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Race, Ethnicity, and the Health of Americans

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Race, Ethnicity, and the Health of Americans SYDNEY S. SPIVACK PROGRAM IN APPLIED SOCIAL RESEARCH AND SOCIAL POLICY Race, Ethnicity, and the Health of Americans ASA SERIES ON HOW RACE AND ETHNICITY MATTER July 2005 SERIES BACKGROUND This on-line publication by the American Sociological Association (ASA) is one in a five-part series on the institutional aspects of race, racism, and race relations, a project intended to help commemorate the ASA centennial (1905-2005) and designed for a general read- ership. As a professional membership association, the ASA seeks to promote the contributions and uses of sociology to the public. These synthetic summaries provide an overview of the research evidence on how race remains an important social factor in understanding disparities in the well being of Americans in many important areas of life (including employment, health, income and wealth, housing and neighborhoods, and criminal justice) although demonstrable changes have occurred in American society over the last century. Published under the auspices of ASA’s Sydney S. Spivack Program in Applied Social Research and Social Policy, these syntheses are based upon a vast literature of published research by sociologists and other scholars. This body of research was reviewed and assessed at a working conference of 45 social scientists that At the dawn of the twenty-first century, attempted to create an integrated map of social science Americans are in general healthier than ever before as a knowledge in these areas. The effort was organized by result of technological advances, preventive medicine, Felice J. Levine, former ASA Executive Officer, Roberta Spalter-Roth, Director of the ASA Research and and broader access to health care; yet some racial and Development Department, and Patricia E. White, ethnic groups are less healthy, receive poorer care, and Sociology Program Officer at the National Science cannot expect to live as long as others (40). Statistics Foundation (when on detail to ASA), and supported by generous grants from the Ford Foundation and the W.G. show marked differences in life expectancy, mortality, Kellogg Foundation. incidence of disease, and causes of death across racial In conjunction with the Clinton administration’s and ethnic groups. Why is this? Presidential Initiative on Race: One America, the ASA was encouraged by the White House Office of Science Technology Policy to undertake this ambitious examina- According to popular opinion, racial groups are viewed tion of relevant arenas of research, explicate what the as physically distinguishable populations that have a social sciences know, dispel myths and misconceptions common ancestry (1). Although genetics and biology about race, and identify gaps in our knowledge. The account for some aspects of the variation in health status purpose of the President’s overall initiative, begun in late 1997, was to “help educate the nation about the among racial and ethnic groups, social science research facts surrounding the issue of race” and included many demonstrates the powerful influence on health of risk- activities such as university, community, and national taking and preventive behavior, social and economic dialogues; government initiatives and conferences; and topical reports. inequalities, communities and environments, health The ASA’s original materials have been updated, policy, and racist practices. These overlapping dynamics synthesized, and developed for this Centennial Series play a significant role in explaining racial and ethnic under the direction of Roberta Spalter-Roth. The authors disparities in health outcomes (21; 27; 33; 47; 58; 80). of this summary are Roberta Spalter-Roth, Terri Ann Lowenthal, and Mercedes Rubio. > RACE, ETHNICITY, AND THE AMERICAN LABOR MARKET: WHAT’S AT WORK? Even with the growing sophistication of biological psychological well-being are ways to measure the and genetic research, sociology reminds us that health of a nation. In the United States, these race is not an immutable category; rather it is a health indicators reveal marked disparities among “social category,” subject to change, with real racial and ethnic groups. consequences for health and well-being (16). Although Americans on average live longer than The United States health care system has been in the past1, African Americans can expect to live described as “provider-friendly” (31). Racial prej- an average of five fewer years than whites. When udices and practices are sex is included in the analysis, white women have “Although Americans institutionalized in this the longest life span of 80.3 years, while African on average live longer system and frequently American men have the shortest of 68.8 years than in the past, result in unequal access to (see Table 1). Unfortunately, comparable data are medical care, unequal treat- not available for other racial and ethnic groups. African Americans can ment for similar severity of expect to live an illnesses and conditions, There are also striking racial and ethnic differ- average of five fewer and differences in heath ences in infant mortality rates. African American years than whites.” insurance protection (24). infants have the highest mortality rates and are Public policies are also part more than twice as likely as white infants to die of the equation for they can in their first year of life. Asian-Pacific American either reinforce or mitigate these racially infants have the lowest mortality rates, but there disparate practices (47, 48, 49). are notable differences within this population group: Infant mortality ranges from a low of 4.3 This summary report on race, ethnicity, and the for Japanese Americans to a high of 8.2 deaths health of Americans begins by describing key per 1000 live births for Native Hawaiians. differences in indicators of life and death health Similarly, while Latino infants overall are less status among racial and ethnic groups. Further, it likely than non-Hispanic white infants to die in uses sociological and other social science concepts their first year of life, differences among Latinos and research to explain how these differences range from 4.7 deaths per 1000 live births for occur by examining the role of income, neighbor- Cubans to 8.1 for Puerto Ricans living on the hood segregation, and racial discriminatory prac- mainland (see Table 2). tices. These data show how at individual, community, and institutional levels, differential As with life expectancy, death rates vary among access and treatment constructs, creates, and racial and ethnic groups.2 Asian-Pacific maintains racial differences in health status. Americans have the lowest death rates, and African Americans the highest—a pattern that LIFE AND DEATH CHANCES: holds true for men and women of both races. WHAT THE DATA SHOW Whites have the second highest overall death Life and death measures of health status, rates of all major race and ethnic groups. including life expectancy, infant mortality, African Americans have higher death rates than mortality and causes of death, mental health and non-Hispanic whites for eight of the ten leading 1 In 1950, life expectancy (at birth) for all Americans was 68.2 years; by 2000, life expectancy was 77.0 years. 2 Age-adjusted death rates, which reflect the likelihood of death at a given age, fell 39 percent from 1950 to 1998, for the population as a whole. 2 ASA SERIES ON HOW RACE AND ETHNICITY MATTER TABLE 1. Life Expectancy at Birth, by Race and Gender (Selected Years 1970–2002) LIFE EXPECTANCY AT BIRTH ALL RACES WHITE BLACK OR AFRICAN AMERICAN Both Male Female Both Male Female Both Male Female YEAR Sexes Sexes Sexes 1970 70.8 67.1 74.7 71.7 68.0 75.6 64.1 60.0 68.3 1980 73.7 70.0 77.4 74.4 70.7 78.1 68.1 63.8 72.5 1990 75.4 71.8 78.8 76.1 72.7 79.4 69.1 64.5 73.6 1995 75.8 72.5 78.9 76.5 73.4 79.6 69.6 65.2 73.9 1999 76.7 73.9 79.4 77.3 74.6 79.9 71.4 67.8 74.7 2000 77.0 74.3 79.7 77.6 74.9 80.1 71.9 68.3 75.2 2001 77.2 74.4 79.8 77.7 75.0 80.2 72.2 68.6 75.5 2002 77.3 74.5 79.9 77.7 75.1 80.3 72.3 68.8 75.6 Source: National Center for Health Statistics. 2004. Health, United States, 2004, with Chartbook on Trends in the Health of Americans, Hyattsville, MD. TABLE 2. Infant Mortality Rates According to Race: United States 1996–1998 Race of Mother and Hispanic Origin of Mother Rates* White/Nonwhite Ratio White, non-Hispanic 6.0 Black, non-Hispanic 13.9 2.32 American Indian or Alaskan Native 9.3 1.55 Asian or Pacific Islander 5.2 0.87 Chinese 3.4 0.57 Japanese 4.3 0.72 Filipino 5.9 0.98 Hawaiian and part Hawaiian 8.2 1.37 Other Asian or Pacific Islander 5.5 0.92 Hispanic origin 5.9 0.98 Mexican 5.8 0.97 Puerto Rican 8.1 1.35 Cuban 4.7 0.78 Central and South American 5.2 0.87 Other and unknown Hispanic 6.8 1.13 *Infant deaths per 1000 live births. Source: National Center for Health Statistics, 2001, p. 153 as cited in Rubio and Williams, 2004. 3 > RACE, ETHNICITY, AND THE HEALTH OF AMERICANS causes of death. Cause-specific mortality gaps group in the United States) and whites, even among these groups are, in some cases, substan- though the two groups have comparable life tial; for example, the death rate from HIV-related expectancies and mortality rates. disease is ten times greater for African Ameri- cans than for non-Hispanic whites. This result is Along with key indicators of mortality and life obtained by dividing 8.32 by .79 (see Table 3).
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