Race and Disease

What is the difference between health inequality and health disparities? Dr. Olivia Carter-Pokras, Associate Professor at the University of Maryland School of Medicine and the School of Public Health, said that health inequality is just a difference in health; health disparities are marked not only by a discernible difference in health, but also an injustice that can be changed. Dr. Carter-Pokras has over 25 years of health disparities research experience within the Federal government and academia, and was previously the Director of the Division of Policy and Data, Office of Minority Health, Department of Health and Human Services. Here at the National Institute on Drug Abuse (NIDA), I attended a presentation Dr. Carter-Pokras gave about health disparities.

After the seminar, I began to think about race in general. When I first arrived at NIDA, research fellows were invited to the Smithsonian National Museum of Natural History in Washington, DC. The museum held an exhibit called “Race: Are we so different?” One idea the exhibit emphasized over and over is that race is a social rather than a biological construct. This means that we created the idea of race to distinguish one human from another. However, someone on the other side of the world is only 0.1% different from me at the genetic level. This may be hard to believe considering that humans come in many different shapes, sizes and colors. The exhibit had strong scientific and historical evidence to support the idea that race is purely a man-made idea.

If race cannot be defined by our genes, why do health care professionals use race to infer other characteristics about their patients? Why does the new Patient Protection and Affordable Care Act (ACA) require the Federal government to collect racial data?

There are a few instances in which race (heritage, to be more accurate) may help physicians and allied health care professionals better treat their patients. However, this is a line that must be walked carefully. For example, some ethnic groups do have a higher prevalence of certain diseases (e.g. Ashkenazi Jews have a higher prevalence of Tay-Sachs disease and African-Americans have a higher prevalence of Sickle Cell Anemia). If a physician understands these links, a diagnosis may be made sooner. However, sometimes making assumptions about race and disease can hurt a patient. The Race exhibit at the Smithsonian featured a video of a father whose infant daughter was not quickly diagnosed with Sickle Cell Anemia. The parents were both white and Sickle Cell Anemia seemed like an unlikely cause of the baby's illness. However, the father was of Sicilian ancestry. A simple blood test confirmed the baby had Sickle Cell Anemia. This was an example in which generalizations about ethnicity and disease can be harmful. Though it may not be commonly known, Sickle Cell Anemia spread to places in southern Europe as well as throughout Africa.

The ACA is working to eliminate health disparities. In a 2011 report, the American Medical Association says the first step to eliminating disparities is to detect them. If this is true then the collection of racial is data is justified. However, a closer look at what we define as race may actually be an indicator of the greater disparities that exist among social determinants of health. For example, while it is true that many minorities endure numerous health disparities, this is often due to the environment in which minorities live and inequities in education, socioeconomic status, and other factors—not race. Poor whites have similar health outcomes to those of ethnic minorities. Similarly, ethnic minorities with higher socioeconomic status have better health outcomes than their poorer counterparts. Race should not define who we are nor how healthy we can be. We should focus on improving the conditions in which many disadvantaged people live which will result in an improvement in health.