Black Americans continue to have large numbers of premature and excess deaths, measured against white experience, from seven major causes. Major differences in chronic disease, disability and case fatality rates persist despite similarities in the amount of health care received; the nature and quality of care is likely to be dissimilar. Epidemiological and clinical evidence suggests various strategies to reduce these differentials through well-designed public health efforts at prevention. These will have to deal with harsh realities of sociocultural, economic, and political contexts.

Ethnic minority populations show patterns of health, health care use, and mortality that differ from the overall U.S. population. Each of the broad groups of minorities (Asian Hispanic, Native, and African Americans) has a unique background of sociocultural factors that influence these patterns. Thus, the larger social environment for ethnic populations, including political, environmental, historical, and economic factors, is a major variable in possible health outcomes. The individual portions in this panel report of the conference seek to identify such factors for each ethnic group and to suggest those macrosocial influences that are most important for observed health effects.

An aging population and extended longevity are increasing the number of older people needing informal and family support. At the same time, women, the traditional caregivers, have entered the work force in record numbers. Consequently, concerns about how to care for dependent family members have become workplace issues. In response to the needs of employees who care for family members, employers have produced an array of policies, benefits, and programs, including flexible work schedules and information and referral services. Although these programs are a valuable complement to community services and government initiatives, relatively few employers have recognized the potential effects of caregiving on absenteeism, productivity, and turnover; even fewer have responded with workplace programs directed to the needs of their caregiving employees. To fill the gap, the government is considering mandating employee benefits, such as leave time for family illness. Community services are increasingly being directed to the needs of older people and their caregivers.

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