Issue Brief – Race and Ethnicity Matters: Concepts and Challenges of Racial and Ethnic Classifications in Public Health
The Connecticut Health Disparities Project
Connecticut Department of Public Health
Alison Stratton, PhD
Ava Nepaul, MA
Margaret Hynes, PhD, MPH
Race, Ethnicity and Health Disparities: An Introduction
Extraordinary improvements in the health of all Americans have been made since the early 20th century. However, not everyone benefits equally from these advances in the public’s health. Nor is every group equally burdened by the leading causes of death, which in the United States today are no longer infectious diseases, but rather chronic diseases such as heart disease, cancer, stroke, and diabetes.
“Health disparities”—those avoidable differences in health among specific population groups that result from cumulative social disadvantages (Stratton, Hynes, and Nepaul 2007)—exist for many minority populations in the United States. As used here, “minorities” are those populations in a society that are in a position of cultural and political non-dominance and disadvantage. As a result, they may experience reduced healthcare quality and access, and increased rates of disease, disability, and death compared to the overall U.S. population. For example, U.S. minority populations might include racial and ethnic minorities, limited English proficiency populations, people living in poverty, and homeless persons.
The Connecticut Health Disparities Project at the Department of Public Health (DPH), in conjunction with other agencies and programs, is taking a new look at health disparities and the collection of “race” and “ethnicity” data. Differential treatment of people based on the ideas of race and ethnicity is a social reality for all Americans (Nepaul, Hynes and Stratton 2007) and has a large impact on Americans’ health and general well-being. In order to track the health impact of these ideas of race and ethnicity, health departments at all levels need to collect consistent and comprehensive health information using racial and ethnic classification tools.
However, race and ethnicity data alone are not sufficient to accurately depict health disparities (Nepaul, Hynes and Stratton 2007). In fact, social structural factors (such as poverty, [low income environments, socioeconomic status and social supports) are equally if not more important as fundamental causes of health disparities (Link and Phelan 1995).
In this Issue Brief, then, we seek to address these questions: How have people defined and used the concepts of “race,” and “ethnicity?” How useful or consistent is our current collection of racial and ethnic data in the effort to reduce and eliminate health disparities? What other factors have an impact on people’s health? Below we: 1) introduce the history, theoretical foundations, and uses of the ideas of “race” and ethnicity” in public health data collection; 2) discuss why they are difficult, yet necessary, concepts to use in studying health in the United States; and 3) stress the need for inclusion of socio-economic and other demographic factors in the collection and analysis of health data to more fully illuminate health disparities…
…Race and ethnicity are neither scientifically reliable nor valid categories, and assignments to racial or ethnic categories are often based on observer biases, changing situational identities, and historical-political vagaries (Lee 1993; Kaplan and Bennett 2003; Williams 2007). In real life, people do not have only one fixed racial or ethnic identity which remains the same over time and space and that can be accurately measured. A further complication inherent in categorization is that people embrace biracial, multiracial, and multi-ethnic identities, which makes the categories even more difficult to sustain, compare, and enumerate. Current racial and ethnic categories for federal data collection are not sensitive to the complex intra-group heterogeneity that exists in the nation (Kaplan and Bennett 2003; Office of Management and Budget 1997).
Despite such inconsistencies in use and logic, the ideology of race is deeply ingrained in American culture. People acting on these beliefs and practices create a social reality for themselves and others based in part on these perceived racial or ethnic differences between people. This reality includes the structures, beliefs and practices of health care, medicine and economics that contribute to health disparities for minority populations (Williams, Lavizzo-Mourey and Warren 1994)…
Read the entire report here.