America Becoming Racial Trends and Their Consequences: Volume II (2001) / Chapter Skim
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14. Racial Variations in Adult Health Status: Patterns, Paradoxes, and Prospects
14. Racial Variations in Adult Health Status: Patterns, Paradoxes, and Prospects
Pages 371-410
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From page 371... ...
Guidelines laid out by the federal government's Office of Management and Budget (OMB) for categorizing race and ethnicity currently stipulate five racial categories White, Black, American Indian or Alaska Native, Asian, Native Hawaiian, or other Pacific Islander and one ethnic categoryHispanic (Tabulation Working Group, 1999~.
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From page 372... ...
Other than Blacks, all racial groups had death rates lower than those of Whites; Asians and other Pacific Islanders had the lowest rates. Since 1950, there has been a consistent pattern of declining rates from coronary heart disease for both Blacks and Whites.
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From page 373... ...
With the exception of Asians and other Pacific Islanders between 1990 and 1995, heart disease mortality declined for all racial groups. Table 14-1B shows the minority/White ratios for heart disease.
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From page 374... ...
In 1996, diabetes was the seventh leading cause of death in the United States, claiming 61,767 lives. Table 14-3A shows that in 1995 Blacks, Native Americans or Alaska Natives, and Hispanics had higher death rates than Whites, and the rate for Asians or Pacific Islanders was slightly lower than that of Whites.
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From page 375... ...
Asians or Pacific Islanders had rates that were markedly lower than all other groups, whereas Native Americans or Alaska Natives had rates that were markedly higher. Their rates declined between 1980 and 1990, but an upward trend was evident from 1990 to 1995.
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From page 376... ...
Table 14-5 shows that Blacks and Native Americans or Alaska Natives had higher pneumonia/ influenza death rates in 1995 than Whites, while Asian or Pacific Islander and Hispanic groups had lower rates. Between 1950 and 1980, there were TABLE 14-5 Trends in Flu and Pneumonia Mortality, 1950-1995 1950 1960 1970 1980 1985 1990 1995 A
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From page 377... ...
Data for Native Americans or Alaska Natives and Hispanics also show a general pattern of declining rates, with the Native American or Alaska Native/ White ratio in 1995 (1.15:1) smaller than it was in 1980 (1.59:1~.
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From page 378... ...
In 1996, firearms were used in 70 to 80 percent of homicides of White, Black, and Hispanic men age 25 to 44 and between 50 and 60 percent of homicides of women (National Center for Health Statistics, 1998~. Age-adjusted death rates from homicide in Table 14-7A show that in 1995, Blacks, Hispanics, and Native Americans or Alaska Natives had mortality rates considerably higher than those of Asians or Pacific Islanders and Whites.
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From page 379... ...
Table 14-8 shows that, in 1995, Native Americans or Alaska Natives had a suicide rate slightly higher than that of Whites, with Blacks, Asians or Pacific Islanders, and Hispanics having rates considerably lower. The table also shows that there was remarkable consistency in suicide rates over time for the White population, with the rate changing from 11.6 in 1950 to 11.9 in 1995.
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From page 380... ...
Asians or Pacific Islanders consistently have lower death rates than Whites. Native Americans or Alaska Natives and Hispanics generally have lower death rates than Whites for the two leading causes of death in the United States (coronary heart disease and cancer)
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From page 381... ...
First, the lower rate of suicide for Blacks compared to Whites is consistent with other mental health data and reflects a well-documented paradox in the health literature. Blacks tend to rate higher than Whites on indicators of physical health problems, and Blacks rate lower than Whites on indicators of subjective well-being, such as life satisfaction and happiness (Hughes and Thomas, 1998~; but Blacks have comparable or better rates than Whites on other indicators of mental health.
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From page 382... ...
These data should be interpreted with caution because of the relatively small sample of Hispanics (n = 737~. Large epidemiological surveys like ECA and NCS provide no data on the mental health problems of Asians or Pacific Islanders or Native Americans or Alaska Natives.
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From page 383... ...
Subgroup variations within the major racial categories tend to predict variation in sociodemographic and socioeconomic characteristics in access to and use of medical care and in health status. For example, the Native American or Alaska Native category consists of more than 250 federally recognized tribes; 209 Alaska Native villages; 65 communities that have been recognized as tribes by the states in which they are located, but not by the federal government; and several dozen other communities that have not received any formal recognition (Norton and Manson, 1996~.
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From page 384... ...
IHS data reveal that death rates for this population vary considerably from state to state, with rates being higher in states that have larger concentrations of Native Americans or Alaska Natives (IHS, 1997~. In addition, there is considerable tribal-specific variation within a given state.
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From page 385... ...
Bureau of the Census, 1993~. Overall median income and aggregate poverty level mask the tremendous heterogeneity within that population, and it is these differences that predict variations in health status.
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From page 386... ...
Distinctive cultural and geographical regions predict variations in the economic and social experience of Blacks (Green, 1978~. Health researchers have documented variations in morbidity and mortality based on region of birth (Fang et al., 1997~.
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From page 387... ...
A growing body of evidence indicates that funeral home directors and other officials who record racial status on death certificates misclassify a relatively high proportion of Native Americans or Alaska Natives, Hispanics, and Asians or Pacific Islanders as White. This has serious implications for the quality and accuracy of mortality data trends for these populations (Hahn, 1992~.
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From page 388... ...
Thus, there is more genetic variation within races than between them, and, at best, genetic and biological differences play a minor role in accounting for the observed racial disparities in health (Kaufman and Cooper, 1995~. A prominent hypothesis in the health literature is that racial differences in socioeconomic status (SES)
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From page 389... ...
Forty-four percent of the White population responding to the survey believe that most Blacks are lazy; 56 percent believe most Blacks prefer to live off welfare, and 50 percent believe most Blacks are prone to violence. Relatively small percentages of Whites were willing to endorse positive stereotypes of Blacks.
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From page 391... ...
Residential de facto segregation has been a primary mechanism by which racial inequality has been created and reinforced. Racial segregation has limited access to educational and employment opportunities, which has led to truncated socioeconomic mobility for Blacks and Native Americans or Alaska Natives (laynes and Williams, 1987; Massey and Denton, 1993~.
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From page 392... ...
Given the link between employment and health insurance, the high levels of unemployment, instability of employment, and the overrepresentation of racial minorities in jobs that do not provide adequate benefits, Blacks and Hispanics have lower levels of health insurance coverage than Whites. National data reveal that Blacks and Hispanics are disadvantaged compared to Whites on indicators of both access to ambulatory medical care and the quality of care received (Blendon et al., 1989; Council on Ethical and Judicial Affairs,
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From page 393... ...
Similarly, a national study using randomly selected hospitals found that among patients with pneumonia, non-Whites (mainly Blacks) compared to Whites, received fewer hospital services than expected on the basis of their health status and had longer than expected hospital lengths of stay (Yergan et al., 1987~.
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From page 394... ...
4. Bilateral orchiectomy, removal of both testes, often reflective of delayed diagnosis or initial treatment in the case of prostate cancer, was 2.2 times more likely to be performed on Black men than on White men.
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From page 395... ...
(1999) followed for three months a random sample of 4,905 patients undergoing angiography to determine racial differences in the receipt of coronary artery bypass graft (CABG)
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From page 396... ...
Two studies of Hispanic females note that self-reported experiences of discrimination are positively related to psychological distress (Amaro et al., 1987; Salgado de Snyder, 1987~. Epidemiologic studies indicate that, at least under some conditions, racial discrimination is positively related to blood pressure among Blacks (Krieger, 1990; Krieger and Sidney, 1996~.
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From page 397... ...
For example, cigarette smoking and alcohol use were risk factors in five of the six causes of death responsible for the 60,000 annual excess deaths in the Black population compared to the White population (U.S. Department of Health and Human Services, 1985~.
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From page 398... ...
Future research must give greater attention to comprehensively assessing racial minority status and including identifiers for ethnic variation within each of the five OMB categories. The availability of adequate data for Native Americans or Alaska Natives, Hispanics, and Asians or Pacific Islanders is still a major problem.
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From page 399... ...
FUTURE TRENDS A number of factors are likely to affect future patterns in the health status of racial minority populations in the United States. One likely trend is that increasing length of stay and greater acculturation of Hispanic and Asian or Pacific Islander populations will lead to worsening health for them (Hernandez and Charney, 1998~.
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From page 400... ...
Health status is affected not only by current SES but by exposure to economic deprivation over one's life course. Several studies reveal that early-life economic and health conditions have long-term adverse consequences for adult health (see, e.g., Elo and Preston, 1992~.
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From page 401... ...
indicated that, although Whites tend to view all minority populations more negatively than they view other Whites, Blacks tended to be viewed more negatively than other minority groups. A key characteristic of racial prejudice has been an explicit desire to maintain social distance from defined outgroups; and with 25 to 44 percent of Hispanics and 25 to 50 percent of Asian or Pacific Islander subgroups marrying persons of other races (primarily White)
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From page 402... ...
First, some evidence suggests that because of the economic links tying various communities together, health problems that initially are more prevalent in minority communities eventually spread to other areas and populations (Wallace and Wallace, 1997~. If unaddressed, the health problems of minority populations will eventually become the health problems of the larger society.
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From page 403... ...
Gibbons 1989 Relationship of racial stressors to blood pressure responses and anger expression in Black college students. Health Psychology 8:541-556.
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From page 404... ...
Kimball 1994 Correctness of racial coding of American Indians and Alaska Natives on the Washington State death certificate. American Journal of Preventive Medicine 10:290294.
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From page 405... ...
James, S 1993 Racial and ethnic differences in infant mortality and low birth weight: A psychosocial critique.
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From page 406... ...
Sidney 1996 Racial discrimination and blood pressure: The CARDIA study of young Black and White adults. American Journal of Public Health 86:1370-1378.
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From page 407... ...
Marmot, M., and S Syme 1976 Acculturation and coronary heart disease in Japanese-Americans.
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From page 408... ...
1997 Neighborhood social environments and the distribution of low birthweight in Chicago. American Journal of Public Health 87:597-603.
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From page 409... ...
United Church of Christ Commission for Racial Justice 1987 Toxic Wastes and Race in the United States: A National Report on the Racial and Socioeconomic Characteristics of Communities with Hazardous Waste Sites. New York: United Church of Christ.
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From page 410... ...
Anderson 1997 Racial differences in physical and mental health: Socioeconomic status, stress, and discrimination. Journal of Health Psychology 2~3~:335-351.
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