less, minorities, the poor, the medically underserved, and children suffer disproportionately from these burdens in terms of health disparities.

In some racial and ethnic groups, cancer rates are higher and accelerating, according to Jones (see Newell, 1988). The reasons for these disparities may include the environment, hormones, and genetics but also involve socioeconomic status. “Although racial classifications are a social construct, these classifications continue to have an impact on the health of this nation,” said Jones, adding that “health is probably the best indicator of the failure of this nation to address the issue of skin color and social class and the future well-being of this nation.” Because we do not apply what we know about prevention and treatment equally to all parts of society, we are not achieving the health gains that are currently possible.

Because we do not apply what we know about prevention and treatment equally to all parts of society, we are not achieving the health gains that are currently possible.

Lovell Jones

Higher income permits increased access to medical care and enables people to afford better housing, live in better neighborhoods, and have opportunities to promote their health behaviors. Higher incomes also tend to help people participate in clinical research studies, said Weinberg; thus, disparities in access to health care can affect enrollment in research studies. Demographic studies of cancer must consider the diversity within affluent groups as well as within less economically affluent groups.

INFLUENCE OF MIGRATION

Researchers have to consider immigration patterns and countries of origin because these factors play a primary role in predisposition to cancer. Individuals from many geographic locations have different diets, exposures, and degrees of acculturations but are commonly grouped together. For example, the “Hispanic” group in the United States consists of individuals who have migrated from Mexico, South America, Cuba, the U.S. territory of Puerto Rico, as well as those born in the United States. Further, even though the vast majority (64–65 percent) of all Hispanics in the United States are Mexican Americans, there may be differences among this group. As seen in Figure 4-1, three distinct Mexican American populations have migrated to the United States. Although they are all grouped as Mexican Americans, they will have some differences in diet and exposure. What this suggests is that the outcomes of a study of Hispanics in Texas may differ from those of Hispanics in California.

As we address issues in cancer, “we need to remember that one size does not fit all,” said Jones. Within special populations, vulnerable groups, or ethnic minorities, we have to remember that not all members are the same polymorphically and that children are not small adults.



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