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Strategies to Reduce Health Disparities
Harold L. Hodgkinson, Ed.D., Director, Center for Demographic Studies, Institute for Educational Leadership, Alexandria, VA
A number of demographic factors have significant impacts on policymakers' and program developers' ability and need to address racial and ethnic health disparities.
Dr. Hodgkinson stressed that race is very important politically, historically, and personally in America, but as commonly used, the term does not meet the scientific definition of race, and therefore has no biological basis when applied to human populations. The term, when commonly used to discuss human populations, has more affinity with the scientific definition of species than of race.
Among human populations:
- There are more genetic differences within a race than between races.
- There are large cultural variations within races (e.g., "Hispanic" includes Mexicans, Puerto Ricans, Cubans, Costa Ricans, and others).
- The definition of "race" changes over time. Members of different European countries were formerly considered to be of different races. These differences blended away over time through marriage. Today's racial distinctions will probably be assimilated in the same way.
- The census can be described as a public opinion poll, as race is self-identified by those answering. The controversy over the 2000 census illustrates this point: Although six race categories were available in the 1990 census, 126 different combinations could be specified in the 2000 census. Seven million people identified themselves as multiracial.
- If Hispanic persons are considered an ethnic group instead of a race, questions could arise over the proper role of agencies such as the Federal Office of Civil Rights.
Growth in minority populations is outpacing the growth of white populations. Although net growth of white persons between 2000 and 2010 is expected to be greater than 5 million, net growth of minority populations is expected to increase by close to 18 million. Minorities will compose 50 percent of U.S. youth by 2025, 50 percent of persons of all ages in 2050. Diversity is concentrated in only 200 of our 3,000 counties; 80 percent of U.S. counties are 95 percent white.
Hispanic and Asian people will account for 61 percent of the U.S. population growth between 1995 and 2025:
- The number of Hispanic persons in the 2000 census increased nearly 60 percent from 1990, bringing the number of Hispanic persons roughly equal to the number of black persons.
- California will add 12 million Hispanic and 6 million Asian people.
- Texas and Florida will add 8 million Hispanic persons.
- Over their lifetimes, the average birth rate for Hispanic women is 3.0 births, the average for black women is 2.6 births, and the average for white women is 1.7 births.
- The number of black births rose from 358,114 in 1946 to 607,556 in 1964. Approximately 70 percent of those born in 1964 graduated from high school (higher than the national average for white persons in this timeframe). High school graduation rates are now the same for black and white persons. Twenty percent of black families have above-average incomes.
The number of American Indians/Alaska Natives (AI/AN) will increase from 2.0 million to 3.4 million between 1995 and 2025.
As overall birth rates in the United States decrease, immigrants will become an increasingly important proportion of the working age population. Although immigrants in the last century came mostly from European countries, they now come primarily from Latin America and Asia. Immigrants often have different cultural values from the dominant culture in such areas as:
- Time (past, present, future).
- Family (nuclear, extended).
- Hierarchy (autocracy, flat).
- Activity (doing, being, becoming).
- Context: Either high context (e.g., gestures, glances, eyebrows, shouts, touching, moving around, and inflection are all part of word meaning) or low context (word meaning is provided through words alone).
Poverty frequently affects health status. Approximately 26 percent of all black Americans and more than 37 percent of black children are poor. Twenty-seven percent of all Hispanic persons and close to 37 percent of Hispanic children are poor. Dr. Hodgkinson pointed out that the United States and England, which he perceives as having visible class structures and distinctions, have much greater variations in the health and lifespans of all their citizens than do other countries.
Hodgkinson H. Census 2000 is coming! Education Week 1999 Sep 29;34,48.
The Commonwealth Fund. U.S. Minority Health: Chartbook. New York (NY): The Fund; 1999 May.