Muntuwandi (talk | contribs) m moved Race and health in the United States to Race and health over redirect: To globalize the article |
WeijiBaikeBianji (talk | contribs) →Race and genetics biomedical research: removed fudged passage (discussed on talk page of Race (classification of humans) and edited in light of sources at hand. Collins source needs verification. |
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==Race and genetics biomedical research== |
==Race and genetics biomedical research== |
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{{See also|Ancestry and health#Race and genetic biomedical research}} |
{{See also|Ancestry and health#Race and genetic biomedical research}} |
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Some doctors consider it useful to take race into account when treating disease because diseases and treatment responses tend to cluster by geographic ancestry.<ref>Satel, Sally. [http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html "I Am a Racially Profiling Doctor"]. The New York Times, published May 5, 2002</ref> But this practice is criticized by epidemiologists who have carefully studied how little "race" serves as a predictor of disease.<ref name="KaufmanCooper2010">{{Cite book |title=What's the Use of Race?: Modern Governance and the Biology of Difference |chapter=Racial and Ethnic Identity in Medical Evaluations and Treatments |last1=Kaufman |first1=Jay S. |last2=Cooper |first2=Richard S. |editor1-last=Whitmarsh |editor1-first=Ian |editor2-last=Jones |editor2-first=David S. |year=2010 |publisher=MIT Press |location=Cambridge (MA) |isbn=978-0-262-51424-8 |laysummary=http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=12183 |laydate=7 September 2010 |ref=harv }}</ref> |
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Since the turn of the millennium, the use of racial categories as a tool for evaluating genetically conditioned health risks and treatment choices has seen a marked increase. The main impetus for this development is the possibility of improving the prevention and treatment of certain [[disease]]s by predicting hard-to-ascertain factors, such as genetically conditioned health factors, on the basis of more easily ascertained characteristics such as phenotype and racial self-identification. Since medical judgment often involves decision-making under uncertain conditions,<ref name="whitmarsh 9">Ian Whitmarsh and David S. Jones, 2010, ''What's the Use of Race? Modern Governance and the Biology of Difference'', MIT press. Chapter 9.</ref> many doctors consider it useful to take race into account when treating disease because diseases and treatment responses tend to cluster by geographic ancestry.<ref>Satel, Sally. [http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html "I Am a Racially Profiling Doctor"]. The New York Times, published May 5, 2002</ref> The discovery that certain diseases have a considerable degree of correlation with racial identification further sparked the interest in using race as a proxy for bio-geographical ancestry and genetic buildup. Some of the genetically linked diseases that have been found to be particularly prevalent in some populations are [[Cystic fibrosis]], [[Lactose intolerance]], [[Tay-Sachs Disease]], [[sickle cell anemia]], and [[Crohn disease]].<ref name="whitmarsh 9"></ref> There is a general consensus in medicine that the ability to treat diseases improves with greater specificity of genetic analysis, and that the use of racial groups as a predictor of genetic buildup is a crude and imperfect way to identify genetic clusters that correlate with disease risk. However, until cheaper and more widely available methods of genetic analysis are commonplace, the consideration of race remains a worthwhile practice for many doctors and researchers.<ref name="collins">Collins, Francis S. ''What we do and don't know about 'race', 'ethnicity', genetics and health at the dawn of the genome era.'' Nature Genetics Supplement, volume 36 No. 11, November 2004.</ref> |
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The perceived benefit to using race as a consideration in biomedicine is based on the series of surrogate relationships between self-identified race and disease risk.<ref name="collins"></ref> Analysis of [[microsatellite DNA]] markers and [[SNPs]] from human populations have shown that using a combination of these polymorphic genes it is possible to determine a person's geographic ancestry with a high degree of accuracy. Furthermore, analyzing the fraction of human genetic variation that lies within and between geographically separated populations has shown that the genes that are geographically highly differentiated in their allelic frequencies are not typical of the human genome in general.<ref>''Revisiting race in a genomic age''. By Barbara A. Koenig, Sandra Soo-Jin Lee, Sarah S. Richardson. |
The perceived benefit to using race as a consideration in biomedicine is based on the series of surrogate relationships between self-identified race and disease risk.<ref name="collins"></ref>{{verify source}} Analysis of [[microsatellite DNA]] markers and [[SNPs]] from human populations have shown that using a combination of these polymorphic genes it is possible to determine a person's geographic ancestry with a high degree of accuracy. Furthermore, analyzing the fraction of human genetic variation that lies within and between geographically separated populations has shown that the genes that are geographically highly differentiated in their allelic frequencies are not typical of the human genome in general.<ref>''Revisiting race in a genomic age''. By Barbara A. Koenig, Sandra Soo-Jin Lee, Sarah S. Richardson. Rutgers University Press, 2008. Chapter 5.</ref>{{verify source}} Since race can be seen as an imperfect surrogate for ancestral geographic region, it is in turn a surrogate for variation across one's genome. There is therefore a degree of correlation between genome-wide variation and variation at specific loci associated with disease. The ways in which these variants interact with environmental factors can subsequently give an approximation of propensity for disease or for preferred treatment response, although the approximation is less than perfect.<ref name="collins"></ref> |
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[[Image:Sickle cell distribution.jpg|thumb|right|180px|distribution of the sickle cell trait]] |
[[Image:Sickle cell distribution.jpg|thumb|right|180px|distribution of the sickle cell trait]] |
Revision as of 00:32, 7 October 2010
Race |
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History |
Society |
Race and... |
By location |
Related topics |
Race and health research is mostly from the United States. 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. 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.[2][3]
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 of ethnic minorities is an emerging topic of study in health research.[4] David Williams writes that because race is, in his view, 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.[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 (European American), Asian, native Hawaiian or other Pacific Islander, and American Indian or Alaska native. 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. 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.
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. 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
Health disparities refer to gaps in the quality of health and health care across racial and ethnic groups.[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."[12]
In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos.[13] When compared to European Americans, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes.[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 European Americans.[15] In addition, adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.[15] Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.[14]
In the United States
The twentieth century witnessed a great expansion of the upper bounds of the human life span. At the beginning of the century, average life expectancy in the United States was 47 years. 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.S. population has increased substantially, race disparities in longevity have been persistent. African American life expectancy at birth is persistently five to seven years lower than European Americans.[16] Crime plays a significant role in this racial gap in life expectancy. A report from the U.S. Department of Justice states "In 2005, homicide victimization rates for blacks were 6 times higher than the rates for whites" and "94% of black victims were killed by blacks." [17]
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.[18] U.S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos.[19] Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U.S. population.[20] European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics.[21] 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.[21]
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.[22] A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education.[23] 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.[24]
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.[25] 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. 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.[26]
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.[27] Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature.[28] 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.[29]
Racism
Racial differences in health often persist even at "equivalent" socioeconomics levels. 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.[30] Using The Schedule of Racist Events (SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. 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.[31] 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.[32] 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."[33] 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.[34]
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.[35] Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured.[36]
In other cases inequalities in health care reflect a systemic bias in the way medical procedures and treatments are prescribed for different ethnic groups. 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.[37] 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,[38] renal failure,[39] bladder cancer,[40] and pneumonia.[41] 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.[42]
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.[43] 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.[44] Diabetes and obesity are more common among Native Americans living on U.S. reservations than among those living outside reservations.[45]
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. Even after diagnosis, black women are less likely to get treatment compared to white women.[46] University of Wisconsin African-American studies Professor Michael Thornton said the report’s results show racism still exists today. "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."[47]
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.[48] 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.[49]
Cardiovascular disease
Research has explored the impact of encounters with racism or discrimination on physiological activity. Most of the research has focused on traits that cause exaggerated responses, such as neuroticism, strong racial identification, or hostility.[50] Several studies suggest that higher blood pressure levels are associated with a tendency not to downplay racist and discriminatory incidents, or that directly addressing or challenging unfair situations reduces blood pressure.[50] Personal experiences of racist behaviors cause physiological arousal and increase stress and blood pressure.[50]
Although the relationship racism and health is unclear and findings have been inconsistent, three likely mechanisms for cardiovascular damage have been identified:[51]
- Institutional racism leads to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions.
- Personal experiences of racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health.
- Negative self-evaluations and accepting negative cultural stereotypes as true (internalized racism) can harm cardiovascular health.
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.[52] 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.[53]
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 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. 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.[54]
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. 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.[16] 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 European Americans was not associated in either direction with residential segregation.[55]
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. 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.[56] 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.[57] Moreover, segregation strongly influences premature mortality in the US.[58]
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.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.
- 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, 71.2 years.
- High-risk urban Blacks, $14,800, 71.1 years.[22]
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.[59][60]
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%.[61] 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.[30]
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. 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.[62]
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. 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.[63] This may have an indirect impact on health since young people have fewer places to play and adults have fewer opportunities for exercise.[63]
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.[64] Institutionalized racism affects general health care as well as the quality of AIDS health intervention and services in minority communities. 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.[65]
Race and genetics biomedical research
Some doctors consider it useful to take race into account when treating disease because diseases and treatment responses tend to cluster by geographic ancestry.[66] But this practice is criticized by epidemiologists who have carefully studied how little "race" serves as a predictor of disease.[67]
The perceived benefit to using race as a consideration in biomedicine is based on the series of surrogate relationships between self-identified race and disease risk.[68][verification needed] Analysis of microsatellite DNA markers and SNPs from human populations have shown that using a combination of these polymorphic genes it is possible to determine a person's geographic ancestry with a high degree of accuracy. Furthermore, analyzing the fraction of human genetic variation that lies within and between geographically separated populations has shown that the genes that are geographically highly differentiated in their allelic frequencies are not typical of the human genome in general.[69][verification needed] Since race can be seen as an imperfect surrogate for ancestral geographic region, it is in turn a surrogate for variation across one's genome. There is therefore a degree of correlation between genome-wide variation and variation at specific loci associated with disease. The ways in which these variants interact with environmental factors can subsequently give an approximation of propensity for disease or for preferred treatment response, although the approximation is less than perfect.[68]
A classic example of a disease that tends to correlate with ethnic clusters is Tay-Sachs, an autosomal recessive disorder that has been shown to be more frequent among Ashkenazi Jews than among other Jewish groups and non-Jewish populations, though it also does occur in other groups.[70] Sickle-cell anemia, another well-known genetic disorder, has been seen as most prevalent in populations of sub-Saharan African ancestry, but it is now known also to be common among Latin-American, Indian, Saudi Arab, and Mediterranean populations. The portion of the population with the sickle cell trait is higher in some regions than in others, since it offers some resistance to malaria and consequently has been positively selected in regions where malaria is present.[71] While a correlation between sickle cell and race does exist, some researchers believe that the trait correlates more strongly with geographic ancestry traced to regions with a historical prevalence of malaria. For example, a substantial percentage of people with Sicilian ancestry also carry the sickle cell trait, since malaria was a serious problem there historically.[72] Gene flow and intermixture can also have an effect on predicting relationships between race and race-linked disorders. Multiple sclerosis, for example, is typically associated with people of European descent, but due to admixture African Americans have elevated levels of the disorder relative to Africans.[73]
Race-based medicine is the term for medicines that are targeted at specific ethnic clusters which are shown to have a propensity for a certain disorder. The first example of this in the U.S. was when BiDil, a medication for congestive heart failure, was licensed specifically for use in American patients that self-identify as black.[74] Previous studies had shown that African American patients with congestive heart failure generally respond less effectively to traditional treatments than white patients with similar conditions.[75] After two trials, BiDil was licensed exclusively for use in African American patients. Critics have argued that this particular licensing was unwarranted, since the trials did not in fact show that the drug was more effective in African Americans than in other groups, but merely that it was more effective in African Americans than another similar drug. It was also only tested in African American and white males, but not in any other racial groups or among women. This peculiar trial and licensing procedure has prompted suggestions that the licensing was in fact used as a race based advertising scheme.[76]
The continued use of racial categories as proxies for knowledge about genetically determined health concerns in populations has been criticized widely. Outram and Ellison have identified the most common concerns expressed in relation to this practice: most genetic variation is found within racial groups whereas very little genetic variation loosely coincides with racial groups, but without making any well-defined genetic criteria for ascription of individuals to racial groups possible. Completely genetically homogenous racial groups have never existed and therefore phenotypic traits, and variation between them, do not translate directly to similar variation in genotypic traits. The continued use of racial categories as proxies for genetic variation has a social function of cementing socially constructed racial categories as if they were natural classes, which could result in increased stereotyping and discrimination in society.[77] In many cases, health disparities will be caused by environmental factors common to certain populations and geographic areas, such as differences in culture, diet, education, socioeconomic status, and access to health care, rather than by allele clusters.[68] Another concern is that the way in which research emphasizes differences in health risk and health care need among racial groups can lead to the development of racial discrimination in health services.[77]
There is general agreement that a goal of health-related genetics should be to move past the weak surrogate relationships of racial health disparity and get to the root causes of health and disease. This largely includes research which strives to define human variation with greater specificity across the world.[68] One such emerging method is known as ethnogenetic layering, which is a non-typological alternative to depending on the racial paradigm in biomedicine. It works by focusing on geographically identified microethnic groups, which are far more nuanced and sensitive than simple race analyses.[78]
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
- ^ Centers for Disease Control and Prevention (2005). "Health disparities experienced by black or African Americans--United States". Morbidity and Mortality Weekly Report. 54 (1): 1–3. PMID 15647722.
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ignored (help) - ^ Wallace, Robert (2003). "A Racialized Medical Genomics: Shiny, Bright and Wrong". Race: The Power of an Illusion.
- ^ Garcia, Richard (2003). "The misuse of race in medical diagnosis". Race: The Power of an Illusion. Reprinted from: Garcia RS (2003). "The misuse of race in medical diagnosis". The Chronicle of Higher Education. 49 (35): B15. PMID 15287125.
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ignored (help) - ^ McKenzie K (2003). "Racism and health". BMJ. 326 (7380): 65–6. doi:10.1136/bmj.326.7380.65. PMC 1125019. PMID 12521953.
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ignored (help) - ^ Williams DR, Lavizzo-Mourey R, Warren RC (1994). "The concept of race and health status in America". Public Health Reports. 109 (1): 26–41. PMC 1402239. PMID 8303011.
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: CS1 maint: multiple names: authors list (link) - ^ Sheldon TA, Parker H (1992). "Race and ethnicity in health research". Journal of Public Health Medicine. 14 (2): 104–10. PMID 1515192.
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ignored (help) - ^ Williams DR (1994). "The concept of race in Health Services Research: 1966 to 1990". Health Services Research. 29 (3): 261–74. PMC 1070005. PMID 8063565.
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ignored (help) - ^ Goodman AH (2000). "Why genes don't count (for racial differences in health)". American Journal of Public Health. 90 (11): 1699–702. doi:10.2105/AJPH.90.11.1699. PMC 1446406. PMID 11076233.
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ignored (help) - ^ LaVeist TA (2000). "On the study of race, racism, and health: a shift from description to explanation". International Journal of Health Services. 30 (1): 217–9. doi:10.2190/LKDF-UJQ5-W1KU-GLR1. PMID 10707307.
- ^ a b Collins FS (2004). "What we do and don't know about 'race', 'ethnicity', genetics and health at the dawn of the genome era". Nature Genetics. 36 (11 Suppl): S13–5. doi:10.1038/ng1436. PMID 15507997.
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- ^ Goldberg, Janet; Hayes, William; Huntley, Jill (2004). Understanding Health Disparities (PDF). Health Policy Institute of Ohio. p. 3.
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ignored (help) - ^ Goldberg, Janet; Hayes, William; Huntley, Jill (2004). Understanding Health Disparities (PDF). Health Policy Institute of Ohio.
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ignored (help)[page needed] - ^ a b Goldberg, Janet; Hayes, William; Huntley, Jill (2004). Understanding Health Disparities (PDF). Health Policy Institute of Ohio. pp. 4–5.
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ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) - ^ Crimmins EM, Saito Y (2001). "Trends in healthy life expectancy in the United States, 1970-1990: gender, racial, and educational differences". Social Science & Medicine. 52 (11): 1629–41. doi:10.1016/S0277-9536(00)00273-2. PMID 11327137.
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- ^ Laveist TA (1993). "Segregation, poverty, and empowerment: health consequences for African Americans". The Milbank Quarterly. 71 (1). Blackwell Publishing: 41–64. doi:10.2307/3350274. PMID 8450822.
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- ^ "Health Care for Minority Women: Recent Findings". Program Brief. AHRQ Publication No. 09-PB003. Rockville, MD: Agency for Healthcare Research and Quality. 2009.
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- ^ Wisconsin Cancer Incidence and Mortality, 2000-2004 Wisconsin Department of Health and Family Services
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- ^ Gee GC (2002). "A multilevel analysis of the relationship between institutional and individual racial discrimination and health status". American Journal of Public Health. 92 (4): 615–23. doi:10.2105/AJPH.92.4.615. PMC 1447127. PMID 11919062.
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- ^ Bird ST, Bogart LM (2005). "Conspiracy beliefs about HIV/AIDS and birth control among African Americans: implications for the prevention of HIV, other STIs, and unintended pregnancy". The Journal of Social Issues. 61 (1): 109–26. doi:10.1111/j.0022-4537.2005.00396.x. PMID 17073026.
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ignored (help) - ^ Thomas SB, Quinn SC (1991). "The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community". American Journal of Public Health. 81 (11): 1498–505. doi:10.2105/AJPH.81.11.1498. PMC 1405662. PMID 1951814.
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ignored (help) - ^ Hart KD, Kunitz SJ, Sell RR, Mukamel DB (1998). "Metropolitan governance, residential segregation, and mortality among African Americans". American Journal of Public Health. 88 (3): 434–8. doi:10.2105/AJPH.88.3.434. PMC 1508338. PMID 9518976.
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: Invalid|ref=harv
(help); Unknown parameter|laydate=
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ignored (help) - ^ a b c d Cite error: The named reference
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was invoked but never defined (see the help page). - ^ Revisiting race in a genomic age. By Barbara A. Koenig, Sandra Soo-Jin Lee, Sarah S. Richardson. Rutgers University Press, 2008. Chapter 5.
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: CS1 maint: multiple names: authors list (link) - Dvornyk V, Liu XH, Shen H; et al. (2003). "Differentiation of Caucasians and Chinese at bone mass candidate genes: implication for ethnic difference of bone mass". Annals of Human Genetics. 67 (Pt 3): 216–27. doi:10.1046/j.1469-1809.2003.00037.x. PMID 12914574.
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ignored (help)CS1 maint: multiple names: authors list (link) - "Genes, drugs and race". Nature Genetics. 29 (3): 239–40. 2001. doi:10.1038/ng1101-239. PMID 11687784.
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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
- RACE: The Power of an Illusion companion site