Question

What are the arguments and guiding principles that the authors in the additional readings present, to suggest that they are in favor of “comparison population”, in lieu of the currently used term ‘White population’? How does this improve the conceptualization, categorization and naming of different racial and ethnic groups, when understanding their health?

Answer 1

The concepts of ethnicity and race in health care and public health raise difficult ethical issues, which have seldom been explicitly considered.Ethnicity  and race are controversial variables in epidemiology and public health, including the many branches of these disciplines, and yet they are of central interest.The fuel of epidemiology is the analysis of differences in the pattern of ill health and disease in populations.public health policy is largely founded upon such analyses, particularly where differences are inequitable in the sense of unjust. The central epidemiological question is this: For example, why in comparison with the British population as a whole is diabetes so common in people who originate in India but live , and bring benefit to all populations. The mysteries behind the myriad of ethnic differences are, however, not easily solved. An emphasis on disease differences, so appropriate to the analysis required in the science of epidemiology, is deeply influential in the health policy and management arena where it is sometimes inappropriate for similarities may matter more.As interest in, and the influence of, research on ethnicity and race is rising it is important that the conceptual basis of the work is sound. The forces that will stimulate more work on ethnicity, race, and health include the new genetics, the focus on health and health care inequalities, globalisation, migration, and the increase in the movement of refugees and asylum seekers.

As implied above the concepts of ethnicity and race are being hotly debated in epidemiology. Furthermore, there is no consensus on appropriate terms for use in the scientific study of health by ethnicity and race, and published guidelines on how to use these concepts, from a number of journal, are yet to be widely adopted.

The word ethnicity derives from the Greek word ethnos, meaning a nation. Ethnicity is a multi-faceted quality that refers to the group to which people belong, and/or are perceived to belong, as a result of certain shared characteristics, including geographical and ancestral origins, but particularly cultural traditions and languages. The characteristics that define ethnicity are not fixed or easily measured, so ethnicity is imprecise and fluid. Ethnicity differs from race, nationality, religion, and migrant status, sometimes in subtle ways, but may include facets of these other concepts. It follows that investigators who wish to study ethnicity should collect data on such underlying factors, especially language, religion, country of birth, and family origins.

Veterans Affairs (VA) patient populations are becoming increasingly diverse in race and ethnicity. The purpose of this paper is to (1) document the importance of using consistent standards of conceptualizing and categorizing race and ethnicity in health services research, (2) provide an overview of different methods currently used to assess race and ethnicity in health services research, and (3) suggest assessment methods that could be incorporated into health services research to ensure accurate assessment of disease prevalence and incidence, as well as accounts of appropriate health services use, in patients with different racial and ethnic backgrounds.

Principal Findings-

Race is a complex, multidimensional construct. For some individuals, institutionalized racism and internalized racism are intertwined in the effects of race on health outcomes and health services use. Ethnicity is most commonly used as a social–political construct and includes shared origin, shared language, and shared cultural traditions. Acculturation appears to affect the strength of the relationships among ethnicity, health outcomes, and health services use.

Conclusions-

Improved and consistent methods of data collection need to be developed for use by VA researchers across the country. VA research sites with patients representing specific population groups could use a core set of demographic items in addition to expanded modules designed to assess the ethnic diversity within these population groups. Improved and consistent methods of data collection could result in the collection of higher-quality data, which could lead to the identification of race- and ethnic-specific health services needs. These investigations could in turn lead to the development of interventions designed to reduce or eliminate these disparities.