffer from among the highest rates of cervical and stomach cancers of all U.S. population groups and experience poorer health overall than U.S. whites (Miller et al., 1996).

Socioeconomic status appears to operate in complex ways with race and ethnicity to account for the observed differences in health status. In general, white Americans enjoy higher incomes and education attainment levels than any other U.S. racial and ethnic group and therefore are more likely to have health insurance and to be better educated with regard to healthy behaviors and diets, are more likely to seek routine medical care, and are more likely to have better access to preventive medical services.

Socioeconomic factors, however, do not completely account for racial and ethnic differences in health status (Williams et al., 1994). Several studies indicate that racial disparities in health status persist even when controlling for socioeconomic status (Advisory Board to the President's Initiative on Race, 1998). Mounting evidence indicates that in addition to resource inequities, other factors, including discrimination in the health care system, racism-related stresses, migration, and differences in levels of acculturation may also lead to poor health among members of racial minority groups (Council of Economic Advisors, 1998; Advisory Board to the President's Initiative on Race, 1998; Williams et al., 1994). As discussed later in this report, disparities in exposure to environmental hazards are also suspected as a factor in the relatively poorer health of individuals in minority and lower-income communities in the United States.

The following examples show that significant disparities exist between U.S. racial and ethnic groups in terms of several key health indicators, even when socioeconomic differences are taken into account.



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