The Race for Good Health

New research examines why minorities are 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.

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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.

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