Understanding Social Influences on Healthcare

Disparities

Akiko S. Hosler, Ph.D.

New York State Dept of Health & University at AlbanyThe 19th National Conference on Chronic Disease Prevention and

ControlMarch 2005

Why Racial/Ethnic Disparities Exist?

• Because racial/ethnic categories are socially constructed to reflect existing socioeconomic differences and inequalities

• Race/ethnic categories are dependent on the society’s collective perception that such differences are important

• Race/ethnic categories are not fixed – Change over time within the same society – Each society has its own unique way to

differentiate people based on hereditary characteristics

Examples of Race/Ethnicity as a

Social Construct • “Hispanic” category appeared first time in

the 1980 census • In the 1790 census (the first census), “free

white males” “free white females” “other persons” and “slaves” were used

• In Great Britain today, “Arabs” “(South) Asians” and “West Indians” are distinctive categories

• U.S. categories are not scientific ( genetics)– Violate the basic principles of taxonomy– Rely self-reporting

But Why Race/Ethnicity Still

Important?

• A representation of the structure and dynamics of our society

• Functional purposes – to advocate needs, interests

• Basis of self identity and group identity for some individuals

• Governments are responsible for keeping track of historic changes of race/ethnic differences (OMB standards)

Healthcare Disparities - Social Phenomena

• Remind us that health has biomedical causes and social causes

• Certain health-related processes and outcomes are better understood & dealt with on the population basis

• Continuing effort to search for “social variables” that make sense – Beyond race/ethnicity, income & education

– Beyond descriptive, cross-sectional analysis

New York State’s Experience

• Russian-speaking immigrants in NYS– High rates of obesity & diabetes, lack of knowledge on A1C

(language, refugee status, economic & cultural issues) Ethnicity &

Disease. 2004;14:372-377 • Puerto Rican adults with diabetes in NYC

– Adequate healthcare access, but prevention for cardiovascular complications inadequate (language for older generations, perception for need) American Journal of Public Health. 2004;94:434-437. May/June

2005 issue the Diabetes Educator • Japanese residents in Westchester County

– Low rates of obesity & diabetes, adequate preventive care, but men are at risk for diabetes (high socio-economic status, work-related inactivity and stress for men) Am J of Public Health. 2003:93:1279-1280