Excerpt

The Panel on Race, Ethnicity, and Health in Later Life was established in 2001 under the auspices of the Committee on Population of the National Research Council. The panel’s task was to inform the National Institute on Aging about recent research findings on racial and ethnic differences in health in late life and to help in developing a future research agenda for reducing them. This project was a follow-up to a 1994 Committee on Population workshop, which resulted in a volume of papers published by the National Academy Press, Racial and Ethnic Differences in the Health of Older Americans.

The panel was asked to organize a 2-day workshop, bringing together leading researchers from a variety of disciplines and professional orientations to summarize current research and to identify research priorities. That workshop was held in March 2002 in Washington, D.C. The panel also was asked to produce a summary of the state of knowledge incorporating this information and to provide recommendations for further work. The initial plan called for the papers and the panel report to be published in a single volume, but it was decided to publish the papers and the panel report separately. The papers are presented in this volume. The panel’s final report is available in a companion volume, Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda.

Contents

• The National Academies
• Committee on Population 2004
• Panel on Race, Ethnicity, and Health in Later Life
• Contributors
• Preface
• 1. Introduction
  • THE SIGNIFICANCE OF THE CHAPTERS IN THIS VOLUME
  • SECTION I: THE NATURE OF RACIAL AND ETHNIC DIFFERENCES
  • SECTION II: TWO KEY CONCEPTUAL AND METHODOLOGICAL CHALLENGES
  • SECTION III: THE SEARCH FOR CAUSAL PATHWAYS
  • SECTION IV: THE CHALLENGE OF IDENTIFYING EFFECTIVE INTERVENTIONS
  • SECTION V: TWO INTERNATIONAL COMPARISONS
  • ACKNOWLEDGMENTS
  • REFERENCES
• I. The Nature of Racial and Ethnic Differences
  • 2. Racial and Ethnic Identification, Official Classifications, and Health Disparities
    • RACIAL AND ETHNIC IDENTITY
    • RACIAL AND ETHNIC IDENTIFICATION IN EXISTING DATA USED TO STUDY HEALTH DISPARITIES
    • THE LIMITATIONS OF EXISTING DATA SOURCES
    • SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
    • ACKNOWLEDGMENTS
    • REFERENCES FOR DATA SETS
    • REFERENCES
  • 3. Racial and Ethnic Disparities in Health and Mortality Among the U.S. Elderly Population
    • RACIAL/ETHNIC MORTALITY DISPARITIES AMONG THE ELDERLY
    • RACIAL/ETHNIC DISPARITIES IN HEALTH AND ACTIVITY LIMITATIONS AMONG THE ELDERLY
    • COMPARING RACIAL/ETHNIC DISPARITIES AMONG THE ELDERLY WITH THOSE EXHIBITED BY YOUNGER AGE GROUPS
    • HOW DO HEALTH AND MORTALITY DISPARITIES AMONG THE ELDERLY CORRESPOND WITH DIFFERENTIALS IN SOCIODEMOGRAPHIC FACTORS?
    • BASIC RACIAL/ETHNIC MODELS OF OLDER ADULT HEALTH, ACTIVITY LIMITATIONS, AND MORTALITY
    • CONCLUSION
    • REFERENCES
  • 4. Ethnic Differences in Dementia and Alzheimer's Disease
    • EPIDEMIOLOGY OF AD: CROSS-CULTURAL COMPARISONS
    • STATISTICAL LIMITATIONS
    • COGNITIVE TEST PERFORMANCE
    • GENETICS
    • NONGENETIC RISK FACTORS
    • CULTURAL BELIEFS ABOUT DEMENTIA AND COGNITIVE DECLINE
    • CONCLUSIONS AND FUTURE DIRECTIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
• II. Two Key Conceptual and Methodological Challenges
  • 5. The Life-Course Contribution to Ethnic Disparities in Health
    • POPULATION HEALTH PERSPECTIVE
    • UNDERSTANDING THE LIFE-COURSE
    • BRINGING DEVELOPMENT AND AGING TOGETHER
    • OPPORTUNITIES FOR ETHNICITY TO AFFECT DEVELOPMENTAL TRAJECTORIES
    • COMPLEMENTARY EXPLANATIONS FOR ETHNIC DIFFERENCES ACROSS THE LIFE-COURSE
    • AN AGENDA FOR RESEARCH
    • REFERENCES
  • 6. Selection Processes in the Study of Racial and Ethnic Differentials in Adult Health and Mortality
    • CONCEPTUAL CLARIFICATION: NATURE OF SELECTION PROCESSES
    • SELECTION PROCESSES IN THE LITERATURE ON HEALTH AND MORTALITY DIFFERENTIALS
    • SELECTION PROCESSES RELEVANT FOR RACIAL AND ETHNIC DISPARITIES
    • APPROACHES TO MODEL SELECTION PROCESSES
    • REFERENCES
  • 7. Immigrant Health: Selectivity and Acculturation
    • HEALTH OF THE NATIVE BORN AND FOREIGN BORN: AN OVERVIEW
    • MAIN FINDINGS FROM THE LITERATURE
    • THEORETICAL ISSUES
    • THE HEALTH OF NEW LEGAL IMMIGRANTS
    • EMPIRICAL MODELS OF HEALTH SELECTIVITY AND HEALTH TRAJECTORIES
    • RECOMMENDATIONS ON RESEARCH PRIORITIES AND FUNDING
    • ACKNOWLEDGMENT
    • REFERENCES
• III. The Search for Causal Pathways
  • 8. Genetic Factors in Ethnic Disparities in Health
    • ETHNIC DISPARITIES IN HEALTH STATUS
    • THE CONTRIBUTION OF GENETIC EPIDEMIOLOGY TO UNDERSTANDING ETHNIC DISPARITIES
    • WHAT IS THIS THING CALLED RACE?
    • GENETICS AND THE HEALTH STATUS OF BLACK AMERICANS
    • CONCLUSIONS
    • REFERENCES
  • 9. Race/Ethnicity, Socioeconomic Status, and Health
    • CONCEPTIONS OF SOCIOECONOMIC STATUS
    • MECHANISMS THROUGH WHICH SES WORKS TO AFFECT HEALTH
    • CONCEPTIONS OF HEALTH AND THEIR RELATIONSHIP TO SOCIOECONOMIC STATUS AND RACE/ETHNICITY
    • SOCIOECONOMIC STATUS, AGE, AND HEALTH
    • HOW DOES SOCIOECONOMIC STATUS VARY BY RACE/ETHNIC GROUPS IN MAJOR HEALTH SURVEYS?
    • SOCIOECONOMIC AND RACIAL/ETHNIC DIFFERENCES IN HEALTH
    • EFFECT OF SOCIOECONOMIC STATUS WITHIN ETHNIC GROUPS
    • CONCLUSIONS
    • RECOMMENDATIONS
    • REFERENCES
  • 10. The Role of Social and Personal Resources in Ethnic Disparities in Late-Life Health
    • TOWARD A CONCEPTUAL FRAMEWORK
    • DIFFERENCES IN SOCIAL AND PERSONAL RESOURCES AMONG OLDER ADULTS OF DIFFERENT RACIAL OR ETHNIC BACKGROUNDS
    • SOCIAL AND PERSONAL RESOURCES AND HEALTH DISPARITIES IN LATE LIFE
    • FUTURE DIRECTIONS: TOWARD ELIMINATION OF RACIAL/ETHNIC DISPARITIES RELATED TO SOCIAL AND PERSONAL RESOURCES
    • SUMMARY AND CONCLUSIONS
    • ACKNOWLEDGMENT
    • REFERENCES
  • 11. What Makes a Place Healthy? Neighborhood Influences on Racial/ Ethnic Disparities in Health over the Life Course
    • THE CONCEPT OF NEIGHBORHOOD
    • WHAT DO WE KNOW ABOUT NEIGHBORHOODS AND HEALTH?
    • UNDERSTANDING WHY NEIGHBORHOODS MATTER
    • PATHWAYS TO HEALTH: SPECIFICITY, NATURAL HISTORY, AND LIFE COURSE
    • SELECTION PROCESSES
    • CONCLUSION
    • REFERENCES
  • 12. Racial/Ethnic Disparities in Health Behaviors: A Challenge to Current Assumptions
    • POPULATION PROJECTIONS
    • RACIAL/ETHNIC DISPARITIES IN CHRONIC DISEASE INCIDENCE AND MORTALITY
    • THE ROLE OF RESIDENTIAL ENVIRONMENTS
    • IMPLICATIONS OF OUR FINDINGS
    • CONCLUSIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
  • 13. Cumulative Psychosocial Risks and Resilience: A Conceptual Perspective on Ethnic Health Disparities in Late Life
    • AGING AND DEPRESSION
    • ETHNIC DISPARITIES IN DEPRESSION
    • ETHNIC DIFFERENCES IN DEPRESSION AMONG THE ELDERLY
    • CONCEPTUAL MODEL OF CUMULATIVE BIOPSYCHOSOCIAL VULNERABILITY AND RESILIENCE IN LATE LIFE
    • LIFETIME BURDEN OF ADVERSITIES
    • ALLOSTATIC LOAD AS A BIOBEHAVIORAL MEDIATOR OF RISK
    • LIFETIME ADVANTAGES AS PSYCHOSOCIAL MODERATORS OF RISK
    • SUMMARY AND RECOMMENDATIONS FOR FUTURE RESEARCH
    • ACKNOWLEDGMENTS
    • REFERENCES
  • 14. Significance of Perceived Racism: Toward Understanding Ethnic Group Disparities in Health, the Later Years
    • CONCEPTUALIZATIONS OF RACISM
    • PERCEIVED RACISM AND HEALTH DISPARITIES: A PROPOSED MODEL
    • DIRECTIONS FOR FUTURE RESEARCH
    • ACKNOWLEDGMENTS
    • REFERENCES
  • 15. A Neurovisceral Integration Model of Health Disparities in Aging
    • AUTONOMIC IMBALANCE IN DISEASE AND NEGATIVE EMOTIONS
    • THE MODEL IN A NUTSHELL
    • RELEVANCE TO HEALTH DISPARITIES
    • FUTURE DIRECTIONS AND RECOMMENDATIONS FOR RESEARCH
    • REFERENCES
  • 16. Geography and Racial Health Disparities
    • THE GEOGRAPHY OF HEALTH CARE
    • RACIAL DIFFERENCES IN WHERE (AND FROM WHOM) HEALTH CARE IS PROVIDED
    • GEOGRAPHIC VARIATIONS IN THE EXTENT OF RACIAL DISPARITIES: AN EXAMPLE
    • THE INTERACTION BETWEEN GEOGRAPHY AND RACIAL DISPARITIES: STATISTICAL ISSUES
    • GEOGRAPHY AND RACIAL DISPARITIES: POLICY IMPLICATIONS AND CONCLUSIONS
    • ACKNOWLEDGMENTS
    • Annex to Chapter 16 DEFINITIONS USED IN THE DARTMOUTH ATLAS OF HEALTH CARE
    • REFERENCES
• IV. The Challenge of Identifying Effective Interventions
  • 17. Behavioral Health Interventions: What Works and Why?
    • THE NATURE OF BEHAVIORAL INTERVENTIONS
    • INDIVIDUAL INTERVENTIONS
    • COMMUNITY-LEVEL INTERVENTIONS
    • NATIONAL INTERVENTIONS
    • IMPLICATIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
• V. Two International Comparisons
  • 18. Ethnic Disparities in Aging Health: What Can We Learn from the United Kingdom?
    • MIGRATION OF ETHNIC MINORITY GROUPS TO THE UNITED KINGDOM
    • SOCIAL AND ECONOMIC CIRCUMSTANCES OF OLDER ETHNIC MINORITIES IN THE UNITED KINGDOM
    • PATTERNING OF ETHNIC INEQUALITIES IN HEALTH IN THE UNITED KINGDOM
    • AGE AND ETHNIC INEQUALITIES IN HEALTH
    • DIFFERENCES IN HEALTH BEHAVIORS
    • EXPLAINING THE RELATIONSHIP BETWEEN AGE AND ETHNIC INEQUALITIES IN HEALTH
    • CONCLUSION AND RECOMMENDATIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
  • 19. An Exploratory Investigation into Racial Disparities in the Health of Older South Africans
    • HEALTH IN SOUTH AFRICA
    • INVESTIGATING DISPARITIES IN THE HEALTH OF OLDER SOUTH AFRICANS
    • CAUSE OF DEATH AMONG PEOPLE AGED 45 YEARS AND OLDER
    • RELATIONSHIP OF POPULATION GROUP AND SELECTED ADULT HEALTH INDICATORS
    • DISCUSSION
    • CONCLUSIONS
    • REFERENCES

This study was supported by Contract No. N01-OD-4-2139, TO #78 between the National Academy of Sciences and the National Institute on Aging and a grant from the Andrew W. Mellon Foundation.

Suggested citation:

National Research Council. (2004). Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. N.B. Anderson, R.A. Bulatao, and B. Cohen, Editors. Panel on Race, Ethnicity, and Health in Later Life. Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.