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Race and health research is mostly from the United States. The term race or racial group usually refers to the concept of categorizing Humans into Populations or groups on the basis of various sets Notions of race based on Human genetic variation have replaced historical approaches such as Craniology with the advent of Human genetics in Human genetic variation is the natural variation in gene frequencies observed between the genomes of individuals or groups of humans The historical definition of race was an immutable and distinct type or Species, sharing distinct racial characteristics such as constitution temperament The study of race and intelligence is a controversial field which seeks to determine whether or not human intellectual abilities vary between races The modern controversy Social interpretation of physical variation Incongruities of racial classifications Even as the idea of "race" was becoming a powerful organizing principle in many List of racism-related topics|Racism by country Racism, by its simplest definition is the belief that race is the primary determinant of human traits and capacities and that Anti-miscegenation laws, also known as miscegenation laws, were laws that banned Interracial marriage and sometimes interracial sex between whites and members of other Racialism is an emphasis on race or racial considerations Racialism entails a belief in the existence and significance of racial categories but not necessarily in a Racial profiling is the inclusion of racial or ethnic characteristics in determining whether a person is considered likely to commit a particular type of crime or The United States is a racially diverse country There is an extensive history of race-based Slavery, the abolishment of it and its economic Brazil is a racially diverse and Multiracial country Intermarriage among different Ethnic groups has been part of the country's history Human evolution, or anthropogenesis, is the part of biological Evolution concerning the emergence of Homo sapiens as a distinct Species Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is This is a list of topics related to Racism: A Affirmative action Afrocentrism Anti-Arabism The United States of America —commonly referred to as the It has found both current and historical racial differences in the frequency, treatments, and availability of treatments for several diseases. This can add up to significant group differences in variables such as life expectancy. Life expectancy is the average number of years of life remaining at a given age Many explanations for such differences have been argued, including socioeconomic factors (e. g. , education, employment, and income), lifestyle behaviors (e. g. , physical activity and alcohol intake), social environment (e. g. , educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e. g. , cancer screening and vaccination)^[1] as well as to treatment (through lack of insurance, lack of hospitals in certain areas, etc. ), among other environmental differences. Some diseases may also be influenced by genes which differ in frequency between groups, such as sickle-cell anemia, which occurs overwhelmingly among some black populations, although the significance in clinical medicine of race categories as a proxy for exact genotypes of individuals has been questioned. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid The term black people usually refers to a racial group of Humans with dark Skin color, but the term has also been used to categorise a number of diverse The genotype is the genetic constitution of a cell an organism or an individual (i ^{[2] [3]}

Contents 1 Background 1.1 Race and racism 1.2 Health 1.3 Health disparities 2 In the United States 2.1 History 2.2 Racism 2.2.1 Inequalities in health care 2.2.2 Cardiovascular disease 2.2.3 Fear of racism 2.2.4 Segregation 2.3 Socioeconomic factors 2.4 Trends 3 Environmental racism 4 Race and genetic biomedical research 4.1 Genetic differences among races 4.2 Disease association studies 4.3 The effects of racial and ethnic identities on health 4.4 Human Genome Diversity Project 5 See also 6 References 7 Further reading 8 External links

Background

Race and racism

There is considerable debate about the usefulness of racial categories in studies of health. Likewise, the effects of racism on social mobility, segregation and psychological well-being being of ethnic minorities is an emerging topic of study in health research. ^[4] David Williams writes that because race is an unscientific, societally constructed taxonomy, racial or ethnic variations in health status result primarily from variations among races in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors and resources. Although race has only limited biological significance, the concept of race is socially meaningful in the study of health. ^[5] Trevor A. Sheldon and Hilda Parker write that thought and care is needed before data are routinely categorized by race or before race is included as a variable in medical research. They write that the tendency to collect routine ethnic data and include ethnic variables in an ad hoc and uncritical way in the United Kingdom and other countries may help transform minorities into mere statistical categories and produce data and findings which reinforce stereotypes. A stereotype (from Greek: stereo + týpos = "solid impression" is a generalized perception of first impressions behaviors presumed by a group ^[6] David Williams writes that terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors. ^[7] A. H. Goodman writes that using race as a proxy for genetic differences limits understandings of the complex interactions among political-economic processes, lived experiences, and human biologies. ^[8] Thomas A. LaVeist writes that while no credible scientist believes that race has any biological or genetic basis, it does have profound social meaning, rooted in history but with contemporary consequences. Racial status is a risk marker for exposure to racism, which may be a primary etiological factor in race differences in morbidity and mortality. ^[9]

In biomedical research conducted in the U. S. , the 2000 US census definition of race is often applied. This grouping recognizes five races: black or African American, white, Asian, native Hawaiian or other Pacific Islander, and American Indian or Alaska native. Black is the Color of objects that do not emit or Reflect Light in any part of the Visible spectrum; they absorb all such frequencies of African Americans or Black Americans are citizens or residents of the United States who have origins in any of the black populations of Africa White is a Color, the perception which is evoked by Light that stimulates all three types of color sensitive Cone cells in the Human eye Asian or Asiatic is a Demonym for people from Asia. However the use of the term varies by country and person often referring to people from a particular "Kanaka" redirects here For the Tamil actress see Kanaka (actress. Pacific Islander (or Pacific Person, pl Pacific People, also called Oceanic[s] ' is a geographic term to describe the Austronesian Alaska Natives are Indigenous peoples of the Americas native to the state of Alaska within the United States. However, this definition is inconsistently applied across the range of studies that address race as a medical factor, making assessment of the utility of racial categorization in medicine more difficult.

From the perspective of genetics, human population structure is the result of patterns of mating. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is The world population is the total number of living Humans on Earth at a given time In Biology, mating is the pairing of opposite- Sex or hermaphroditic Organisms for copulation and in Social animals also to raise their Francis Collins writes that increasing scientific evidence indicates that genetic variation can be used to make a reasonably accurate prediction of geographic origins of an individual, at least if that individual's grandparents all came from the same part of the world. ^[10] Migration between countries in the last two centuries, with consequent racial admixture has caused some to question the significance of this notion of race to medicine. Human migration denotes any movement by Humans from one locality to another sometimes over long distances or In Chemistry, a mixture is a substance made by combining two or more different materials without a chemical reaction occurring (the objects do not bond together

In multiracial societies such as the United States, racial groups differ greatly in regard to social and cultural correlates such as economic status and access to healthcare. The United States of America —commonly referred to as the Health care is the prevention treatment and management of illness and the preservation of mental health through the services offered by the medical, Nursing These factors are believed to explain most if not all of the differential health care outcomes among races. An open area of investigation is whether genetic differences still show evidence of presences after social and cultural correlates are taken into account.

Health

Health is measured through variable such as life expectancy, and incidence of diseases. The undeniable existence of health disparities indicate that there is a correlation between self-identified race or ethnicity and health or disease in some cases. But the relationship among these factors is complex and poorly understood. Some researchers suggest that to unravel the real causes of health disparities, research must move beyond weakly correlated variables, such as self-identified race or ethnicity, towards an understanding of the more proximate environmental and genetic factors. ^[10]

Health disparities

Main article: Health disparities

Health disparities refer to gaps in the quality of health and health care across racial and ethnic groups. Health disparities (also called Healthcare inequality in some countries refer to gaps in the quality of Health and Health care across racial Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity Health care is the prevention treatment and management of illness and the preservation of mental health through the services offered by the medical, Nursing The term race or racial group usually refers to the concept of categorizing Humans into Populations or groups on the basis of various sets ^[11] The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care. The Health Resources and Services Administration (HRSA an agency within the United States Department of Health and Human Services, is the primary Federal agency for improving "^[12]

In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. The United States of America —commonly referred to as the African Americans or Black Americans are citizens or residents of the United States who have origins in any of the black populations of Africa Native Americans in the United States are the indigenous peoples from the regions of North America now encompassed by the continental United States Asian Americans are Americans of Asian ancestry. They include sub-ethnic groups such as Chinese Americans Filipino Americans Indian ^[13] When compared to whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. White People is the second album by Handsome Boy Modeling School. ^[14] Among the disease-specific examples of racial and ethnic disparities in the United States is the cancer incidence rate among African Americans, which is 10 % higher than among whites. ^[15] In addition, adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes. ^[16] Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Infant mortality is defined as the number of deaths of Infants (one year of age or younger per 1000 live births ^[17]

In the United States

See also: Health care in the United States

The twentieth century witnessed a great expansion of the upper bounds of the human life span. Health care in the United States is provided by many separate legal entities At the beginning of the century, average life expectancy in the United States was 47 years. Life expectancy is the average number of years of life remaining at a given age By century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although longevity in the U. The word longevity is sometimes used as a synonym for " Life expectancy " in Demography. S. population has increased substantially, race disparities in longevity have been persistent. The term race or racial group usually refers to the concept of categorizing Humans into Populations or groups on the basis of various sets African American life expectancy at birth is persistently five to seven years lower than whites. African Americans or Black Americans are citizens or residents of the United States who have origins in any of the black populations of Africa White People is the second album by Handsome Boy Modeling School. ^[18] Princeton Survey Research Associates found that in 1999 most whites were unaware that race and ethnicity may affect the quality and ease of access to health care. ^[19] U. S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos (Vega and Amaro 1994). Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U. S. population (Mahoney and Michalek 1998). European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics (Hummer et al. 2004). In the United States, African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death (Hummer et al. 2004).

The vast majority of studies focus on the black-white contrast, but a rapidly growing literature describes variations in health status among America's increasingly diverse racial populations. Where people live, combined with race and income, play a huge role in whether they may die young. Income, refers to consumption opportunity gained by an entity within a specified time frame which is generally expressed in monetary terms ^[20] A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education. ^[21] A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. Still, sixty-five-year-old black men had a lower total life expectancy (11. 4 years) and active life expectancy (10 years) than white men (total life expectancy, 12. 6 years; active life expectancy, 11. 2 years) The differences were reduced when the data were controlled for education. ^[22]

History

Disparities in health and life span among blacks and whites in the US have existed since the period of slavery. David R. Williams and Chiquita Collins write that, although racial taxonomies are socially constructed and arbitrary, race is still one of the major bases of division in American life. Throughout US history racial disparities in health have been pervasive. ^[23] Clayton and Byrd write that there have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865-1872) was linked to Freedmen's Bureau legislation and the second (1965-1975) was a part of the Black Civil Rights Movement. The Bureau of Refugees Freedmen and Abandoned Lands (usually referred to as the Freedmen's Bureau) was a U The American Civil Rights Movement (1955–1968 refers to the reform movements in the United States aimed at abolishing racial discrimination against African Both had dramatic and positive effects on black health status and outcome, but were discontinued. Although African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980. ^[24]

Demographic changes can have broad impacts on the health of ethnic groups. Cities in the United States have undergone major social transitions during the 1970s 1980s and 1990s. Notable factors in these shifts have been sustained rates of black poverty and intensified racial segregation, often as a result of redlining. Redlining is the practice of denying or increasing the cost of services such as Banking, Insurance, access to jobs access to health care or even Supermarkets ^[25] Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature. ^[26] Race has played a decisive role race in shaping systems of medical care in the United States. The divided health system persists, in spite of federal efforts to end segregation, health care remains, at best widely segregated both exacerbating and distorting racial disparities. ^[27]

Racism

Main article: Racism in the United States

Racial differences in health often persist even at "equivalent" socioeconomics levels. Racism in the United States has been a major issue since the colonial era Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health. ^[28] Using The Schedule of Racist Events (SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. Psychometrics of racism is an emerging field that aims to measure the incidence and impacts of racism on the psychological well-being of people of all races Hope Landrine and Elizabeth A. Klonoff found that racist discrimination is rampant in the lives of African Americans and is strongly related to psychiatric symptoms. ^[29] A study on racist events in the lives of African American women found that lifetime racism was positively related to lifetime history of both physical disease and frequency of recent common colds. These relationships were largely unaccounted for by other variables. Demographic variables such as income and education were not related to experiences of racism. The results suggest that racism can be detrimental to African American's well being. ^[30] The physiological stress caused by racism has been documented in studies by Claude Steele, Joshua Aronson, and Steven Spencer on what they term "stereotype threat. Claude Mason Steele is an American social psychology professor at Stanford University, where he has taught since 1991 Stereotype threat is the fear that one's behaviour will confirm an existing Stereotype of a group with which one identifies "^[31] Kennedy et al found that both measures of collective disrespect were strongly correlated with black mortality (r = 0. 53 to 0. 56), as well as with white mortality (r = 0. 48 to 0. 54). A 1 percent increase in the prevalence of those who believed that blacks lacked innate ability was associated with an increase in age-adjusted black mortality rate of 359. 8 per 100,000 (95% confidence interval: 187. 5 to 532. 1 deaths per 100,000). These data suggest that racism, measured as an ecologic characteristic, is associated with higher mortality in both blacks and whites. ^[32]

Inequalities in health care

There is a great deal of research into inequalities in health care. In some cases these inequalities are a result of income and a lack of health insurance a barrier to receiving services. Almost two-thirds (62 percent) of Hispanic adults aged 19 to 64 (15 million people) were uninsured at some point during the past year, a rate more than triple that of working-age white adults (20 percent). One-third of working-age black adults (more than 6 million people) were also uninsured or experienced a gap in coverage during the year. Blacks had the most problems with medical debt, with 61 percent of uninsured black adults reporting medical bill or debt problems, vs. 56 percent of whites and 35 percent of Hispanics. ^[33] Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured. ^[34]

In other cases inequalities in health care reflect a systemic bias in the way medical procedures and treatments are prescribed for different ethnic groups. Systemic bias is the inherent tendency of a process to favour particular outcomes Raj Bhopal writes that the history of racism in science and medicine shows that people and institutions behave according to the ethos of their times and warns of dangers to avoid in the future. Scientific racism denotes the use of scientific or ostensibly scientific findings and methods to support or validate racist attitudes and worldviews ^[35] Nancy Krieger contended that much modern research supported the assumptions needed to justify racism. Racism underlies unexplained inequities in health care, including treatment for heart disease,^[36] renal failure,^[37] bladder cancer,^[38] and pneumonia. ^[39] Raj Bhopal writes that these inequalities have been documented in numerous studies. The consistent and repeated findings that black Americans receive less health care than white Americans—particularly where this involves expensive new technology—is an indictment of American health care. ^[40]

The infant mortality rate for African Americans is approximately twice the rate for European Americans, but, in a study that looked at members of these two groups who belonged to the military and received care through the same medical system, their infant mortality rates were essentially equivalent (Rawlings and Weir 1992). Recent immigrants to the United States from Mexico have better indicators on some measures of health than do Mexican Americans who are more assimilated into American culture (Franzini et al. 2001). Diabetes and obesity are more common among Native Americans living on U. S. reservations than among those living outside reservations (Cooper et al. 1997).

A report from Wisconsin’s Department of Health and Family Services showed that while black women are more likely to die from breast cancer, white women are more likely to be diagnosed with breast cancer. Breast cancer is a Cancer that starts in the cells of the Breast in women and men Even after diagnosis, black women are less likely to get treatment compared to white women. ^[41] University of Wisconsin African-American studies Professor Michael Thornton said the report’s results show racism still exists today. List of racism-related topics|Racism by country Racism, by its simplest definition is the belief that race is the primary determinant of human traits and capacities and that "There’s a lot of research that suggests that who gets taken seriously in hospitals and doctors’ offices is related to race and gender," Thornton said. "It’s related to the fact that many black women are less likely to be taken seriously compared to the white women when they go in for certain illnesses. "^[42]

Krieger writes that given growing appreciation of how race is a social, not biological, construct, some epidemiologists are proposing that studies omit data on "race" and instead collect better socioeconomic data. Krieger writes that this suggestion ignores a growing body of evidence on how noneconomic as well as economic aspects of racial discrimination are embodied and harm health across the lifecourse. ^[43] Gilbert C. Gee's study A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status found that individual (self-perceived) and institutional (segregation and redlining) racial discrimination is associated with poor health status among members of an ethnic group. Redlining is the practice of denying or increasing the cost of services such as Banking, Insurance, access to jobs access to health care or even Supermarkets ^[44]

Cardiovascular disease

See also: Cardiovascular disease

In a summary of recent studies Jules P. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Harrell, Sadiki Hall, and James Taliaferro describe how a growing body of research has explored the impact of encounters with racism or discrimination on physiological activity. Several of the studies suggest that higher blood pressure levels are associated with the tendency not to recall or report occurrences identified as racist and discriminatory. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated In other words, suppression of awareness of instances of racism has a direct impact on the blood pressure of the person experiencing the racist event. Investigators have reported that physiological arousal is associated with laboratory analogs of ethnic discrimination and mistreatment. ^[45] Racism may lead to a higher incidence of cardiovascular disease in African Americans in three ways:

1. Institutional racism leads to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Institutional Racism (or structural racism or systemic racism) refers to a form of Racism which occurs specifically in institutions such as public
2. Perceived racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. In chemistry a stressor is something that either speeds up a Reaction rate or keeps the reaction rate the same
3. Negative self-evaluations and accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health. Oppression is the act of using power to empower and/or privilege a group at the expense of disempowering marginalizing silencing and subordinating another group ^[46]

Fear of racism

While actual racism continues to have adverse impacts on health, fear of racism, due to historical precedents, can also cause some minority populations to avoid seeking medical help. For example, a 2003 study showed that a large percentage of respondents perceived discrimination targeted at African American women in the area of reproductive health. Within the framework of WHO 's definition of Health as a state of complete physical mental and social well-being and not merely the absence of disease or infirmity reproductive ^[47] Likewise beliefs such as "The government is trying to limit the Black population by encouraging the use of condoms" have also been studied as possible explanations for the different attitudes of whites and blacks towards efforts to prevent the spread of HIV/AIDS. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome ^[48]

Infamous examples of real racism in the past, such as the Tuskegee Syphilis Study (1932-1972), have injured the level of trust in the Black community towards public health efforts. The Tuskegee Study of Untreated Syphilis in the Black Man (also known as the Tuskegee Syphilis Study, Pelkola Syphilis Study, Public Health Service Syphilis Study The Tuskegee study deliberately left Black men diagnosed with syphilis untreated for 40 years. It was the longest nontherapeutic experiment on human beings in medical history. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The false belief that AIDS is a form of genocide is rooted in recent experiences of real racism. Genocide is the deliberate and systematic destruction in whole or in part of an ethnic racial religious or national group These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. Researchers in public health hope that open and honest conversations about racism in the past can help rebuild trust and improve the health of people in these communities. ^[49]

Segregation

Some researchers suggest that racial segregation may lead to disparities in health and mortality. Thomas LaVeis (1989; 1993) tested the hypothesis that segregation would aid in explaining race differences in infant mortality rates across cities. Racial segregation in the United States is the Racial segregation of facilities services and opportunities such as housing education employment and transportation along Analyzing 176 large and midsized cities, LaVeist found support for the hypothesis. Since LaVeist's studies, segregation has received increased attention as a determinant of race disparities in mortality. ^[18] Studies have shown that mortality rates for male and female African Americans are lower in areas with lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. ^[50]

In a study by Sharon A. Jackson, Roger T. Anderson, Norman J. Johnson and Paul D. Sorlie the researchers found that, after adjustment for family income, mortality risk increased with increasing minority residential segregation among Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time In most age/race/gender groups, the highest and lowest mortality risks occurred in the highest and lowest categories of residential segregation, respectively. These results suggest that minority residential segregation may influence mortality risk and underscore the traditional emphasis on the social underpinnings of disease and death. ^[51] Rates of heart disease among African Americans are associated with the segregation patterns in the neighborhoods where they live (Fang et al. 1998). Stephanie A. Bond Huie writes that neighborhoods affect health and mortality outcomes primarily in an indirect fashion through environmental factors such as smoking, diet, exercise, stress, and access to health insurance and medical providers. ^[52] Moreover, segregation strongly influences premature mortality in the US. ^[53]

Socioeconomic factors

A study by Christopher Murray contends the differences are so stark it is "as if there are eight separate Americas instead of one. " Leading the nation in longevity are Asian-American women who live in Bergen County, N. Asian Americans are Americans of Asian ancestry. They include sub-ethnic groups such as Chinese Americans Filipino Americans Indian J. , and typically reach their 91st birthdays, concluded Murray’s county-by-county analysis. On the opposite extreme are American Indian men in swaths of South Dakota, who die around 58. For indigenous peoples in the United States other than Hawaii and Alaska see also Native Americans in the United States.

• Asian-Americans, average per capita income of $21,566, have a life expectancy of 84. 9 years.
• Northland low-income rural Whites, $17,758, 79 years.
• Middle America (mostly White), $24,640, 77. 9 years.
• Low-income Whites in Appalachia, Mississippi Valley, $16,390, 75 years.
• Western American Indians, $10,029, 72. 7 years.
• Black Middle America, $15,412, 72. 9 years.
• Southern low-income rural Blacks, $10,463, 71. The Southern United States &mdashcommonly referred to as the American South, Dixie, or simply the South &mdashconstitutes a large distinctive 2 years.
• High-risk urban Blacks, $14,800, 71. 1 years. ^[20]

The risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting that socioeconomic inequities are the root causes of most of the differences (Cooper et al. 2003; Cooper 2004).

Trends

Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. ^[54] David Williams writes that higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death. ^[55]

Environmental racism

Main article: Environmental racism

Environmental racism is a form of racial discrimination where race-based differential enforcement of environmental rules and regulations; the intentional or unintentional targeting of minority communities for the siting of polluting industries such as toxic waste disposal; and the exclusion of people of color or lack thereof from public and private boards, commissions, and regulatory bodies results in greater exposure to pollution. Environmental racism refers to intentional or unintentional Racial discrimination in the enforcement of environmental rules and regulations the intentional or unintentional List of racism-related topics|Racism by country Racism, by its simplest definition is the belief that race is the primary determinant of human traits and capacities and that Pollution is the introduction of contaminants into an environment that causes instability disorder harm or discomfort to the physical systems or living organisms they are in For other uses of this term see Industry (disambiguation An industry (from Latin industrius, "diligent industrious" Toxic waste is waste material often in chemical form that can cause death or injury to living creatures RD Bullard writes that a growing body of evidence reveals that people of color and low-income persons have borne greater environmental and health risks than the society at large in their neighbourhoods, workplaces and playgrounds. ^[56]

Policies related to redlining and urban decay can also acts as a form of environmental racism, and in turn have an impact on public health. Redlining is the practice of denying or increasing the cost of services such as Banking, Insurance, access to jobs access to health care or even Supermarkets Urban decay is a process by which a City, or a part of a city falls into a state of disrepair Environmental racism refers to intentional or unintentional Racial discrimination in the enforcement of environmental rules and regulations the intentional or unintentional Urban minority communities may face environmental racism in the form of parks that are smaller, less accessible and of poorer quality than those in more affluent or white areas in some cities. ^[57] This may have an indirect impact on health since young people have fewer places to play and adults have fewer opportunities for exercise. ^[57]

Robert Wallace writes that the pattern of the AIDS outbreak during the 80s was affected by the outcomes of a program of 'planned shrinkage' directed in African-American and Hispanic communities, and implemented through systematic denial of municipal services, particularly fire extinguishment resources, essential for maintaining urban levels of population density and ensuring community stability. Planned shrinkage is a United States policy of withdrawing essential city services (such as police patrols garbage removal street repairs and fire services from ^[58] Institutionalized racism affects general health care as well as the quality of AIDS health intervention and services in minority communities. Institutional Racism (or structural racism or systemic racism) refers to a form of Racism which occurs specifically in institutions such as public The overrepresentation of minorities in various disease categories, including AIDS, is partially related to environmental racism. The national response to the AIDS epidemic in minority communities was slow during the 80s and 90s showing an insensitivity to ethnic diversity in prevention efforts and AIDS health services. ^[59]

Race and genetic biomedical research

The role of race in biomedicine is actively debated among biomedical researchers. Biomedical research (or experimental medicine) in general simply known as medical research, is the Basic research or Applied research conducted The primary impetus for considering race in biomedical research is the possibility of improving the prevention and treatment of diseases. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Many previous studies have observed that disease susceptibility and environmental responses vary by race. Thus, some researchers believe that race may be an informative category for biomedical research. Other researchers believe that racial categories have no valid biomedical applications, and may be socially harmful (Jackson, 2004).

The role of race in biomedicine is actively debated among biomedical researchers. Biomedical research (or experimental medicine) in general simply known as medical research, is the Basic research or Applied research conducted

Several questions are considered:

• can the concept of "race" be considered valid?
• When should race be taken into account when studying humans?
• What definition of race is appropriate for biomedical research?
• Do the biological differences between races justify the use of racial categories in research?
• Can genetic assignment to population groups be used in lieu of self-identified race?
• What are the ethical implications of using race in research?

The primary impetus for considering race in biomedical research is the possibility of improving the prevention and treatment of diseases. Bioethics is the philosophical study of the ethical controversies brought about by advances in Biology and Medicine. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Many previous studies have observed that disease susceptibility and environmental responses vary by race. Thus, some researchers believe that race may be an informative category for biomedical research. Other researchers believe that racial categories have no valid biomedical applications, and may be socially harmful (Jackson, 2004).

Genetic differences among races

Further information: Race and population genetics

“	Most Americans still believe that there is some biological legitimacy to our socially constructed racial categories. The term race or racial group usually refers to the concept of categorizing Humans into Populations or groups on the basis of various sets However, our modern scientific understanding of human genetic diversity flies in the face of all of our social stereotypes.	”
—Joseph L. Graves, Jr. Joseph L Graves, Jr is Dean of University Studies and Professor of Biological Studies at North Carolina Agricultural and Technical State University. , evolutionary biologist

The biomedical relevance of genetic differences among races is a matter of debate. In general, genetic clusters exist that correspond roughly to the census definition of race and to self-identified ancestry. An ancestor is a Parent or ( recursively) the parent of an ancestor (i One large exception to this correspondence is that South, Central, and West Asians (e. g. Asian Indians) cluster with Europeans and are separate from East Asians. The association between race and genetics also breaks down for groups, such as Hispanics, that exhibit a pattern of geographical stratification of ancestry. Hispanic (hispano hispánico hispânico Hispānus adjective from ''Hispānia'', the Roman name for the Iberian Peninsula) is a term that historically Some researchers argue that the available evidence supports the notion that some of the genetic differences between races have biomedical significance, and thus should be studied.

An alternative view argues that the underlying genetic-cluster categories can be used in lieu of racial labels for biomedical purposes. Proponents of this view argue that by directly examining the genotype, the problem of using racial labels can be avoided. The genotype is the genetic constitution of a cell an organism or an individual (i Moreover, they argue that genotyping is more reliable than using self-identified race as a proxy for ancestry. Some fear that the use of racial labels in biomedical research runs the risk of unintentionally exasperating health disparities, since doing so would mask risk factors such as exposure to racism and economic differences.

Proponents of using race in biomedical research argue that ignoring race will be detrimental to the health of minority groups. They argue that disease risk factors differ substantially between racial groups, that relying only on genotypical classes ignores non-genetic racial factors that impact health, and, furthermore, that minorities would be poorly represented in clinical trials if race were ignored. A risk factor is a variable associated with an increased risk of Disease or Infection. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices

These issues can be illustrated by looking at an example, sickle-cell disease. Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid This disease has a clear relation to geographic origin since the associated gene also provides protection to a common tropical disease, Malaria. Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including Thus, it is much more common in people of African descent than in whites. In an emergency room, this may help a doctor doing an initial diagnosis if a patient presents with symptoms compatible with this disease. However, this is still unreliable evidence. Testing the genotype by examining the blood of the patient gives the definitive evidence, not the race. The genotype is the genetic constitution of a cell an organism or an individual (i Also, the disease does not follow absolute racial lines, it is most common in African American and Hispanics of Caribbean ancestry, but the trait has also been found in those with Middle Eastern, Indian, Latin American, Native American, and Mediterranean heritage, making it difficult to exclude patients who present with compatible symptoms simply based on race. [1] Most diseases argued to have some correlation to race have much weaker correlation to geographic origin than sickle-cell disease, meaning that the value of knowing the race and not the exact genotype is even weaker.

Disease association studies

Michael Bamshad writes that inference about an individual’s ancestry trough self-identified race can make it easier to predict how likely an individual is to have a some disease-causing variants. HbSallele in sub-Saharan Africans and Southern Europeans or the C282Y-HFEand ∆508-CFTRalleles, which cause haemochromatosis and cystic fibrosis, respectively,in Northern Europeans are well known examples,but many others have been discovered. Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs ^[60] It is believed that many of these mutations first occurred in the population that is most affected.

The common disease-common variant (often abbreviated CD-CV) hypothesis predicts common disease causing alleles will be found in all populations. The common disease-common variant (often abbreviated CD-CV hypothesis predicts that common disease-causing alleles or variants will be found in all human populations An often cited example is an allele of apolipoprotein E, APOE ε4, which is associated in a dose-dependent manner with susceptibility to Alzheimer's disease. Alzheimer's disease ( AD) also called Alzheimer disease or simply Alzheimer's, is the most common form of Dementia. This allele is found in Africans, Asians and Europeans. However, many disease causing alleles are found to have different (technically called epistatic) effects in different populations. Epistasis is the Interaction between genes Epistasis takes place when the action of one Gene is modified by one or several other genes which are sometimes called For example, the increased risk of Alzheimer's disease that is associated with the APOE ε4 allele is 5-fold higher in individuals with Asian rather than African ancestry. Alzheimer's disease ( AD) also called Alzheimer disease or simply Alzheimer's, is the most common form of Dementia.

Polymorphisms in the regulatory region of the CCR5 gene affect the rate of progression to AIDS and death in HIV infected patients. CCR5, short for chemokine (C-C motif receptor 5, is a Chemokine receptor. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome While some CCR5 haplotypes are beneficial in multiple populations, other haplotypes have population-specific effects. The term haplotype is a contraction of the term " haploid Genotype. For example, the HHE haplotype of CCR5 is associated with delayed disease progression in European-Americans, but accelerated disease progression in African-Americans. Similarly, alleles of the CARD15 (also called NOD2) gene are associated with Crohn's disease, an inflammatory bowel disorder, in European-Americans. Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus However, none of these or any other alleles of CARD15 have been associated with Crohn's disease in African-Americans or Asians.

The effects of racial and ethnic identities on health

Although, considerable evidence indicates that the racial and ethnic health disparities observed in the United States arise mostly through the effects of discrimination, differences in treatment, poverty, lack of access to health care, health-related behaviors, racism, stress, and other socially mediated forces, differences in allele frequencies certainly contribute to group differences in the incidence of some monogenic diseases, and they may contribute to differences in the incidence of some common diseases (Risch et al. Poverty (also called penury) is deprivation of common necessities that determine the quality of life including food clothing shelter and safe Drinking water, and 2002; Burchard et al. 2003; Tate and Goldstein 2004). For the monogenic diseases, the frequency of causative alleles usually correlates best with ancestry, whether familial (for example, Ellis-van Creveld syndrome among the Pennsylvania Amish), ethnic (Tay-Sachs disease among Ashkenazi Jewish populations), or geographical (hemoglobinopathies among people with ancestors who lived in malarial regions). Ellis-van Creveld Syndrome (also called chondroectodermal dysplasia or mesoectodermal dysplasia) is a rare Genetic disorder of the Skeletal The Amish (ˈɑːmɪʃ are members of an Anabaptist Christian denomination best known for Simple living, Plain dress and resisting modern conveniences Tay-Sachs disease (abbreviated TSD, also known as GM2 Gangliosidosis, Hexosaminidase A deficiency or Sphingolipidosis) is a Genetic Ashkenazi Jews, also known as Ashkenazic Jews or Ashkenazim ( Hebrew: אַשְׁכֲּנָזִים, ˌaʃkəˈnazim sing To the extent that ancestry corresponds with racial or ethnic groups or subgroups, the incidence of monogenic diseases can differ between groups categorized by race or ethnicity, and health-care professionals typically take these patterns into account in making diagnoses.

Even with common diseases involving numerous genetic variants and environmental factors, investigators point to evidence suggesting the involvement of differentially distributed alleles with small to moderate effects. Frequently cited examples include hypertension (Douglas et al. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated 1996), diabetes (Gower et al. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc 2003), obesity (Fernandez et al. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected 2003), and prostate cancer (Platz et al. 2000). However, in none of these cases has allelic variation in a susceptibility gene been shown to account for a significant fraction of the difference in disease prevalence among groups, and the role of genetic factors in generating these differences remains uncertain (Mountain and Risch 2004).

Human Genome Diversity Project

The Human Genome Diversity Project (HGDP) has attempted to map the DNA that varies between humans. The Human Genome Diversity Project ( HGDP) was started by Stanford University 's Morrison Institute and a collaboration of scientists around the world The Human Genome Diversity Project ( HGDP) was started by Stanford University 's Morrison Institute and a collaboration of scientists around the world Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known In the future, HGDP could possibly reveal new data in disease surveillance, human development and anthropology. The Human Genome Diversity Project ( HGDP) was started by Stanford University 's Morrison Institute and a collaboration of scientists around the world Clinical surveillance (or Syndromic surveillance) refers to the Surveillance (systematic collection analysis and interpretation of health data about a clinical Human development is the process of Growing to maturity In biological terms this entails growth from a one-celled Zygote to an adult Human being Anthropology (/ˌænθɹəˈpɒlədʒi/ from Greek grc ἄνθρωπος anthrōpos, "human" -λογία -logia) is the study of HGDP could unlock secrets behind and create new strategies for managing the vulnerability of ethnic groups to certain diseases. The Human Genome Diversity Project ( HGDP) was started by Stanford University 's Morrison Institute and a collaboration of scientists around the world A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly It could also show how human populations have adapted to these vulnerabilities. In Biology a population is the collection of inter-breeding organisms of a particular Species; in Sociology To date, HGDP research has collected samples from 52 distinct ethnic groups, this methodology has been criticised by some on the basis that ethnic groups are considered socio-cultural constructs and not biological populations. Anthropologist Jonathan Marks has stated that: "As any anthropologist knows, ethnic groups are categories of human invention, not given by nature. Jonathan Marks (born 1955 is a biological Anthropologist at the University of North Carolina at Charlotte. Their boundaries are porous, their existence historically ephemeral. There are the French, but no more Franks; there are the English, but no Saxons; and Navajos, but no Anasazi. . . we cannot really know the nature of the actual relationship of the modern group to the ancient one. . . The worst mistake you can make in human biology is to confuse constructed categories with natural ones. And to overload a big project with cultural categories as the overall sampling strategy would be a serious problem. First it would make those labels appear to be genetic units; indeed, it would make them genetic units, which they had not been previously. Second, it would emphasise the genetic distinctions among these groups; it would force them to be genetically distinct by being labeled at the outset. "^[61] Many indigenous peoples have refused to take part in the HGDP due to concerns about misuse of the data: "In December [1993], a World Council of Indigenous Peoples in Guatemala repudiated the HGDP. "^[61] The project has raised ethical questions. Some worry that the results will be misued by racists. ^[62] However, members of this project have been described as "liberals who argue that the project will help to reduce racism by showing that the concept of race is scientifically unsustainable" by Human Genetics Alert (HGA)^[63]

See also

• Health and intelligence
• Race and height
• List of countries by life expectancy
• Health disparities
• Center for Minority Health
• Black Report
• Pharmacogenomics
• Medical genetics
• Ethnic bioweapon
• Social determinants of health

References

Further reading

• Bohannon, A. D. (1999), ‘Osteoporosis and African American women’, J. Women's Health Gend. Based Med. Vol. 8, pp. 609-615.
• Boni, R. , Schuster, C. , Nehrhoff, B. and Burg, G. (2002), ‘Epidemiology of skin cancer’, Neuroendocrinol. Lett. Vol. 23 (Suppl. 2), pp. 48-51.
• Douglas, J. G. , Thibonnier, M. and Wright, Jr. , J. T. (1996), ‘Essential hypertension: Racial/ethnic differences in pathophysiology’, J. Assoc. Acad. Minor. Phys. Vol. 7, pp. 16-21.
• Dvornyk, V. et al. Differentiation of Caucasians and Chinese at Bone Mass Candidate Genes: Implication for Ethnic Difference of Bone Mass. Ann. Hum. Genet. 67, 216 - 227 (2003)
• Editorial. Genes, drugs and race. Nature Genetics 29, 239 - 240 (2001).
• Farrer, L. A. et al. Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium. JAMA 278, 1349-1356 (1997).
• Ferguson, R. and Morrissey, E. (1993), ‘Risk factors for end-stage renal disease among minorities’, Transplant. Proc. Vol. 25, pp. 2415-2420.
• Fernandez, J. R. et al. Association of African genetic admixture with resting metabolic rate and obesity among women. Obes. Res. 11, 904-911 (2003).
• Gaines, K. and Burke, G. (1995), ‘Ethnic differences in stroke: Black-white differences in the United States population. SECORDS Investigators. Southeastern Consortium on Racial Differences in Stroke’, Neuroepidemiology Vol. 14, pp. 209-239.
• Gonzalez, E. et al. Race-specific HIV-1 disease-modifying effects associated with CCR5 haplotypes. Proc. Natl Acad. Sci. USA. 96, 12004-12009 (1999).
• Gower, B. A. et al. Using genetic admixture to explain racial differences in insulin-related phenotypes. Diabetes 52, 1047-1051 (2003).
• Halder I, Shriver MD. (2003). Measuring and using admixture to study the genetics of complex diseases. Hum Genomics 1, 52-62.
• Hardy, J. , Singleton, A. & Gwinn-Hardy, K. Ethnic differences and disease phenotypes. Science 300, 739-740 (2003).
• Hargrave, R. , Stoeklin, M. , Haan, M. and Reed, B. (2000), ‘Clinical aspects of dementia in African-American, Hispanic, and white patients’, J. Nat. Med. Assoc. Vol. 92, pp. 15-21.
• Hodge, A. M. and Zimmet, P. Z. (1994), ‘The epidemiology of obesity’, Baillieres Clin. Endocrinol. Metab. Vol. 8, pp. 577-599.
• Hoffman, R. M. , Gilliland, F. D. , Eley, J. W. et al. (2001), ‘Racial and ethnic differences in advanced-stage prostate cancer: The Prostate Cancer Outcomes Study’, J. Nat. Cancer Inst. Vol. 93, pp. 388-395.
• Holden, C. Race and medicine. Science 302, 594-596 (2003).
• Hugot, J. P. et al. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease. Nature 411, 599-603 (2001).
• Inoue, N. Lack of common NOD2 variants in Japanese patients with Crohn's disease. Gastroenterology 123, 86-91 (2002).
• Jackson, F. L. C. (2004). Book chapter: Human genetic variation and health: new assessment approaches based on ethnogenetic layering British Medical Bulletin 2004; 69: 215–235 DOI: 10. 1093/bmb/ldh012. Retrieved 29 December 2006.
• Martin, M. P. et al. Genetic acceleration of AIDS progression by a promoter variant of CCR5. Science 282, 1907-1911 (1998).
• Martinez, N. C. (1993), ‘Diabetes and minority populations. Focus on Mexican Americans’, Nurs. Clin. North Am. Vol. 28, pp. 87-95.
• Martinson, J. J. , Chapman, N. H. , Rees, D. C. , Liu, Y. T. & Clegg, J. B. Global distribution of the CCR5 gene 32-basepair deletion. Nature Genet. 16, 100-103 (1997).
• McKeigue, P. M. , Miller, G. J. and Marmot, M. G. (1989), ‘Coronary heart disease in south Asians overseas: A review’, J. Clin. Epidemiol. Vol. 42, pp. 597-609.
• McKeigue, P. M. , Shah, B. and Marmot, M. G. (1991), ‘Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians’, Lancet Vol. 337, pp. 382-386.
• Molokhia, M. and McKeigue, P. M. (2000), ‘Risk for rheumatic disease in relation to ethnicity and admixture’, Arthritis Res. Vol. 2, pp. 115-125.
• Ogura, Y. et al. A frameshift mutation in NOD2 associated with susceptibility to Crohn's disease. Nature 411, 603-606 (2001).
• Risch, N. ; Burchard, E. ; Ziv, E. & Tang, H. (2002). Categorization of humans in biomedical research: genes, race and disease. Genome Biol. 3, comment2007. [2]
• Rosati, G. (2001), ‘The prevalence of multiple sclerosis in the world: An update’, Neurol. Sci. Vol. 22, pp. 117-139.
• Schwartz, A. G. and Swanson, G. M. (1997), ‘Lung carcinoma in African Americans and whites. A population-based study in metropolitan Detroit, Michigan’, Cancer Vol. 79, pp. 45-52.
• Shimizu, H. , Wu, A. H. , Koo, L. C. et al. (1985), ‘Lung cancer in women living in the Pacific Basin area’, Nat. Cancer Inst. Monogr. Vol. 69, pp. 197-201.
• Songer, T. J. and Zimmet, P. Z. (1995), ‘Epidemiology of type II diabetes: An international perspective’, Pharmacoeconomics Vol. 8 (Suppl. 1), pp. 1-11.
• Wiencke, J. K. Impact of race/ethnicity on molecular pathways in human cancer. Nature Rev. Cancer 4, 79-84 (2003).
• Yancy, C. D. Does race matter in heart failure. Am. Heart J. 146, 203-206 (2003).
• Zoratti, R. (1998), ‘A review on ethnic differences in plasma triglycerides and high-density-lipoprotein cholesterol: Is the lipid pattern the key factor for the low coronary heart disease rate in people of African origin?’, Eur. J. Epidemiol. Vol. 14, pp. 9-21.

External links

• Cultural Diversity in Healthcare Speaker Series University of Wisconsin School of Medicine and Public Health
• Cultural Diversity in Healthcare Research Symposium University of Wisconsin School of Medicine and Public Health
• News-Medical.net
• Unnatural causes, videos on how racial inequalities influence health

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