augment judiciously selected extant surveys in the United States and other countries as the central sources for investigating inequalities in health, including assessment of predisease pathways, collective community influences, macro-level socioeconomic change, and intervening psychosocial and behavioral factors (positive and negative).

RACIAL AND ETHNIC INEQUALITY AND DISCRIMINATION

In the United States race is strongly associated with socioeconomic inequality. For example, blacks, Hispanics, and Native Americans have lower levels of income and education and higher rates of poverty and unemployment than whites. Given the strong association between race/ethnicity and SES, race/ethnicity not surprisingly is a strong predictor of health status in the United States. Moreover, available data suggest that the gap in health status between the advantaged white population and disadvantaged racial/ethnic minorities is widening over time for multiple indicators of health status (Williams, in press).

Racial/Ethnic Differences in Health Status

The association between race and health is complex and varies by the health status indicator and the particular racial group under consideration (Williams, in press). There is no generic minority health model, but all of the economically disadvantaged racial/ethnic minority populations have higher morbidity and mortality than whites for some health conditions. National mortality rates in the United States reveal that blacks consistently have higher death rates than whites for almost all the leading causes of death (National Center for Health Statistics, 1998). The notable exception to this pattern is markedly lower suicide rates for blacks compared to whites, despite rising rates of suicide over time. Hispanics consistently have lower death rates than non-Hispanic whites for the two leading causes of death in the United States (coronary heart disease and cancer) but higher death rates for several other causes of death, including diabetes, homicide, cirrhosis of the liver, and HIV/AIDS. Death rates of Hispanics exceed those of whites in the 15-44 age group (Fingerhut and Makuc, 1992). Hispanics also have elevated rates of infectious diseases such as measles, rubella, tetanus, tuberculosis, and syphilis (Vega and Amaro, 1994). Native Americans have lower death rates than whites for heart disease and cancer but higher mortality rates from injuries, flu and pneumonia, diabetes, suicide, and cirrhosis of the liver. In addition, the health status of the 60 percent of Native Americans who are covered by the Indian Health Service (a federal agency that provides medical care to Native Americans who live on or near reservations) is considerably worse than that of the national average for Native Americans (U.S. Department of Health and Human Services, 1997).



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