to be victims of homicide than girls (1,748 boys aged 15 to 19 were killed compared to 345 teen girls in 1999 aged 15 to 19). Thus, homicide prevention efforts typically focus on young males. For those concerned about support for survivors, special attention to the psychological impact on young male siblings and friends of teen homicide victims may serve dual goals of support for the grieving and preventing further violence.

Socioeconomic and Ethnocultural Differences

A number of studies have examined the association between socioeconomic variables—including income, education, and social status—and variations in mortality among geographic areas and population subgroups (see, e.g., IOM, 2002). Nonetheless, the validity of racial categories and their relevance in clinical and health care research and decisionmaking are sometimes controversial.8 Concerns about the appropriate use of such categories without adequate attention to underlying differences in access to health care, poverty, and other factors are reasonable. Nonetheless, racial and ethnic disparities in health outcomes and health care access are troubling and cannot be ignored in health care research, planning, and delivery. For example, in addition to considering underlying sources of disparities and developing programs to counter them, advocates of palliative care must consider disparities in the help available to and desired by families for themselves and their children.

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For example, a recent editorial in the New England Journal of Medicine argues that race is a social not a scientific construct and that “attributing differences in a biological end point to race is not only imprecise but also of no proven value in treating an individual patient,” although it may be important in the formulation of “just and impartial public policies” (Schwartz, 2001, p. 1392). A second editorial argues that “racial differences . . . have practical importance for the choice and dose of drugs” but emphasizes the clinical importance of identifying and understanding “the genetic determinants of the reported racial differences” rather than relying on self or other reports (Wood, 2001, p. 1395). In the same issue, authors of an article reporting outcomes by racial categories note that such categories may be “only a surrogate marker for genetic or other factors” (Exner et al., 2001, p. 1355). Brosco (1999) suggests that the American habit of separating statistics based on race, especially infant mortality statistics, has led to a policy in children’s health that focuses on welfare and reducing poverty rather than on improving all children’s health. He argues that such policy allows for bias against certain races, or moral character judgments against socioeconomically disadvantaged groups, and may contribute to resistance to policies that would benefit all children, such as universal health care coverage for children. Others argue that the collection of information on race, ethnicity, and primary language is necessary to guide social policy to reduce racial and ethnic disparities in health status (Perot and Youdelman, 2001). The AAP (2000h) has concluded that it “is no longer sufficient to use [racial, gender, and socioeconomic] categories as explanatory. If data relevant to the underlying social mechanisms have not been collected and are otherwise unavailable, researchers should discuss this as a limitation of the possible conclusions of the presented research.”



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