Health disparities: causes, impacts, and interventions

Race and Class As the Ignored Determinants of Health Disparities

For decades researchers have kept statistics, in the United States, regarding health disparities amongst its citizens. The most common stratification of this research often lies along the lines of race. Many studies have been performed regarding the differences in health issues among those of the Caucasian, Black, Hispanic, Native American, Asian, etc. populations.

However, very rarely "(t)he U.S. government is one of the few developed Western nations that does not routinely report health statistics by class" (Kawachi, Daniels, & Robinson 141). As Kawachi, Daniels and Robinson note, there is very little information on important health disparity topics by such class stratifications as: income, occupation, or educational attainment. Where class is the ignored determinant of health disparities, race has become the increasingly more common variable.

Race is "a way to categorize humans, (and) race has since come to take on a wide range of meanings, mixing social and biologic ingredients in varied proportions. This plasticity has made it a tool that fits equally well in the hands of demagogues who want to justify genocide and eugenics and of health scientists who want to improve surveillance for diseases" (Kauffman, Cooper, & Ward 1166). Kawachi, Daniels and Robinson discuss three primary views of racial health disparities.

First, there are the biological links to disparities that give rise to research centered on race-based genetic susceptibility to diseases. Kauffman, Cooper, and Ward support this first view.

Although they mention that class could be a factor in health disparities, they note that there are racial and ethnic differences in the causes, expression, and prevalence of various diseases. The relative importance of bias, culture, socioeconomic status, access to care, and environmental and genetic influences on the development of disease is an empirical question that, in most cases, remains unanswered. Although there are potential social costs associated with linking race or ethnic background with genetics, we believe that these potential costs are outweighed by the benefits in terms of diagnosis and research. Ignoring racial and ethnic differences in medicine and biomedical research will not make them disappear. Rather than ignoring these differences, scientists should continue to use them as starting points for further research. Only by focusing attention on these issues can we hope to understand better the variations among racial and ethnic groups in the prevalence and severity of diseases and in responses to treatment (1174)

The second is that race is often used as a proxy for class.

And, the third category is what Kawachi, Daniels and Robinson argue is the most defensible, that race and class are two separate issues, and should be treated as such.