I Ethnogeriatrics Foundations

Why Ethnogeriatrics Is Important

Jeannine S. Skinner, Lauren Duke, and Consuelo H. Wilkins

Ethnogeriatrics Foundations: Defining Key Terms and Concepts

Ethnogerontology is the study of the causes, processes, and consequences of race, national origin, culture, minority group, and ethnic group status on individual and population aging in the three broad categories of biological, psychological, and social aging [3]. Ethnogeriatrics refers to the influence of culture, race, and ethnicity on health care for older persons from diverse ethnoracial populations.

The United States (U.S.) Census and Office of Management and Budget (OMB) defines race as a sociocultural construct that is not biologically, anthropologically, or genetically based [4]. Federal taxonomy mandates the minimum categorization of five racial groups (Asian, American Indian or Alaskan Native, Native Hawaiian or other Pacific Islander, Black or African American, and White). According to this taxonomy, ethnicity, a separate construct, is categorized as Hispanic or Latino [5]. Table 1.1 provides detailed description of U.S. federal race/ethnicity classifications. Conventional practices classify race based on phenotypic attributes such as facial features and skin color [6]. Ethnicity focuses less on physical attributes and encompasses cultural, behavioral, and environmental factors, which may be a more relevant construct for examining differences in health [7 ] . The Office of Minority Health defines culture as the “thoughts, communications, actions, customs, beliefs,

J.S. Skinner, Ph.D. • L. Duke, M.A.

Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Biomedical Building, Nashville, TN 37208, USA

C.H. Wilkins, M.D., M.S.C.I. (*)

Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Biomedical Building, Nashville, TN 37208, USA

Meharry Medical College , Nashville , TN , USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017

L. Cummings-Vaughn, D.M. Cruz-Oliver (eds.), Ethnogeriatrics, DOI 10.1007/978-3-319-16558-5_1

Table 1.1 U.S. Federal Office ofManagement and Budget race and ethnicity categories

Race or ethnicity


American Indian or Alaska Native

A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment


A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam

Black or African American

A person having origins in any of the black racial groups of Africa

Native Hawaiian or Other Pacific Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands


A person having origins in any of the original peoples of Europe, the Middle East, or North Africa

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race

Note: Data from U.S. Office of Management and Budget. Revision to the Standards for Classification of Federal Data on Race and Ethnicity 1997

values, institutions of racial, ethnic, religious, or social groups” [8]. Culture also informs lifestyle and health behaviors and thus plays an important role in ethnora- cial differences in disease and chronic health conditions. Relatedly, cultural competence refers to the knowledge and interpersonal skills that allow health providers to understand, appreciate, and work with individuals from cultures other than their own [9]. Improving cultural competence among health care providers may be a critical step toward addressing health disparities [10]. Cultural humility describes the process of self-reflection and self-critique in one’s limitations in intercultural understanding and recognition of the power imbalance between patients and providers. Cultural humility helps to facilitate mutual respect and communication between patients and providers [11].

The U.S. Department of Health and Human Services and the Center for Disease Control defines health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” [12]. Dressler and colleagues [13] add to the definition by noting health disparities also refer to differences in morbidity, mortality, and health care access by race and ethnicity. Related terms include health inequality and health inequity. Health inequality refers to systemic differences in the health of groups and communities occupying unequal positions in society [14], whereas health inequity describes inequalities in health that are the consequence of bias or injustice [15]. Despite differences among these terms, they are often used interchangeably [16]. Social determinants of health refer to the effect of social and economic factors that both directly and indirectly affect health. Several conceptual models of social determinants of health have been proposed [17-19]. While these models differ in complexity, most express health as the byproduct of downstream and proximal factors such as health-related attitudes

Table 1.2 Definitions of key definitions related to ethnogeriatrics




The process of adopting the attitudes, values, and behaviors of a different culture



The knowledge and skill to engage with people from different cultures and backgrounds

Cultural humility

The process of self-reflection in order to understand limitations in intercultural understanding


A society’s collective thoughts, actions, customs, beliefs, and values


A group based on shared beliefs, cultural, behavioral, and environmental factors


The influence of culture, ethnicity, and race on health care in older adults


Study of the causes, processes, and consequences of race and ethnicity on aging

Health disparity

A health difference based on social, economic, and/or environmental disadvantage

Health inequality

Systemic health differences between groups based on differences in societal position

Health inequity

Health differences that are the product of bias or injustice


A social construct to define differences, usually physical attributes, between groups that has no biological basis

Social determinants of health

The direct or indirect effect of social and economic factors on health



A person’s or group’s position in society based on educational attainment, income, and occupational status

and behaviors, which are influenced by upstream and more distal factors such as socioeconomic opportunities and resources (e.g., housing, income, and food supply) [20]. Table 1.2 presents definitions of key terms related to ethnogeriatrics.

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