Race/Ethnicity References - Conceptualization & Data Quality
Center for Aging in Diverse Communities (CADC), UCSF
and RCMAR Coordinating
Center (UCLA)
Although the concept of race is regularly used as a meaningful descriptor in health research, many have challenged the scientific utility of the concept. There is no doubt that the construct of race is often used in an uncritical manner. It is sometimes used as a proxy for socioeconomic status and is very often used synonymously with such terms as ethnicity and culture. As a result, the scientific community is witnessing an increase in writings questioning the existence of race as a biologically or genetically meaningful construct. Similarly, some have noted that while terms such as “Black,” “Hispanic,” “Asian,” “American Indian,” and “White,” may be bureaucratically convenient, they have made talking and thinking about race and ethnicity somewhat simplistic. Some argue that these are overly broad pan-ethnic labels that categorize a disparate number of groups who happen to share a few visible characteristics such as skin color and a few other identifiable physical features. Others argue that these are biologically meaningful population groups with significant genetic differences. These varying perspectives have resulted in some interesting and provocative reading material. This reading list is based on the assumption that all social scientists interested in a deeper understanding of population group differences can benefit from exposure to the ongoing debate about the appropriate conceptualization and measurement (e.g., self-report versus observer report) of race and ethnicity and the quality of data on race/ethnicity in different datasets.
Conceptualizations of Race and Ethnicity in Health Research
Bhopal R, Donaldson L. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. American Journal of Public Health. 1998;88:1303-1307.
The request for scientifically appropriate terminology in research on race, ethnicity, and health has largely bypassed the term White. This and other words, such as Caucasian, are embedded in clinical and epidemiological discourse, yet they are rarely defined. This commentary analyzes the issue from the perspective of the epidemiology of the health of minority ethnic and racial groups in Europe and the United States. Terminology that reflects the research purpose-for examples, reference, control, or comparison--is better (unlike White, these terms imply no norm). This paper widens the debate on nomenclature for racial and ethnic groups. Many issues need exploration, including whether there is a shared understanding among the international research community of the terms discussed.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Buehler JW. Abandoning race as a variable in public health research. American Journal of Public Health. 1999;89(5):783. Comment.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Cooper RS, Freeman VL. Limitations in the use of race in the study of disease causation. Journal of the National Medical Association. 1999;91(7):379-83.
Tremendous variation exists in the rates of many chronic diseases across racial groups, and serious technical and conceptual limitations hamper the ability of racial comparisons to illuminate the causative pathways. First, race is confounded by social class, Second, statistical "adjustments" for race effects can be misleading since residual confounding may be misconstrued as a genetic effect. Third, the biologic concept of race tempts us to ignore the context dependency of genetic expression. To move forward on the problem of prostate cancer and other diseases distinguished by marked ethnic differentials, investigators need a more comprehensive understanding of the factors that mediate the apparent effect of race combined with valid measures of those factors, as well as novel strategies that can help overcome the technical and interpretive limitations of statistical adjustment. Finally, the "grand" theories of race-based genetic susceptibility must be replaced with rigorous criteria to determine when a trait can be ascribed to some genetic origin.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Corcos AF. The myth of human races East Lansing: Michigan State University Press; 1997.
Ford ME, Kelly PA. Conceptualizing and categorizing race and ethnicity in health services research. Health Services Research. 2005;40(5 Pt 2):1658-75.
The purpose of this paper is to (1) document the importance of using consistent standards of conceptualizing and categorizing race and ethnicity in health services research, (2) provide an overview of different methods currently used to assess race and ethnicity in health services research, and (3) suggest assessment methods that could be incorporated into health services research to ensure accurate assessment of disease prevalence and incidence, as well as accounts of appropriate health services use, in patients with different racial and ethnic backgrounds.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Freeman HP. The meaning of race in science - considerations for cancer research. Concerns of special populations in the National Cancer Program. Cancer. 1998;82:219-225.
Congressional historical article.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Hahn RA, Wetterhall SF, Gay GA, et al. The recording of demographic information on death certificates: a national survey of funeral directors. Public Health Reports. 2002;117(1):37-43.
Measuring racial disparities in mortality relies on accurate reporting of race on death certificates. This study looks at how funeral directors determine race for filling out death certificates. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Herman AA. Toward a conceptualization of race in epidemiologic research. Ethnicity & Disease. 1996;6(1,2):7-20.
This paper is a review of the prevailing conceptual basis of the use of race in health research. The author explores the current definitions of race in health research, and describes some of the history of race fabrication. In the examination of the association between race and disease the author describes black/white differences in age-adjusted mortality, infant mortality rates and birthweight. The analysis of race and disease is frustrated by incomplete theoretical constructs. Race, as used in health research, tends to be a unidimensional construct and the complex interplay between race and other social status variables is simplified. These problems are illustrated, and the author suggests a multidimensional construct of race.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Kaufman JS. How inconsistencies in racial classification demystify the race construct in public health statistics. Epidemiology. 1999;10(2):101-103.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Kagawa-Singer M. From genes to social science: impact of the simplistic interpretation of race, ethnicity, and culture on cancer outcome. Cancer. 2001;91(1 Suppl):226-32.
Argues for attention to culture in addition to SES as a way to make sense of health behavior differences between populations, especially because of the importance of health behavior in cancer etiology and treatment. Provides multilevel conceptual models that incorporate culture.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Krieger N. Stormy weather: race, gene expression, and the science of health disparities. American Journal of Public Health. 2005;95(12);2155-60.
In the current US political climate, conservative foundations are seeking to frame debates over determinants of racial/ethnic health disparities as a matter of "politically correct" unscientific ideology (concerning the health impacts of discrimination) vs scientific yet "politically incorrect" expertise rooted in biological facts (concerning genes). I draw on historical and contemporary examples to place conservative polemics in context, and also highlight fundamental flaws in their arguments involving the use of spurious categories (e.g., Caucasian), logical fallacies, temporal fallacies, and an erroneous emphasis on gene frequency over gene expression.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health. 2005; 82(2 Suppl 3):iii26-34.
This article (1) outlines the magnitude of confounding between race and socioeconomic status; (2) demonstrates problems caused by this confounding; (3) examines the degree to which race disparities are a function of socioeconomic status; and (4) discusses considerations for advancing research on health disparities after accounting for the confounding of race and socioeconomic status.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Martinez RM. Why race and gender remain important in health services research. American Journal of Preventive Medicine. 1996;12(5):316-318.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Oliver MN, Muntaner C. Researching health inequities among African Americans: the imperative to understand social class. International Journal of Health Services. 2005; 35(3):485-98.
Research aimed at increasing our understanding of health disparities and designing and evaluating interventions to improve African-American health is hampered by a liberal, classless approach. Authors argue for a theoretical framework that recognizes that class exploitation sets the stage for and interacts with racial discrimination to determine racial inequities in health.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Phelan JC, Link BG. Controlling disease and creating disparities: a fundamental cause perspective. J Gerontol B Psychol Sci Soc Sci. 2005 Oct;60 Spec No 2:27-33.
Any explanation that ignores large improvements in population health and fails to account for the emergence of disparities for specific diseases is an inadequate explanation of current disparities. We argue that genetic explanations and some prominent social causation explanations are incompatible with these facts. We propose that the theory of "fundamental causes" can account for both vast improvements in population health and the creation of large socioeconomic and racial disparities in mortality for specific causes of death over time. Specifically, we argue that it is our enormously expanded capacity to control disease and death in combination with existing social and economic inequalities that create health disparities by race and socioeconomic status: When we develop the ability to control disease and death, the benefits of this new-found ability are distributed according to resources of knowledge, money, power, prestige, and beneficial social connections. We present data on changing mortality patterns by race and socioeconomic status for two types of diseases: those for which our capacity to prevent death has increased significantly and those for which we remain largely unable to prevent death. Time trends in mortality patterns are consistent with the fundamental cause explanation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Rabin R. The use of race as a variable in public health research. American Journal of Public Health. 1999;89(5):783.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Sondik EJ, Lucas JW, Madans JH, Smith SS. Race/ethnicity and the 2000 census: Implications for public health. American Journal of Public Health. 2000;90(11):1709-1713.
This article addresses the potential impact of the revised standards for race and ethnicity on data from the 2000 census and public health data sources. The relationship between race/ethnicity and health in selected measuresis examined, identifying the factors that influence race/ethnicity identification, considering past experience in race/ethnicity reporting, and exploring the challenges in understanding and managing the effects of new racial/ethnic categories in various data sets. The multiple-race group seems to compose only a small percentage of the US population and may have little impact on data for single-race groups. More research is needed to support a thorough understanding of the reporting of multirace data and the development of techniques for analyzing these data.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Travassos C, Williams DR. The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States. Cad Saude Publica. 2004;20(3):660-78.
This article reviews the literature on the concept and measurement of race and compares how the findings apply to the United States and Brazil. We discuss in detail the data quality issues related to the measurement of race and the problems raised by measuring race in multiracial societies like Brazil. We discuss how these issues and problems apply to public health.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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White-Means SI. Conceptualizing race in economic models of medical utilization: a case study of community-based elders and the emergency room. Health Services Research. 1995;30(1):207-223.
There is no consensus on the appropriate conceptualization of race in economic models of health care because race is rarely the primary focus for analysis of the market. This article presents an alternative framework for conceptualizing race in health economic models. A case study is analyzed to illustrate the value of the alternative conceptualization. Findings clearly document the importance of model stratification according to race and indicate that empirical results are improved when medical utilization models are refined in a way that reflects the unique experiences of the population that is studied.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Whitfield KB, D. Individual differences, ethnicity, and aging: What can gero-genetic studies contribute? African American Research Perspectives. 2000;6(2):115.
Presents the value of using quantitative genetic approaches to understanding individual differences and ethnic diversity in aging. There are three major points discussed: 1) the difference between race and ethnicity, 2) inter-versus intra-group differences, and 3) the contribution of quantitative genetics methods to understanding individual variation within ethnic groups and differences and similarities between ethnic groups. Also includes a discussion of several twin studies of older African Americans.
http://www.rcgd.isr.umich.edu/prba/perspectives/springsummer2000
/kwhitfield2.pdf
Williams DR. Race and health: basic questions, emerging directions [see comments]. Annals of Epidemiology. 1997;7(5):322-33.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Williams DR, Jackson PB. Social sources of racial disparities in health. Health Affairs. 2005;24(2):325-34.
Racial disparities in mortality over time reflect divergent pathways to the current large racial disparities in health. The residential concentration of African Americans is high and distinctive, and the related inequities in neighborhood environments, socioeconomic circumstances, and medical care are important factors in initiating and maintaining racial disparities in health. Efforts are needed to identify and maximize health-enhancing resources that may reduce some of the negative effects of psychosocial factors on health. Health and health disparities are embedded in larger historical, geographic, sociocultural, economic, and political contexts.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Witzig R. The medicalization of race: scientific legitimization of flawed social construct. Annals of Internal Medicine. 1996;125:675-9.
The term "race" has many definitions , but in common and medical usage, defining "race" has meant separating Homo sapiens into three to six groups. This division of Homo sapiens into race taxons started in the 18th century, when the sciences of genetics and evolutionary biology were not yet invented. These disciplines have since shown that human race taxonomy has no scientific basis. Race categories are social constructs, that is, concepts created from prevailing social perceptions without scientific evidence. Despite modern proof that race is arbitrary biological fiction, racial taxons are still used widely in medical teaching, practice, and research. In contrast, ethnicity is a concept that incorporates social, religious, linguistic, dietary, and other variables to identify individual persons and populations. Ethnicity may be able to impart clinical clues to diagnosis if the clinician taking the history is well informed and open minded.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Zimmerman RS, Vega WA, Gil AG, Warheit GJ, Apospori E, Biafora F. Who is Hispanic? Definitions and their consequences. American Journal of Public Health. 1994;84(12):1985-1987.
What is the appropriate method for classifying Spanish-speaking-origin inhabitants of the United States? This paper presents relevant data from the first wave of a longitudinal study of adolescents in the greater Miami area. As expected, the broadest definition--"up to third generation" Hispanic--identified the largest proportion of the sample as Hispanic, whereas parent self-report placed the smallest proportion into the Hispanic category. When policymakers are concerned about enumerating the entire Hispanic population, a definition broader than self-identification should be used; in estimating prevalence rates, however, the use of self-identification may be adequate.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
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Last updated March 2006
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