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During the last 4 decades, a rapid increase has occurred in the number of survey-based and epidemiological studies of the health profiles of adults in general and of the causes of disparities between majority and minority Americans in particular. According to these studies, healthful aging consists of the absence of disease, or at least of the most serious preventable diseases and their consequences, and findings consistently reveal serious African American and Hispanic disadvantages in terms of healthful aging.
We (1) briefly review conceptual and operational definitions of race and Hispanic ethnicity, (2) summarize how ethnicity-based differentials in health are related to social structures, and (3) emphasize the importance of attention to the economic, political, and institutional factors that perpetuate poverty and undermine healthful aging among certain groups. (Am J Public Health. 2006;96:1152-1159. doi:10.2105/AJPH. 2006.085530)
ALTHOUGH THE SUPREME
Court outlawed the principle of separate but equal in 1954 with its famous Brown versus Board of Education decision, many minority Americans find that they are still separate and unequal. Despite a century of impressive innovations in medical science and improvements in public health, poverty continues to undermine the physical and emotional health of a large number of Americans, and serious racial/ethnic health disparities persist.1-3 Low-income families have inadequate health care coverage,4,5 and individuals who lack adequate insurance are more likely to die from cancer and other serious diseases because of late diagnoses and deficient care.6-8 Perhaps the most basic question is whether health disadvantages among minority Americans are the direct and almost complete result of poverty and its correlates. Welldocumented correlates include low educational levels, labor force disadvantages, and residential segregation in ghettos and barrios, where individuals are exposed to environmental and social health risks such as drugs, violence, and family disruption.5,9-14
Racial/ethnic disparities in morbidity and mortality are so glaring that the federal government has been forced to respond, and a large body of research has examined the role sotioeconoinic status (SES) and culture play in these disparities.19 The ultimate goal is to identify the social structural causes of inequities in health so that general population health can be improved. We will present approaches to studying racial/ethnic health disparities by (1) reviewing operational definitions of race and ethnicity and the research tools that estimate differential...