New research examines why minoritiesare more prone to illness than
whites
Minority groups may have come a long way in our society, but when
it comes to health, they're still second-class citizens: Studies show
that minorities tend to get sicker and die younger than their white
counterparts. According to Norman B. Anderson, Ph.D., professor of health
and social behavior at Harvard University, the reasons may not be
biological, but psychological and sociological.
Nancy K. Dess [NKD]: As the first director of the National
Institutes of Health's Office of Behavioral and Social Science Research,
you've had your finger on the pulse of hot health issues for years. These
days, there is much talk about "health disparities." What are
they?
Norman B. Anderson [NBA]: Health disparities are the variations in
the health outcomes of people of different racial, ethnic, socioeconomic
and gender groups. For example, African Americans and Latinos suffer
disproportionately from diseases such as diabetes and AIDS. Similarly, as
people's socioeconomic status (SES) drops, their exposure to practically
every cause of death and disability goes up.
NKD: Are these disparities due to race or ethnicity? Or is poverty
the culprit?
NBA: After accounting for SES, there are fewer racial differences
in health outcomes. But some remain, so there is more to the health gap
than poverty.
NKD: We've known for a while that health is affected by behaviors
such as smoking and dietary habits and by psychosocial factors such as
optimism and social support. Now, we know that these outside factors are
linked with biological pathways such as immune and cardiac function. How
is this research illuminating health disparities?
NBA: For one thing, it drives home the fact that we have to look
beyond biology. In the case of race, the research community has largely
rejected the notion that genes are responsible for the disparities.
Racial groups share over 99.9% of their genes, and genes vary more
between individuals than between groups. The discovery of psychological,
behavioral and social risk factors provides clues about health
disparities and how to reduce them. For example, community-based
interventions targeted at specific groups to reduce behavioral risk
factors may in some cases be the most effective way of reducing
disparities.
NKD: So a "colorblind" approach to health won't fly?
NBA: Well, some factors do influence health in all groups. For
example, a person who smokes, didn't finish high school, is depressed,
doesn't exercise and has a family history of heart disease is more likely
to develop heart disease than someone with only one or two of the
factors--regardless of race. And there are racial variations in certain
risk factors that need to be addressed. However, ethnic differences in
mortality exist even after accounting for all the known risk
factors.
NKD: Why?
NBA: We're just starting to find out. Studies are beginning to link
exposure to racism and discrimination with biological processes. The
social impact of racism has been clear for a long time. Now, we are
beginning to understand its effect on health. We have also learned that
the experience of being poor is very different for blacks, who live in
worse neighborhoods and have to cope with a wider array of stressful
experiences than poor whites. So even when the poverty level is the same,
the impact of poverty may be greater in blacks.
NKD: Despite these health disparities, is overall health in the
U.S. at least better than elsewhere?
NBA: Not really. The U.S., while relatively affluent, ranks 17th in
life expectancy among 33 industrial nations, behind countries like Spain,
Japan, Great Britain and Germany. Why this is so isn't clear, but one
intriguing pattern has emerged: Where the gap between the rich and poor
is smaller, people live longer. For whatever reason, equality seems to be
good for everybody.
NKD: How should the Bush administration use these findings to
improve the nation's health?
NBA: I hope that the new administration will maintain the momentum
we now have to eliminate health disparities. Bipartisanship has moved
this agenda forward so far, including the creation by Congress of the
National Center for Minority Health and Health Disparities. By using
behavioral science, while raising the social and economic standing of
many of our citizens, we all can look forward to a healthier
nation.
Tags:
biological pathways,
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minorities,
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national institutes of health,
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physical health,
psychosocial factors,
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racial differences,
social behavior,
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