At the beginning of the 20th century, health statistics classified the U.S. population into two groups: the white population and everyone else, who were simply non-white. By about the middle of the century, African Americans were recognized as a specific group. During the civil rights movement, however, there was not consensus, even among African Americans, about the use of racial designations. Some felt that racial designations would be used to support racism, but others thought that the use of racial designations was useful for purposes of health planning and assessing the improvement of health status. At this time, the cancer mortality rate among African Americans was just beginning to exceed that among whites. Classification schemes were totally based on race, and Hispanics were not identified. There was a further problem of classification when Hispanics were identified, because they did not fit the usual racial designations. As a result it was necessary to further identify Hispanic whites and non-Hispanic whites. The classification then became racial and ethnic. All other ethnic groups were included in the "Other" category.
With the increasing diversity of the U.S. population, it has become clear that racial designations are inadequate, confusing, and misleading. At the same time there is increasing demand to recognize the identities of the various ethnic groups included in the U.S. population. Until recently there was no routine reporting on cancer among ethnic minorities other than African Americans. This was corrected by the Surveillance, Epidemiology, and End Result (SEER) program monograph entitled Racial/Ethnic Patterns of Cancer in the United States 1988–1992 (Miller et al., 1996). That report, however, does not include data on the medically underserved population, and the source documents from which reports such as that of Miller et al., (1996) are prepared do not provide such information. The problem, then, is to find a method of reporting on cancer information that routinely includes data on ethnic minority and medically underserved populations without at the same time producing an excessive amount of data.
Health statistics are usually described as rates that are calculated from a numerator (numbers of people affected) and a denominator (the numbers of people in the population at large). The denominator is discussed first. In classifying the population, the committee has taken into account the fact that the census and all government agencies must conform to U.S. Office of Management and Budget (OMB) Directive No. 15 (U.S. Office of Management and Budget, 1977) and subsequent revisions. That classification reflects the old notions of four races. An important change would