Racial and Ethnic Differences

Mayberry, R., "Racial and Ethnic Differences in Access to Medical Care," Henry ]. Kaiser Family Foundation, 1-3 (1999). 

How should society take account of racial and ethnic differences in disease and illness, and of the genetic differences that may underlie some of them May it ever legitimately take those differences into account If so, what limits are required Are there ever duties to use race and ethnicity in making health policy and health care decisions In what cases would racial and ethnic categories be prohibited ... 

Plant, E.A., and Sachs-Ericsson, N. (2004). Racial and Ethnic Differences in Depression The Roles of Social Support and Meeting Basic Needs. Journal of Consulting and Clinical Psychology, 12, 41-52. 

Weinick, R. M., Krauss, N. A. (2000, November). Racial and ethnic differences in children s access to care. American Journal of Public Health, 90(11), 1771-1774. 

The importance and clinical applicability of these measurements continue to evolve as there are probably racial and ethnic differences in the relationship between BMI, WC, and risk for development of disease and enhanced comorbidity. ° Table 140-3 outlines the current classification of overweight and obesity using BMI and WC. The table identifies risk for development of type 2 diabetes, hypertension, or cardiovascular disease at various stages of BMI or WC. Note that increased WC confers increased risk even in normal-weight individuals. 

The health care needs of racial and ethnic groups are similar in virtually all respects, but in some cases diseases or drug responsiveness based on genotypic variation may correlate with race or ethnicity. Knowing that those variations exist, when to test for them, and when to take them into account in clinical decisions will require research directed at uncovering genotypic differences that correlate with race or ethnicity. 

It seems clear that government as a funding agency and physicians as clinical providers may take race into account when racial correlations with health status or health care are directly relevant. In many clinical situations moral and legal duties to take race into account in order to respond properly to the patient s health needs may also exist, either because of state action or because of state laws banning racial and ethnic discrimination in public accommodations, which include hospitals and physician offices. Three situations in which a physician may have a duty to recognize racial correlations and order a different test or therapy as a result are discussed below. 

Foreign clinical results are acceptable except in areas where there are immunological and ethnic differences between Japanese and foreigners. The ethnic factors are divided into two components intrinsic factors such as racial factors and physiological differences and extrinsic factors, which include cultural and environmental issues. In these cases, the MHLW may require that some bridging comparative clinical trials be performed with dose ranging protocols. This will enable absorption, distribution, metabolism, and excretion studies to be carried out on Japanese individuals and provide better dosage and indication for the Japanese people. The MHLW also requires that application be accompanied by one year of real-time stability data and that sterility test results be included. 

The reader will note that my white, middle-class conditionings show in this and other examples. For simplicity, 1 ignore class, ethnic, racial, and subcultural differences in the United States in this chapter. 

As the 1980s evolved, environmental justice groups developed in many different racial and ethnic communities African-Americans, Hispanics, Asian-Pacific groups, and the indigenous people of North America. By 1991, the EJ movement had a clear national identify and philosophy, expressed in the Principles of Environmental Justice adopted at the First National People of Color Environmental Leadership Summit in Washington, DC, which was attended by more than a thousand community activists. 

Importantly, different populations tend to have different frequency distributions of alleles and exhibit different patterns of hnkage disequilibrium. This variability exists among both racial and ethnic groups. 

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