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

WHAT IS RACE?

n Biogenetic Factor? n Cultural Factor? n Social Factor?

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

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

Assigning Racial Status: Pre-1989 USA

Assigning Racial Status: Pre-1985 Japan

Assigning Racial Status Brazil

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

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

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)

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)

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)

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)

In % (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. Sickle Cell

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

WHAT IS RACE?

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

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

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

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

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