Table Of ContentMapping “Race”
Critical Issues in Health and Medicine
Edited by Rima D. Apple, University of Wisconsin– Madison,
and Janet Golden, Rutgers University, Camden
Growing criticism of the U.S. health care system is coming from consumers,
politicians, the media, activists, and healthcare professionals. Critical Issues in
Health and Medicine is a collection of books that explores these contemporary
dilemmas from a variety of perspectives, among them political, legal, histori-
cal, sociological, and comparative, and with attention to crucial dimensions
such as race, gender, ethnicity, sexuality, and culture.
For a list of titles in the series, see the last page of the book.
Mapping “Race”
Critical Approaches to Health
Disparities Research
Edited by
Laura E. Gómez and Nancy López
Rutgers University Press
New Brunswick, New Jersey, and London
Library of Congress Cataloging- in- Publication Data
Mapping race : critical approaches to health disparities research / edited by Laura E. Gómez
and Nancy López.
p. ; cm. — (Critical issues in health and medicine)
Includes bibliographical references and index.
ISBN 978– 0– 8135– 6137– 0 (hardcover : alk. paper) — ISBN 978– 0– 8135– 6136– 3 (pbk. :
alk. paper) — ISBN 978– 0– 8135– 6138– 7 (e- book)
I. Gómez, Laura E., 1964– II. López, Nancy, 1969– III. Series: Critical issues in health
and medicine. [DNLM: 1. Continental Population Groups—U nited States. 2. Health Status
Disparities— United States. 3. Health Services Accessibility— United States. WA 300 AA1]
362.1'0973— dc23 2012042036
A British Cataloging-i n- Publication record for this book is available from the British Library.
This collection copyright © 2013 by Rutgers, The State University
Individual chapters copyright © 2013 in the names of their authors
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Contents
List of Figures and Tables vii
Foreword ix
R. Burciaga Valdez
Preface xiii
Chapter 1 Introduction: Taking the Social Construction of Race
Seriously in Health Disparities Research 1
Laura E. Gómez
Part I Charting the Problem 23
Chapter 2 The Politics of Framing Health Disparities:
Markets and Justice 25
Jonathan Kahn
Chapter 3 Looking at the World through “Race”- Colored Glasses:
The Fallacy of Ascertainment Bias in Biomedical
Research and Practice 39
Joseph L. Graves Jr.
Chapter 4 Ethical Dilemmas in Statistical Practice:
The Problem of Race in Biomedicine 53
Jay S. Kaufman
Chapter 5 A Holistic Alternative to Current Survey Research
Approaches to Race 67
John A. Garcia
Part II Navigating Diverse Empirical Settings 85
Chapter 6 Organizational Practice and Social Constraints:
Problems of Racial Identity Data Collection in
Cancer Care and Research 87
Simon J. Craddock Lee
v
vi Contents
Chapter 7 Lessons from Political Science: Health
Status and Improving How We Study Race 104
Gabriel R. Sanchez and Vickie D. Ybarra
Chapter 8 Advancing Asian American Mental Health
Research by Enhancing Racial Identity Measures 117
Derek Kenji Iwamoto, Mai M. Kindaichi,
and Matthew Miller
Part III Surveying Solutions 131
Chapter 9 Representing the Multidimensionality
of Race in Survey Research 133
Aliya Saperstein
Chapter 10 How Racial-G roup Comparisons Create Misinformation
in Depression Research: Using Racial Identity Theory to
Conceptualize Health Disparities 146
Janet E. Helms and Ethan H. Mereish
Chapter 11 Jedi Public Health: Leveraging Contingencies of Social
Identity to Grasp and Eliminate Racial Health Inequality 163
Arline T. Geronimus
Chapter 12 Contextualizing Lived Race-G ender and the Racialized-
Gendered Social Determinants of Health 179
Nancy López
Notes on Contributors 213
Index 217
Figures and Tables
Figures
3.1 Age- Specific Mortality, Selected Years (1963– 2004),
Black/White Americans 40
4.1 Mary Gets a Score of 100 on a Verbal Ability Test 62
6.1 Conceptual Schematic of Identity Data Collection in a Cancer
Service Line 99
12.1 Multidimensional “Race” Data at the Individual, Micro-level 192
12.2 Multidimensional Ethnicity as Distinct from “Race” 198
12.3 Racialized and Gendered Social Determinants of Health:
Multilevel “Race” Data at the Micro-, Meso- , and Macro- levels 200
Tables
3.1 Life of Homo sapiens Condensed into a Calendar Year 46
5.1 Heuristic Chart of Holistic Race Measures 70
6.1 Initial Draft Policy Categories 92
7.1 Determinants of Health Status among Full/Latino Sample
(Ordered Logistic Regression) 111
8.1 PRIAS- 15 and PRIAS- 12 Items Derived from Confirmatory
Factor Analysis on the Original PRIAS 122
8.2 Multiple Regression Using the PRIAS, PRIAS- 15, and
PRIAS- 12 Measures as Predictors and Psychological
Well-B eing as the Outcome 123
10.1 Some Examples of Risk Factors Used as Proxies for Race in
Depression Research 150
10.2 Racial Identity Schemas for People of Color and White People 156
vii
Foreword
In 2008, the National Institutes of Health hosted over five thousand scholars
at its first Science of Eliminating Health Disparities Summit. The subsequent
annual summits were designed to encourage integration of science, practice,
and policy to build a healthier society. As the opening plenary keynote speaker
for the first one, I was asked to address “Health Disparities and the Intersection
of Science and Policy.” I deliberately anchored my talk in an explanation of
health disparities as a reflection of social stratification and inequitable resource
allocations along “racial” and “ethnic” lines. But what do we mean by “racial”
and “ethnic” lines?
The scholars in this volume challenge us to be more precise about how we
define and operationalize this type of stratification. Why? Because individuals
are born into our society that neither treats people nor distributes opportunity
equally. We observe discrimination, poverty, and other forms of oppression
play out at the community level affecting overall community environment and
opportunities. Especially in resource-p oor communities, the stresses of daily
life bear down on the minds and bodies of residents, inviting illness through
environmental exposures and other types of stress that are expressed biologi-
cally in what we recognize as disease.
While Congress has required documenting these “racial” and “ethnic” dis-
parities annually by the Agency for Health Research and Quality, it has done
little to remedy the situation. Over the last few years, private philanthropies,
such as the Robert Wood Johnson Foundation and the California Endowment,
have recognized the need to prevent disparities by addressing the inequities in
our society as well as addressing health care disparities—c reating a more just
society and thus a more healthy nation.
Interdisciplinary research plays an increasingly important role in address-
ing highly complex social issues such as health disparities. It allows schol-
ars to reach beyond the boundaries of their own disciplines and to adapt or
develop new methods of analysis. Institutional policies that support integrat-
ing the social and biological sciences could represent the twenty-fi rst- century
breakthrough similar to what we experienced in the twentieth century when
biological and chemical scientists developed the fields of biochemistry, molec-
ular biology, and molecular genetics that led to the sequencing of the human
genome. Supporting interdisciplinary health and social science investigations
ix
x R. Burciaga Valdez
and the development of transdisciplinary fields requires our nation’s funding
institutions and universities to be more flexible and open to new ways of see-
ing things. The Institute for the Study of “Race” and Social Justice within the
RWJF Center for Health Policy at the University of New Mexico is one example
of such efforts.
Sequencing the human genome provided definitive proof that there is no
genetic or biological evidence for the concept of “race.” Yet in our society we
often rely on assumptions about “race” that erroneously assume that it is inter-
changeable with genes to explain the world and our understanding of it. Scien-
tists are not immune from using the myth of race as biology in dangerous ways.
When I arrived in New Mexico in 2008, I had the opportunity to participate in
the annual Cancer Center retreat. Researchers shared the marvelous molecu-
lar discoveries brought about by genomic research advances, which offer pros-
pects for innovations in treatment for a wide variety of cancers; however, I was
taken aback when colleagues resorted to explaining statistical propensities for
groups of people in New Mexico using wildly inaccurate racial stereotypes.
These genetic reductionist interpretations of health disparities denied Ameri-
can Indian spiritual beliefs, challenged the history of Hispanic settlement in
the region, and posed findings in ways that could be misinterpreted in policy
implementation.
Despite all the problems inherent in the erroneous assumptions associated
with the concept of “race,” it is imperative that we continue to collect data that
captures the lived experiences and practices that contribute to the racialized
inequality that is reproduced at all levels of society. While some may argue for
a color-b lind society and an end to the collection of “race” or “ethnic” data,
this book deliberately understands “race” as a social construction that can be
mapped vis-à - vis legal efforts to eliminate racism in all its forms—i ndividual,
institutional, and systemic. For example, in the areas of banking and housing
we have largely eliminated public policies restricting groups of people from
living in certain areas; however, informal practices in the mortgage and real
estate industries continue to produce de facto segregation.
Over the last several decades, we have negligently accepted racial catego-
ries in our work without the typical scrutiny we use to define variables for
our analyses. Instead of interrogating and capturing the social construction of
race in our research, we have at times blindly treated race as if it were a static
characteristic that allows for the comparison of the health of different groups
in our society. Or we have misused race as a proxy for many unmeasured fac-
tors in our studies, for example, class or culture, thereby masking what may be
amenable to clinical intervention or social policy intervention.
