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Terms for race, ethnicity, and related health issues

Terms for race, ethnicity, and related health issues
Term Definition Comments
Health disparities Preventable differences in the burden of disease, injury, or violence that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and/or environment.
  • Health disparities can be caused by inequities in the social determinants (or drivers) of health, including health care access and quality, systemic racism, and other factors (see below).
  • Examples of such differences include higher disease risk, incidence, prevalence, and/or complications such as mortality.
  • Often is most relevant to marginalized and oppressed groups within a society.
Health equity A state where everyone has a fair and just opportunity to be as healthy as possible; no one is disadvantaged from obtaining optimal health because of social position or other socially determined circumstances.
  • Distinct from equality, in which there is uniform distribution of resources regardless of need.
Ethnicity Social construct that groups people based on cultural markers, such as sharing a common language, religion, traditions, nationality, or having common beliefs.
  • The United States government has traditionally only recognized Hispanic as an ethnicity but more recently has begun to recognize other ethnic groups.
Race[1-3]

Social construct that groups people primarily driven by physical characteristics (eg, skin tone or facial features).

In practice, race is a socially assigned grouping of people into 1 of 4 or 5 historically created "racial groups" based on how society sees you and thinks of you.

Despite the official status of these racial groupings in government, research, and health professions, the term "race" is a misnomer and there is only 1 race (ie, the human race or Homo sapiens).
  • Not determined by biology.
  • There is a wide range of social, biological, and other characteristics within each racial group.
  • Predicated on a false belief of an innate hierarchal racial structure with the "White race" being superior to all other racial groups.
  • Often used for political purposes or to consolidate power for a dominant group.
  • Extensive historical and contemporary use of race-based bias, including in medicine, although manifestations vary worldwide.
Racism[1,2] A system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call race).
  • Often manifests through biases, stereotypes, prejudices, or overt discrimination being embedded into laws, policies, and practices.
  • These organized systems within societies based on race often cause avoidable and unfair inequalities in power, resources, capacities, and opportunities across racial or ethnic groups.[4]
  • Can be systemic/structural, interpersonal, or internalized.[4]
Structural racism

Totality of ways in which societies foster racial discrimination and health inequities through mutually reinforcing systems.[5]

This in turn reinforces discriminatory beliefs, values, and distribution of resources and opportunities, which together affect health outcomes.
  • Creates health inequities via the inequitable distribution of and actions through the social determinants of health listed below and by promoting stress, depression, and despair, which often result in maladaptive coping behaviors (eg, substance abuse, eating disorders) more often noted among marginalized groups, which then leads to health disparities.
Social drivers of health (also known as "social determinants of health")[6-9] The array of economic, political, and social resources and opportunities that comprise the conditions in which people are born, grow, live, work, play, worship, and age as well as the wider set of forces and systems shaping the conditions of daily life that strongly influence health.[9]
  • Includes access to education, housing, employment, economic and social relationships, quality health care, transportation, food security, and physical environment as well as effects of socioeconomic and political systems, the criminal justice system, and more.
  • Inequities in these factors are important drivers of health disparities.
Race- and ethnicity-based medicine[10] The system in which race and ethnicity are characterized as an essential, biological variable and in which this assumption is translated into clinical practice.
  • Based on fallacy because race is a social construct and not biologically determined.
  • Obscures the proximate causes of health inequalities, including social determinants of health, environmental exposures, and racism.
  • Overlooks the wide intragroup variation of risks and outcomes within any group.
Race- and ethnicity-blind medicine Ignores race and ethnicity entirely; avoids documentation or consideration of race as a factor in health outcomes.
  • Overlooks the fact that we live in a society with racialized structures and systems, which indirectly affect health outcomes.
  • Fails to recognize intergroup differences in risk factors and life experiences.
  • Precludes appropriate public health measures, including community-level interventions to promote health equity.
Race- and ethnicity-conscious medicine Recognition that a person's race and ethnicity may impact how they are treated, their experiences, and their access to opportunities and resources.
  • General recognition of race and ethnicity is appropriate and beneficial at a group level.
  • Should not be used to make assumptions about whether/how these factors have impacted a specific individual.
  • Overlap in the downstream effects of the differential treatment by other identities such as sex, gender identity, class, neurodiversity, and more may exist.
References:
  1. Jones CP. Confronting institutionalized racism. Phylon (1960-) 2002; 50:7.
  2. Jones CP. Invited commentary: "Race," racism, and the practice of epidemiology. Am J Epidemiol 2001; 154:299.
  3. Jones CP. Toward the science and practice of anti-racism: Launching a national campaign against dacism. Ethn Dis 2018; 28:231.
  4. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: A systematic review and meta-analysis. PLoS One 2015; 10:e0138511.
  5. Bailey ZD, Krieger N, Agenor M, et al. Structural racism and health inequities in the USA: Evidence and interventions. Lancet 2017; 389:1453.
  6. Jindal M, Trent M, Mistry KB. The intersection of race, racism, and child and adolescent health. Pediatr Rev 2022; 43:415.
  7. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization. https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1 (Accessed on November 13, 2023).
  8. Social determinants of health. Centers for Disease Control and Prevention. https://www.cdc.gov/publichealthgateway/sdoh/index.html (Accessed on August 10, 2023).
  9. Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health (Accessed on March 27, 2023).
  10. La Veist TA. Why we should continue to study race... but do a better job: An essay on race, racism and health. Ethn Dis 1996; 6:21.
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