Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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2 The Importance of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation in Understanding Disparities in Health and Health Care
2 The Importance of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation in Understanding Disparities in Health and Health Care
Pages 21-40
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From page 21... ...
Throughout the report, we use the term SEP (instead of the widely used alternative term socioeconomic status, or SES) to encompass a broad set of socioeconomic characteristics including income, wealth, and education.
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From page 22... ...
In this section, we highlight a few examples of disparity problems.1 Table 2-1 shows infant mortality rates by racial and Hispanic origin of the infant's mother from 1983-2000. In the most recent period shown, 1998-2000, non-Hispanic black infants had the highest infant mortality rates by far, with nearly 14 deaths per thousand live births.
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23 7.0 5.8 9.0 5.1 3.5 3.8 5.9 8.7 5.2 5.7 5.5 8.1 4.3 4.9 6.9 5.9 1998-2000 13.8 13.9 1995-1997 7.4 6.1 9.2 5.1 3.3 4.9 5.7 7.0 5.4 6.1 5.9 8.5 5.3 5.3 7.1 6.1 14.1 14.2 9.0 7.4 6.6 5.1 5.3 6.4 9.0 7.0 7.5 7.2 6.2 6.6 8.2 7.3 1989-1991 17.1 12.6 10.4 17.2 Births Live 1,000 9.8 8.2 7.3 5.8 6.9 6.9 7.6 8.3 7.9 7.3 7.5 9.0 8.1 1986-1988 17.9 13.2 11.1 11.1 17.9 per Origin Deaths Hispanic 9.0 8.3 7.4 6.0 8.2 8.6 9.2 8.8 8.0 8.2 9.8 8.8 Infant 1983-1985 10.6 18.7 13.9 11.3 12.3 18.5 and Race (2003)
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From page 24... ...
For example, Table 2-2, shows differences in the rates at which black and white Medicare enrollees receive selected services and shows that black Medicare enrollees are less likely to receive preventive care. Blacks in general are less likely than whites to visit a physician's office, to see an ophthalmologist, and to have a sigmoidoscopy or colonoscopy.
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. This study also found that women in higher poverty areas were less likely to be diagnosed for breast cancer than women in low poverty areas, but had higher mortality rates from breast cancer.
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For example, in a longitudinal study of British civil servants, those who held professional or executive positions had the lowest mortality rate for coronary heart disease, neoplasms, and nonneoplasms compared with clerical and other occupations (van Rossum et al., 2000)
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Table 2-2 shows that these racial differences may be partially explained by differences in income and in education, at least for women over the age of 65. The ratio of the percentage of black women to the percentage of white women receiving mammograms was 0.92 in 1998.
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From page 28... ...
. The patterns of low access to health care utilization and low use of preventive health services by less acculturated individuals cut across racial groups including many Asian subgroups such as Vietnamese, Chinese, Korean, and Japanese (Yi, 1995; Yeh, 2003)
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From page 29... ...
is housing REACH 2010, a two-phased, 5-year departmental program demonstration project to support community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities. The National Institutes of Health have a Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities.
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From page 30... ...
Using this definition, if members of a group less often receive coronary artery bypass graft because their health status more frequently contraindicates major surgery, this would reflect a health disparity, but not a health care disparity. Similarly, if members of one group more often refuse surgery for a condition while members of another group choose to have the surgery, there is no disparity in health care access.6 However, according to this definition, a disparity would exist if two patients had all the same medical conditions and would have chosen the same treatment if they were offered the same options, but one patient was not given the treatment while the other was.
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From page 31... ...
Although disparities in health and in health care are usually discussed together in this report, the panel recognizes that these two types of disparities, while both important, are not equivalent, nor are the data sources required for understanding the two always the same. For example, disparities in health care are routinely studied by examining data from the health care system, while studies of disparities in health also require information on individuals who do not participate in the health care system.
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From page 32... ...
. The "social constructivist" point of view argues that even though race does not have a meaningful biological definition, it is still an important social and political marker because it reflects, however imperfectly, categories that play important roles in the distribution of power and wealth, discrimination, cultural and personal identity, and group solidarity (American Sociological Association, 2003; Harris, 2002)
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From page 33... ...
. The recently released report of a National Academies panel charged with defining racial discrimination and assessing methodologies to measure it concluded that because race is a salient aspect of social, political, and economic life in the United States, it is necessary to collect data on race and ethnicity to monitor and understand differences among population groups (NRC, 2004)
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Education also relates to income and wealth, as those with higher education levels tend to have higher incomes and wealth. Thus education is also indirectly related to the ability to afford health insurance and to afford higher quality health care.
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.9 Acculturation and Language Use Acculturation is characterized as the dynamic bidirectional process whereby a person or group raised in another culture, typically immigrants, 9The Office of Management and Budget's recent revision of the racial and ethnic categories that calls for a new separate category for Native Hawaiians and other Pacific Islanders will provide for better tracking of the health of the Asian subgroup in the future.
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From page 36... ...
For example, less acculturation (more ethnic distinctness) , as indicated by measures of nativity and measures of language proficiency, has been shown to confer a protective effect due to healthier lifestyles that are associated with greater family and social support and other forms of protective cultural practices.
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From page 37... ...
Discussing medical issues requires a rather advanced level of language proficiency that many nonnative speakers do not have, and the resulting lack of understanding can affect health and health care outcomes. For example, Vietnamese women who are fluent in English are more likely to have a routine place for health care and a regular provider than Vietnamese women who do not speak English (Yi, 1995)
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In 1963 white males in the 6-11 year age range were overweight at higher rates than black males, but in the next 30 years the rate grew faster among blacks, who now have slightly higher rates of overweight status. White and black females initially were equally likely to be overweight, but the rate for black females has increased much more dramatically than for white females, such that in 1994, 17 percent of black females were overweight compared with 10 percent of white females.
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From page 39... ...
Since disparities in health and health care among racial, ethnic, language, and SEP subgroups have been identified, several agencies and governments responsible for ensuring the functioning of health care and public health systems have begun efforts to address identified disparities. The Healthy People 2010 initiative and the Health Disparities Report Card cited previously in this chapter are examples of two disparity-monitoring efforts by the federal government.
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From page 40... ...
40 ELIMINATING HEALTH DISPARITIES ing social variables such as race, ethnicity, SEP, language use, and acculturation and the extent to which these contribute separately and interactively to differences in health and health care is key to that understanding. In the next chapter, we discuss the measurement of these concepts of race, ethnicity, SEP, and language use and acculturation.
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