Panel I: Epidemiology of minority health.

Abstract

Collecting epidemiologic data by ethnicity and race is a highly useful undertaking; but "bench mark" comparisons relative to majority Americans should not take priority over defining the determinants of health status within a minority group. Thus, it is necessary to identify factors contributing to the measured health status and to modify the environment, lifestyles, and behaviors to diminish the likelihood of undesirable health outcomes. This article presents an overview of the health status of African Americans, Asians and Pacific Islanders, and Hispanics. The goals are to provide a framework for the rational interpretation of both health status data and its determinants both within and between minority groups. This approach recognizes the heterogeneity of health status that exists within a minority group and encourages investigators to place more emphasis on the within-group health status differentials as they search for modifiable factors that underlie the risk for undesirable health outcomes.

Bone Density in an Immigrant Population from Southeast Asia

“…Epidemiologic studies on Asian-Americans have typically sampled the Japanese population. Researchers have drawn inferences about the health status or morbidity pattens of the Japanese as an example of Asian/Pacific Islanders, overlooking the issue of ethnic diversity among AsianAmericans [28,29]. Moreover, previous studies on bone loss and the determinants of bone density have targeted white women, and there exists a need to develop research aimed at other affected populations so they may benefit from efforts to prevent osteoporosis-related disability.…”

“…Asian-Americans are one of the fastest growing ethnic minorities in the United States [28]. However, knowledge about health risks, or morbidity and mortality patterns, in this population is very limited.…”

Culturally competent interventions in schools for children with physical health problems

“…For example, differential prevalence, morbidity, and mortality rates have been associated with race and ethnicity for many childhood health conditions including asthma, diabetes, obesity, cancer, sickle cell disease, heart disease, liver disease, substance abuse, and injury Flack et al, 1995;Johnson et al, 1995). Likewise, SES has also been linked to decreased adherence, more medical complications, and increased mortality rate for some pediatric conditions (Clay, 2004;Maloney, Clay, & Robinson, 2005).…”

“…Although a thorough discussion of them is clearly beyond the scope of this article, it is important to understand the full range of possible causes. Proposed factors accounting for these differences include genetic susceptibility to illness, differing beliefs about health and wellness, lifestyle variables associated with culture such as diet and exercise, difference in access to and utilization of preventative and tertiary health care services, differing rates of adherence to medical treatments, environmental influences such as exposure to toxins and violence, differing rates of chronic stress affecting autoimmune functioning, and biases in provision of healthcare services (Flack et al, 1995;Johnson et al, 1995;Penn, Kar, Kramer, Skinner, & Zambrana, 1995). Another potential explanation is the incompatibility with treatments and cultures of patients, which will be discussed below.…”

People need policy and policies need people

“…It is important to recognize the heterogeneity of health status within a minority group and to place more emphasis on within-group health status differentials, especially in the search for modifiable factors that increase the risk for undesirable health outcomes. 9 One reason for the imbalance in data reporting may be the racial/ethnic imbalance among epidemiologists themselves. In 1992, the American College of Epidemiology Committee on Minority Affairs assessed the racial/ethnic distribution of faculty, students, and postdoctoral fellows in epidemiology degree programs in the United States.…”