The Meaning of Race in Medical and Public Health Research

1. The Meaning of Race in Medical and Public Health Research Thomas A. LaVeist, Ph.D. Associate Professor Johns Hopkins School of Public Health

2. WHAT IS RACE? WHAT IS RACE? WHAT IS RACE? WHAT IS RACE?

3. WHAT IS RACE? • Biogenetic Factor? • Cultural Factor? • Social Factor?

4. The Prominence of Race in Health Research Source: AJE Jones, LaVeist, and Lillie-Blanton 1991 HSR Williams (1994) JHSB LaVeist, Williams, Jones and Lillie-Blanton 1992

5. How Race is Typically Used • Sample Selection • Stratification • Binary Variables in Regression to “Control” for Race Effect

6. Assigning Racial Status: Pre-1989USA

7. Assigning Racial Status: Pre-1985Japan

8. Assigning Racial StatusBrazil

9. Preto Retinto (dark Black) Pretos (Black) Cabra (slightly less Black) Cabo Verde (slightly less Black) Mulatto Esuro (dark Mulatto) Mulatto Claro (light Mulatto) Moreno Sararas Blanco Blanco de Terra Mulatto is Divided Based on Darkness of Skin Color

10. Race Defined Persons who are relatively homogeneous with respect to biological inheritance. A Dictionary of Epidemiology (1988)

11. Race 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)

12. Race 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)

13. Race 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)

14. Race 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)

15. Race 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)

16. 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)

17. 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)

18. 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)

19. 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)

20. The Dictionary of Modern Medicine (1992)

21. Sickle Cell 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.

22. Measurement Differs by Data Collection Method • Birth Certificates - assigned mother’s race based on visual assessment of mother • Death Certificates - assigned based on visual assessment of the body • Telephone/Mail Survey - Respondent self-report • Face-to-face Survey - Interviewer’s visual assessment

23. WHAT IS RACE? WHAT IS RACE? WHAT IS RACE? WHAT IS RACE?

24. CONSTRUCT VALIDITY POVERTY Poor Housing Access to Health Care HEALTH STATUS Poor Nutrition Environmental Hazards

25. CONCEPTUAL MODEL OF RACE • RACE LATENT (UNOBSERVED) FACTOR MANIFEST INDICATOR (skin color) • PHYSIOGNOMY CATEGORIZATION INTO RISK/BEHAVIOR GROUPS SOCIETAL CULTURE ETHNICITY HEALTH/ILLNESS BEHAVIOR EXTERNAL RISK EXPOSURE RISK EXPOSURE RACE DIFFERENCES IN HEALTH STATUS OBSERVED HEALTH OUTCOMES

26. USING RACE • Indicate how race was measured • Provide a scientifically valid rationale for including race • Provide a Scientifically valid rationale for excluding race

27. USING RACE • Develop explicit measures for factors believed to be measured by race binary variables • Always provide an interpretation for findings of a significant race effect in your analysis • Treat the race variable with the same degree of caution as other variables

28. The Meaning of Race in Medical and Public Health Research Thomas A. LaVeist, Ph.D. Associate Professor Johns Hopkins School of Public Health