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Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda
There are two approaches that largely avoid these difficult equity issues. A simple approach is to build on the fact that racial and ethnic groups differ in their health problems, as already observed. Focusing on some health problems rather than others, even if no particular groups are targeted, would have a differential effect. Devoting more resources to diabetes, in particular, would probably benefit blacks, Hispanics, and American Indians more than whites or Asians, if the interventions are effective. This approach requires that all groups be reached equally and that the intervention effects do not differ by economic status, important assumptions that cannot be taken for granted. Similarly, programs to improve hospital quality are likely to reduce black-white differences in care to the extent blacks go to poorer quality hospitals, as could efforts to direct patients to better quality hospitals (Skinner et al., 2003).
A second approach comes from noting other differences between racial and ethnic groups. They may react differently to interventions, and some degree of specificity may be appropriate in order to reach members of particular groups. Health motivations, and resulting health-seeking behavior, could vary. While long life is presumably an important personal goal for everyone, the emphasis on it may differ for groups who suffer a multitude of environmental and life stressors (Baum, 2001). Cultural and socioeconomic considerations may influence the perceptions, experiences, and expression of health and illness (Dilworth-Anderson and Gibson, 2002; Goldman and Smith, 2002). For example, for those groups with relatively low life expectancy, quality of life may be a more important consideration than longevity. Thus, interventions that focus on promoting life extension may not be as effective as those that target quality of life.
Similarly, interventions that focus on the personal consequences of behavior may be less effective, for some groups, than those that focus on significant others who may be affected (Warner, 2001). For instance, behavioral interventions directed at the wives of men who have had a heart attack may be more effective, for some groups, than those directed at the men themselves (Taylor et al., 1985).
Finally, different racial and ethnic groups may show age-related changes at different times and to different degrees (Crimmins et al., 2004). Treatment may therefore be more effective at different ages for different groups; for instance, bone density testing at younger ages for white and Asian women in comparison with Hispanic and black women, mammograms at younger ages for black women, and blood pressure screening at younger ages for black men than other groups.