1. Understanding Social Influences on Healthcare Disparities Akiko S. Hosler, Ph.D. New York State Dept of Health & University at Albany The 19 th National Conference on Chronic Disease Prevention and Control March 2005

2. 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

3. 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

4. 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)

5. 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

6. 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