The Meaning of Race in Medical and Public Health Research
description
Transcript of The Meaning of Race in Medical and Public Health Research
The Meaning of Race in Medical The Meaning of Race in Medical and Public Health Researchand Public Health Research
Thomas A. LaVeist, Ph.D.Thomas A. LaVeist, Ph.D.
Associate ProfessorAssociate Professor
Johns Hopkins School of Public HealthJohns Hopkins School of Public Health
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?WHAT IS RACE?
Biogenetic Factor?Biogenetic Factor? Cultural Factor?Cultural Factor? Social Factor?Social Factor?
The Prominence of Race in Health ResearchThe Prominence of Race in Health Research
Percent of articles using race
AJE HSR JHSB
64% 64% 53%
Source: AJE Jones, LaVeist, and Lillie-Blanton 1991 HSR Williams (1994) JHSB LaVeist, Williams, Jones and Lillie-Blanton 1992
How Race is Typically UsedHow Race is Typically Used
Sample SelectionSample Selection StratificationStratification Binary Variables in Regression to Binary Variables in Regression to
“Control” for Race Effect“Control” for Race Effect
Assigning Racial Status: Pre-1989Assigning Racial Status: Pre-1989USAUSA
FATHER MOTHER CHILDWhite White WhiteWhite Black BlackWhite J apanese J apaneseBlack White BlackBlack Black BlackBlack J apanese BlackJ apanese White J apaneseJ apanese Black J apaneseJ apanese J apanese J apanese
Assigning Racial Status: Pre-1985Assigning Racial Status: Pre-1985JapanJapan
FATHER MOTHER CHILD
White J apanese White
Black J apanese Black
J apanese White J apanese
J apanese Black J apanese
Assigning Racial StatusAssigning Racial StatusBrazilBrazil
FATHER MOTHER CHILD
White Black Mulatto
Black White Mulatto
Black Black Black
White White White
Mulatto is Divided Based on Mulatto is Divided Based on Darkness of Skin ColorDarkness of Skin Color
Preto Retinto (dark Black)Preto Retinto (dark Black) Pretos (Black)Pretos (Black) Cabra (slightly less Black)Cabra (slightly less Black) Cabo Verde (slightly less Cabo Verde (slightly less
Black)Black) Mulatto Esuro (dark Mulatto Esuro (dark
Mulatto)Mulatto)
Mulatto Claro (light Mulatto Claro (light Mulatto)Mulatto)
MorenoMoreno SararasSararas BlancoBlanco Blanco de TerraBlanco de Terra
Persons who are relatively homogeneous with respect to
biological inheritance.
A Dictionary of Epidemiology (1988)
Race DefinedRace Defined
1) An ethnic stock, or division of mankind; in a narrower sense, a national or tribal stock; in a still narrower sense, a genealogical line of descent; a class of persons of a common lineage. In genetics, races are considered as populations having different distributions of gene frequencies. 2) a class or breed of animals; a group of individuals having certain characters in common, owing to a common inheritance; a sub-species.
Dorland’s Illustrated Medical Dictionary (1988)
Race DefinedRace Defined
Applied to human beings, the term race implies a blood related group with characteristics and common heredity traits… Primary races or sub-species--the Caucasian, the Mongoloid, and the Negro--are generalized racial types, hypothetical stocks, rather than living races.
Psychiatric Dictionary (1981)
Race DefinedRace Defined
A subspecies or other division or subdivision of a species. Human races are generally defined in terms of original geographic range and common hereditary traits which may be morphological, serological, hematological, immunological, or biochemical. The traditional division of mankind into several well-recognized racial types, such as Caucasoid (White), Negroid (Black), and Mongoloid (yellow) leaves a residue of populations that are of problematical classification, and its focus on a limited range of visible characteristics tends to over simplify and distort the picture of human variation.
International Dictionary of Medicine and Biology (1986)
Race DefinedRace Defined
A phenotypically and/or geographically distinctive sub-specific group, composed of individuals inhabiting a defined geographical and/or ecological region, and possessing characteristic phenotypic and gene frequencies that distinguish it from other such groups. The number of racial groups that one wishes to recognize within a species is usually arbitrary but suitable for the purposes under investigation.
A Dictionary of Genetics (1990)
Race DefinedRace Defined
An ethnic classification, subdivision in the US into five categories, according to origin: 1) White, not Hispanic (Europe, North Africa, Middle East); 2)
Black, not Hispanic (Africa), 3) Hispanic; 4) American Native (Indians, Eskimos); 5) Asian and
Pacific Islanders. Stratification by race is of interest in several areas of medicine for a number of specific
reasons:
The Dictionary of Modern Medicine (1992)
Race DefinedRace Defined
TRANSFUSION MEDICINE
Certain red cell antigens may be relatively uncommon in a particular race and knowledge of race reduces the labor required to find a suitable unit for transfusion.
The Dictionary of Modern Medicine (1992)
TRANSPLANTATION
Human leukocyte antigens (HLA) differ somewhat according to race and may be used to identify potential recipients for organ transplantation.
The Dictionary of Modern Medicine (1992)
PUBLIC POLICY
The Civil Rights Act of 1964 mandated equality in employment and educational policy and knowledge of race favors minority candidates.
The Dictionary of Modern Medicine (1992)
CLINICAL MEDICINE
Some HLAs are more common in certain racial groups and may be associated with particular diseases, thus helping to diagnose and manage difficult cases.
The Dictionary of Modern Medicine (1992)
The Dictionary of Modern Medicine The Dictionary of Modern Medicine (1992)(1992)
Transfusion HLA Diff erences
Transplantation HLA Diff erences
Public Policy Affi rmative Action
Clinical Medicine HLA Diff erences
In 1988 35.4% (93,577) of the 264,019 total deaths among African Americans were considered to be excess deaths. Only 731 (.78%) of these deaths were caused by all anemias, sickle cell or otherwise.
Sickle Cell Sickle Cell
Measurement Differs by Data Collection Measurement Differs by Data Collection MethodMethod
Birth Certificates - assigned mother’s race based Birth Certificates - assigned mother’s race based on visual assessment of motheron visual assessment of mother
Death Certificates - assigned based on visual Death Certificates - assigned based on visual assessment of the bodyassessment of the body
Telephone/Mail Survey - Respondent self-reportTelephone/Mail Survey - Respondent self-report Face-to-face Survey - Interviewer’s visual Face-to-face Survey - Interviewer’s visual
assessmentassessment
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
POVERTY
PoorHousing
Access toHealth Care
PoorNutrition
EnvironmentalHazards
HEALTHSTATUS
CONSTRUCT VALIDITY
CONCEPTUAL MODEL OF RACECONCEPTUAL MODEL OF RACE
LATENT (UNOBSERVED) FACTORRACE
PHYSIOGNOMY
CATEGORIZATION INTO
RISK/BEHAVIOR GROUPS
CULTUREETHNICITY
MANIFEST INDICATOR(skin color)
SOCIETAL
RISK EXPOSUREHEALTH/ILLNESS BEHAVIOR
EXTERNALRISK EXPOSURE
RACE DIFFERENCESIN HEALTH STATUS
OBSERVED HEALTH OUTCOMES
USING RACEUSING RACE
Indicate how race was measuredIndicate how race was measured Provide a scientifically valid rationale for Provide a scientifically valid rationale for
including raceincluding race Provide a Scientifically valid rationale for Provide a Scientifically valid rationale for
excluding raceexcluding race
USING RACEUSING RACE
Develop explicit measures for factors believed to Develop explicit measures for factors believed to be measured by race binary variablesbe measured by race binary variables
Always provide an interpretation for findings of Always provide an interpretation for findings of a significant race effect in your analysisa significant race effect in your analysis
Treat the race variable with the same degree of Treat the race variable with the same degree of caution as other variablescaution as other variables
The Meaning of Race in Medical The Meaning of Race in Medical and Public Health Researchand Public Health Research
Thomas A. LaVeist, Ph.D.Thomas A. LaVeist, Ph.D.
Associate ProfessorAssociate Professor
Johns Hopkins School of Public HealthJohns Hopkins School of Public Health