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Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda
the environment with informational messages, including and perhaps especially messages from one’s peers. The same phenomenon arguably has been at work in the reduction in drunk driving since the early 1980s, spurred by the activities of Mothers Against Drunk Driving and other grassroots programs.
One factor that has helped keep campaigns against smoking and drunk driving going has been the presence of externalities, the argument that others are hurt when people smoke or drive drunk (Cutler, 2004; Warner, 2001). In contrast, this argument has not been prominent so far in attempts to reduce obesity and has not been sufficient in the public debate about guns. Campaigns also have costs, of course. In addition to the resources needed for intervention, there are the burdens, difficult to quantify, that may be imposed on individual behavior, as when smokers are required to limit where they smoke (Gostin, 2001; Warner, 2001).
If whites and minorities benefit equally from society-wide interventions, there would appear to be little reason to target interventions to particular groups. However, interventions do not necessarily have the same effect across racial and ethnic groups. For instance, long-term declines in smoking, roughly similar among whites and blacks, were paralleled among Hispanics and Asian and Pacific Islanders, but at somewhat lower levels, while declines were much more limited among American Indians and Alaska Natives. Particular subgroups among these minorities—reproductive-age American Indian women and Southeast Asian men, for instance, show strikingly high tobacco use (U.S. Department of Health and Human Services, 1998). Aside from smoking policy, quite different types of health policies, such as changes in health care regulation and funding, could also have disparate effects.
Are targeted interventions ever worth consideration? They raise various concerns relating to equity (Hudson, 2002). To the extent that federal social policy has increasingly benefited the aged, what effects have there been on equity across age groups (Meyers and Darity, 2000; Preston, 1984)? What resources are appropriate to address the special needs of particular immigrant groups among the aged, in comparison with groups that have spent their entire lives in the United States (Jasso et al., 2004)? How can one think about the fairness of the distribution of scarce national resources that do not provide broad assistance across the entire population but may be effective in addressing the needs of particular groups? These are broad philosophical and legal questions that are central in the history of the country’s public policy making and its democratic ideals (Gostin, 2001).