Explaining Racial and Ethnic Health Disparities

In this section, we provide a brief overview of the historical context of race in the U.S. Next, we outline major psychosocial and individual level determinants of health. We then discuss how culture intersects with health beliefs and behaviors. Lastly, we review the role of social networks and environmental factors in health disparities.

Historical Context

Historically, disparities in health status between racial groups were attributed to innate biological differences between groups [29], individuals who were not Anglo-Saxons were considered biologically inferior [30]. More recent, evidence- based research has debunked this notion and confirmed racial taxonomy is not discernible based on biological/genetic information [5] and as a result race is now accepted as a sociocultural construct [29]. Because race is socially determined, it is a fluid construct that can change over time and vary by location and culture. Yet it is common practice to assume race and ethnic classifications are static constructs and infer group homogeneity. Studies of race, ethnicity, and gene variation demonstrate greater genetic heterogeneity within than between racial/ethnic groups [6]. This does not negate the importance of race and ethnicity classifications, but these classifications likely serve as surrogate indicators for more meaningful constructs that explain disparities in health. These constructs include cultural experience and beliefs, educational attainment, experiences with discrimination, and socioeconomic positioning [31].

Race, particularly in the U.S., is associated with different life experiences that affect health. For example, African American history is marked with gross social injustices such as slavery, discrimination, and segregation [32]. Similarly, Native Americans/Alaska Natives have experienced historical traumas including exploitation, loss of land, and enculturation [33]. As a result, these groups often cite mistrust of the health care system as a barrier to both health care and participation in clinical research [34,35]. Many ethnoracial groups continue to experience disadvantage and a higher burden of psychosocial stress throughout life. These experiences may promote maladaptive coping strategies and increase vulnerability to disease and ultimately exacerbate health disparities in late-life [33, 36].

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