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