Talk:Race and health

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    [edit] Race and racism section

    I think that much of this material should be in the Race or Racism articles. There could be a smally summary in thie article and a link to these main articles.Ultramarine 06:14, 3 March 2007 (UTC)

    Sorry, read it to rapidly, the articles are directly related to the subject.Ultramarine 17:31, 3 March 2007 (UTC)
    I trimmed it a bit, so I think that also helped. futurebird 17:35, 3 March 2007 (UTC)


    [edit] US centric

    I'm aware that this article is US centric. Anyone have any sources that could help expand the scope? futurebird 17:35, 3 March 2007 (UTC)

    I don't have any sources, but as far as I know, there are several german studies concerning the health of turkish migrants/communication problems with doctors etc. in germany. Maybe that could be one direction to do further research? 87.160.227.109 11:34, 4 March 2007 (UTC)

    [edit] What causes the lower life exptancy?

    It should be possible to find out from official statistcs exactly which diseases or circumstances cause the lower life expectancy.Ultramarine 06:26, 3 March 2007 (UTC)

    1. Diabetes is HUGE for US blacks
    2. "reduced mortality" may come from other factors that don't show up as a cause of death.
    3. I don't know if all of these studies control for violent deaths. Some do, however.

    futurebird 06:40, 3 March 2007 (UTC)

    [edit] Should the "Race in biomedicine" article be merged with this article

    Despite th name, the "Race in biomedicine" article is almost exclusively about genetic explanations and nothing else. Should it be merged to this article? Ultramarine 06:34, 3 March 2007 (UTC)

    Yeah, I think so. futurebird 06:37, 3 March 2007 (UTC)
    Let's put up the "merge" banner. futurebird 06:37, 3 March 2007 (UTC)
    Done. I will merge in a day or two unless there are objections.Ultramarine 06:43, 3 March 2007 (UTC)
    Why would anyone who is not a racist want to take an article that is almost purely about genetics, and therefore scientifically defensible, and mess it up by throwing it in with all the mish-mash of imprecision etc. associated with [race]? To me that's like throwing a slightly misnamed article on "madness" into a context that supports the idea of witchcraft. Wouldn't it be better to isolate the truly scientific stuff regarding genetics and disease (and the empirically defensible stuff about mental illnesses) in an appropriately named article? I would prefer renaming "Race in biomedicine" to "Genetics in biomedicine." Then keep the "Race and health" article for all the cases where racism has an influence on health. In fact, why not rename this article as "Racism against health"? P0M 01:11, 4 March 2007 (UTC)
    You make some good points. It might make more sense to rename the other article. I wonder what ultra thinks about all of this? futurebird 01:15, 4 March 2007 (UTC)
    But, I also think that much of the material in that article supports ideas in this article. It'd help fill out the picture. Race differences in health are mostly about the environment. A few things, like skin cancer are probably about genetics and the environment. futurebird 01:22, 4 March 2007 (UTC)
    Genetics in biomedicine is an extremely broad topic. Researchers are looking for genetic factors in almost every disease and often finding some contribution. This has little to do with "race" in itself. Usually this means that if you have a relative with a certain disease, you yourself may have a higher risk due to shared genes.
    I think that "Race and health" is a good title. This of course includes the effects on health of racism, but there may also be research on genetic differences in health related factors that is legitimate. At the very least there are some not-Pioneer Funded genetic researchers who think that "race" has some value when studying health, so this should be discussed.Ultramarine 10:17, 4 March 2007 (UTC)
    True enough.futurebird 15:34, 4 March 2007 (UTC)
    There are at least two things going on. [Race] is used as a stop-gap measure because it is easy to make a few superficial inquiries and categorize people according to [race] and those categorizations have some predictive value. But they have predictive value because, in an imprecise way, they rope in information about genetics, they rope in information about economics, they rope in information about the environments people are living in (Given a choice, will City Council put the toxic factors dump next to the poor whites in S. Philadelphia, or the poor blacks in W. Philadelphia? Well, if the mayor's name is Rizzo...), etc. But if doctors had the kind of information they really need they would have the genetic "profile" of an individual, his/her history of exposure to various bad factors in the natural and social environment, etc. People in medicine are challenging doctors to avoid snap judgments based on the presumed [race] of an individual patient. Being a certain color doesn't predict with certainty the efficacy or failure of a certain medication. Follow-up study of the patient is essential.P0M 19:53, 4 March 2007 (UTC)
    These are valid points but I do not understand why they cannot be pointed out in this article? My main argument is that the titles "Race and health" and "Race and biomedicine" covers essentially the same tapic, so they should be the same article.Ultramarine 12:00, 5 March 2007 (UTC)
    Again I say: Make the title of the "Race and biomedicine" article fit its content since the authors do not have a strong set to see race as the master concept in the scientific study of medicine. Do not make the content of that article get lost to fit the current titles of the two articles. If you do you reduce clarity by replacing a discusion on gentics, which is a fairly clearly definable concept, with a discussion of a basket case. Risch has an interesting way of arguing for the validity of the concept of race, and it is one that I can accept, but it is not one that glosses over the basket case nature of this concept. P0M 00:57, 12 March 2007 (UTC)

    You said it yourself: "Despite the name, the "Race in biomedicine" article is almost exclusively about genetic explanations and nothing else." Keep one article for genetics-only research and keep the other article for the shotgun "race" approach to discovering causal effects. If you just merge the articles then the distinction between race and genetics will be lost. P0M 05:06, 10 March 2007 (UTC)

    I think your point is that race is not a valid genetic concept. This is of course a valid view held by many people, but there are also serious researchers having the opposite view, that there are some races that are in some sense genetically distinct. This is discussed in the race article. Regardless, the result of scholarly studies using this assumption is a valid view and I think this is the correct place to put these sourced results. Either the race article or some a general genetics in biomedicine article article focus on a broader and more general overview. We should of course mention and link from here to the general discussion regarding whether race is valid genetic concept. Furthermore, even assuming this, it is as you state very questionable if doctors are helped by knowing that a member of a certain race have a slightly higher risk of a disease like hypertension. This is the right article to point this out.Ultramarine 08:21, 10 March 2007 (UTC)

    [edit] Non-genetic and non-racist factors

    The section on "Eight separate Americas" needs to point out that there are at least three separate kinds of causal factors that may be involved:

    1. Racist attitudes can have deleterious effects in themselves.
    2. Racist attitudes can limit care provided.
    3. Cultural attitudes can encourage detrimental choices. (I'm thinking of cultures that associate large amounts of meat, large amounts of fat, large amounts of alcohol, abstinence, etc., with success and/or survival.)
    4. Cultural attitudes can encourage wise choices. (I'm thinking of the longevity of the Chinese people mentioned. How much does that have to do with the prevalence of dishes consisting of large quantities of various kinds of vegetables with only enough meat to provide flavoring. Japanese are believed to gain major health benefits from diets heavy in fish.)

    The non-genetic factors can be associated with genetic factors simply because people isolated enough to have some degree of genetic specificity are also likely to have evolved their own cultural inventions.

    One factor that is often remarked on is that some cultures can make people wary of seeking psychotherapy for fear of ostracism or at least negative reactions from their cohorts. The flip side is that some cultures may have institutions that maximize psychological nurture and mental health. P0M 23:48, 3 March 2007 (UTC)

    I don't think that study talked about causes. It just mentioned the size of the gaps... but, I'll take another look now... futurebird 01:16, 4 March 2007 (UTC)
    I didn't mean to imply that it did. I cooperated with one of the professors here who gave a course on psychological counseling techniques and once a year he would do something on how to try to talk to Chinese patients despite their fear that they would receive negative attention if they went to see "the crazy doctor." I'm pretty sure he encountered this idea in his own research, but I have no idea what his biblio was for that course. The odd thing is that Chinese people have had a two thousand year long tradition of going to teachers/philosophers for advice on how to handle the crazy making events of life. So seeking aid when your life is coming apart is nothing new to the culture. It's just that when it gets handled in a medical context and the word "abnormal" is attached then people take a different attitude toward it.
    If we are concerned to educate people about the forces in life that they could bring to bear to ease their health problems, then a concern with culture would be one thing. I don't mean "which fork do you use for the shrimp" culture, but the kind of things that people invent to solve social problems or head them off before they start. I'm really impressed by the black people in this country who manage to cope on a daily basis. Somebody has learned some vital lessons and has inculcated them in others. For instance, Julian Bond came to Stanford in 1967 or thereabouts to give a talk to a roomful of Stanford students and whoever else showed up. He was driven down from the SF airport by a stunningly attractive woman his own age. (He was as handsome as she was beautiful, which may have a bearing on what happened next.) We got into the seminar room and the spaces around the long table filled up with people, most of them men and most of them looking like ordinary students. Then there was one 30ish white guy who almost immediate started to attack Julian Bond on the grounds that he was having sex with the young woman. A few of us made objections to what the white guy was saying. Finally a couple of us got really angry and I guess that we both had enough aggression in our voices to convince the guy that his mouth was going to get shut one way or another. But what I have never forgotten is that Julian Bond didn't have any apparent emotional reaction to the verbal attacks at all. He had a coping device that he got from his parents or his community that I certainly didn't have. Encouraging culture of this type is on the pro-active side of the game. I wish the parents of some of my 8th grade students could have talked to and guided some of the students whose parents hadn't prepared their children culturally for school. I don't mean that the kids should have been prepared to shut up and act nice or anything like that. Instead, I am thinking of a girl named Mamie who could concentrate on her schoolwork in the midst of absolute chaos. She had a clear idea of what she needed to get out of school, and nobody's disruptive behavior was going to get in her way. (Sadly, I wasn't a good enough teacher to do her much good.)
    With regard to health, the problem for all people everywhere (at least those not forced on a subsistence diet by famine) is how to solve the life problems presented by the ready availability of foods that aren't good for one's health and to maximize the health-giving components. When I was in Taiwan I had a teacher who was tutoring foreign students in Chinese culture to make a living. He lived in cheap housing and he did not have a large budget for food. However, he was very careful about what he ate. He explained that part of his training growing up was in how to maintain a proper diet. He was 60 years old and looked no older than 40 at the time. So his approach to diet was to choose an extra sardine over an extra bowl of rice even though the rice would have sated his hunger and he didn't care for the taste of the sardine that would leave him a little hungry anyway. (My example, not his.)
    The other place where education could make a big difference is in teaching people how to get health information, how to get appropriate medical care, etc. I worried about one of my friends in Philadelphia that, being on a very limited budget after her husband died, she might try to economize on health care. I wondered whether she felt she could approach hospitals that were largely run by white people. I wondered whether she could be assertive enough to get treatment when she needed it. (Even white doctors have problems on that score.) I wondered whether she made health choices on the basis of emotional reactions to various things in her past and in her current environment that would cause her to rationalize poor choices (e.g., on dietary choices). I expected that her church would help her with these issues, but the church may not have had the resources to even know how she should be guided, much less have the counseling skills to get her to change some patterns in her life. If they had all had good information (from something like Wikipedia, for instance), then things might have been much better for her in the last couple of years of her life. But getting the problem solving skills for health maintenance across to people may require the same kind of educational effort that prepared Julian Bond to deal with foul-mouthed racists without risking a heart attack.
    I am basically saying that I hope that there is somebody out there who has written on these issues, someone whom we can quote. There ought to be lots written in the field of public health about how to use mass media and other approaches to get people to maintain a good diet, get needed immunization, etc. But I somehow doubt that much of it will be tailored to the categories of health education as they intersect with categories of [race]. There may be a little written on how to reach out to white people and make them aware that they ought to keep out of intense UV bombardments, how to reach out to blacks regarding heart disease, etc. But I will bet that there is not much written about how the white medical establishment needs to allay suspicion when they are trying to help a population that strongly suspects that even the doctors are part of the racist establishment and not to be trusted. Maybe I'm being unduly pessimistic. If so there ought to be plenty of "race and public health" articles out there somewhere.P0M 05:41, 5 March 2007 (UTC)

    Murray says he was surprised to find that lack of health insurance explained only a small portion of those gaps. Instead, differences in alcohol and tobacco use, blood pressure, cholesterol and obesity seemed to drive death rates.

    Most important, he says, will be pinpointing geographically defined factors such as shared ancestry, dietary customs, local industry and which regions are more or less prone to physical activity.
    Murray is a bit behind the curve. No mention of racism. Shared ancestry? Well, maybe a little, but that's not the lion's share of the cause... What is it with guys named Murray from Harvard? futurebird 01:20, 4 March 2007 (UTC)
    Before he wrote the Bell Curve he wrote another book in which he said that living in limited economic circumstances did not force communities to have a bad social environment. He pointed to ways in which people living in Thai farming communities (in around the 1960s) had no indoor plumbing, no running water, no electrical power, etc., yet they did not feel poor and they did not experience heavy social problems. His observation at that time in his life was that culture was more important than other factors once you had at least enough food and water to live on. So I couldn't figure out where this other stuff came from in his Bell Curve.
    I may not be following the right train of argument here, but what strikes me is that multiple factors protect people against things like alcohol.
    On the socialization side, it has long been noticed in medical/psychiatric literature that Jewish people are very rarely alcoholics. The researchers noted that peer pressure to drink was short-circuited in the Jewish community because drinking alcohol was never a badge of adulthood. Children drank a little wine in the home in a socially appropriate situation. They learned that a little was good for you, and getting wasted made you a loser. The same thing happens in Chinese families.
    On the physiological side, alcohol was invented early in Eurasian history, and distillation was also invented a long time ago. Not many people could afford to purchase large amounts of alcohol to consume, and people whose metabolism could not handle alcohol well became more and more outnumbered by people who survived alcohol consumption with few negative effects. So by the time cheap hard liquor became available, people were relatively well fixed to deal with the negative effects.
    In the Americas, however, neither a cultural awareness of how to derive benefit rather than disaster from drinking was present, nor were the people genetically adapted to "fire water".
    Obesity is a problem that comes with an overabundance of cheap calories. In times of near starvation, the people whose bodies do not waste a single calorie are the ones who survive. In the livestock industry, cows, pigs, and chickens who put on weight most efficiently are called "thrifty eaters." They are "thrifty" for the farmer because it costs less to feed them to market weight. A human who is a "thrifty eater" and raised on the cultural view that the ideal meal is a one-pound T-bone steak, well marbled with fat, and a heaping pile of french fried potatoes will very easily get fat. (People like me can eat and eat and eat and only build more muscle. If I were a cow I would have been culled and run through a meat grinder early in life because the farmer would have figured out that I would never make a steer worthy of being taken to the county fair, nor would my market price pay him back for all the corn I ate.) There is not much people can do about their genetic identities, but people who get educated about the outcomes of eating bad stuff can eat well and prosper without getting super sized. It's a cultural thing.
    People like my orphan friends in Taiwan may grow up feeling that the world owes them a rich diet, and that denying themselves that rich diet would be to sentence themselves to the kind of deprivation that was imposed upon them in the orphanage. It's difficult to get people to change attitudes toward food when the attitudes come from adverse social conditions that needed to be opposed in order to secure one's own survival. I was away from Taiwan for 10 years. When I came back I ran into my old orphanage friends. All but one of the skinny little kids had turned into fat adults in a culture where obesity was rare and usually reserved for old people who led a sedentary life style. My friends enjoyed eating all that food, but it was probably killing them. P0M 19:53, 4 March 2007 (UTC)
    [Race] is being used in medicine, whether I like it or not. Keep "race" in the title of this article.
    Genetics is what needs to be used in medicine (along with other factors noted above). Rename the other article and let it concentrate on how medicine is learning to use scientific genetic information in its work.P0M 19:56, 4 March 2007 (UTC)
    There is already a Medical genetics article. But the intersection of race and health/medicine is small sub-subject of this*. If there are objections to medicinal genetics in general, they should be in a broad article. If there are objections to genetics regarding health and races, that is a much narrower subject.Ultramarine 12:05, 5 March 2007 (UTC)
    • This? This what?????

    Since there is a Medical genetics article, Race in biomedicine article should be merged with it, not with this article. P0M 05:06, 10 March 2007 (UTC)

    For clarity I will reply in only section above.Ultramarine 08:07, 10 March 2007 (UTC)

    [edit] Do not merge with health disparities

    This article should not be merged with health disparities. First off, these are two separate subjects, with health disparities being a subsubject of this article. This means there are large sections of this article which would not be appropriate in the health disparities article. I like how the article is now, with a section of this article being about health disparities with a link to the main health disparities article. Please note, though, that my comments have nothing to do with the larger issues raised on this article's talk page. Only about merging the two articles. Best, --Alabamaboy 23:25, 9 March 2007 (UTC)


    Okay. Fair enough. futurebird 15:51, 10 March 2007 (UTC)

    [edit] European Americans at low risk for obesity

    the US is 40% obese, the vast majority of the obese people are "european americans". this is not a "low" risk and doctors don't treat it that way. doctors they don't make any decisions or recommendations based on these low risks ("i see you're white, feel free to eat mcdonalds regularly....you're at a low risk for obesity"). this should be rephrased or removed. —The preceding unsigned comment was added by 71.112.7.212 (talk) 16:55, 10 March 2007 (UTC).

    I support this change. This article contains a quite a few problems along these lines. Please feel free to help revise it. futurebird 18:02, 10 March 2007 (UTC)

    [edit] Problem with one section, Health disparities

    The section on Health disparities does not work. The first paragraph mentions both health and health care. The second paragraph only adduces instances of differences in health. I think that if the section is going to mean anything it should report any correlations between health of the various [races] and the quality of health care being afforded to them. If lots of people in one group are dying because of melanoma, is that simply because that group is susceptible to that disease, or is it because there is no public health initiative to teach people to look for symptoms, because people's concerns are pooh-poohed when they seek care, because members of that group get poor care when they do present for treatment, etc. P0M 02:05, 11 March 2007 (UTC)

    [edit] Why use unexplained acronyms?

    What is SES supposed to mean? It is linked to an article but "socio-economic" only explains the "SE" part. Readers should not be forced to guess. P0M 02:20, 11 March 2007 (UTC)

    Agree. Let's remove them. futurebird 15:26, 29 September 2007 (UTC)

    [edit] risk table

    I think this table should be deleted because it is overly simplistic. there are no figures to back it up. Muntuwandi 04:30, 11 May 2007 (UTC)

    I agree. futurebird 15:25, 29 September 2007 (UTC)


    [edit] Stuff to add

    Posting some sources to add. futurebird 15:11, 10 October 2007 (UTC)

    http://www.alternet.org/rights/64567/ The Health Risks of Racism By Molly M. Ginty, Women's eNews. Posted October 9, 2007.

    Black women are twice as likely as white women to give birth prematurely and five times more likely to do so in Southern states such as Mississippi. A black woman is 3.7 times more likely to die during pregnancy than a white woman and six times more likely to do so in some urban areas such as New York City. The center's 19-member Courage to Love: Infant Mortality Commission -- funded by the W.K. Kellogg Foundation and partnering with the UCLA School of Public Affairs and the University of Michigan's NIH Roadmap Disparities Center -- says the health problems of black women and black infants stem not just from inadequate medical care but from stress, racism, poverty and other social pressures. Only 75 percent of African American women have prenatal care compared to 89 percent of white women. Black women are more likely than their peers to have hypertension and diabetes, which can leave the fetus undernourished.


    [edit] Image? =

    Crude death rate by country
    Crude death rate by country

    Should we add this image? futurebird 17:30, 1 November 2007 (UTC)