Chapter 30: Race and Ethnic Health Disparities

INTRODUCTION

Race/ethnic disparities in health remain a persistent challenge in the United States. Though health indicators related to life expectancy, infectious diseases, and infant mortality have improved for most Americans, some race/ethnic minority groups continue to experience a disproportionate burden of preventable disease and death compared with non-Hispanic whites.

National data demonstrate that the U.S. population is becoming more racially and ethnically diverse. According to the 2010 U.S. Census, approximately 36% of the U.S. population belonged to a racial/ethnic minority group. By the year 2060, the United States will be majority-minority, with non-Hispanic whites representing approximately 44% of the total U.S. population.¹ These disparities are not only concerning from an inequities standpoint, but also because of the potential to limit improvements in population health with implications for overall healthcare costs.

The 1985 Heckler Report raised national awareness around the problem of race/ethnic disparities and the disproportionate burden of disease experienced by minorities. In accordance with provisions contained in the Minority Health and Health Disparities Research and Education Act of 2000, the National Institutes of Health began to formally integrate disparities research into its strategic plan. Since then, research on race/ethnic health disparities has increased considerably.

In this chapter, we review the empirical evidence around race/ethnic disparities across a range of health outcomes relevant to preventive medicine and public health. We also discuss the potential factors that contribute to race/ethnic health disparities, and provide an overview of the potential approaches and future directions in this area of research. Although similar disparities persist in many countries around the world, we focus this chapter on a discussion of race/ethnic health disparities specific to the United States given the unique historical social and environmental influences that have contributed to race/ethnic disparities in this country.

OVERVIEW OF RACE/ETHNIC HEALTH DISPARITIES

The term “health disparities” is often defined as a difference in which disadvantaged social groups, such as race/ethnic minorities, who have persistently experienced social disadvantage or discrimination, systematically experience worse health than more advantaged social groups.² When these differences in health “are not only unnecessary and avoidable,” and are “considered unfair and unjust,” they are referred to as health inequities.³

Race/Ethnic Definitions

Race/ethnic minority groups in the United States include those individuals who self-identify as Black or African-American, Asian Americans, American Indian or Alaska Native, native Hawaiian or Other Pacific Islander, and Hispanic or Latino populations. Individuals who self-identify as Hispanic or Latino, considered an ethnicity, are persons of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin and may be of any racial category, including white.⁴

Racial and ethnic categories are not static, and have changed considerably over time. Racial categories, in particular, have been included on every U.S. census since 1790, but have changed every decade, reflecting the ...