in health are less tolerable than they would be if the history were more benign, and their documentation and remediation are more important.
It is important to recognize that the same arguments may not apply with equal force to all minority groups. For example, the household incomes and health of some Asian groups exceed those of native-born non-Hispanic whites. Similarly, while Hispanic incomes are similar to those of blacks and are well below those of the white majority, Hispanic health is currently, on particular though not all indicators, at least as good as that of the white majority. On such grounds, it is appropriate to distinguish among ethnic and racial minorities when evaluating the case for reducing health differences. In particular, the argument for reducing the health disadvantages of blacks is quite compelling.
There is also a separate argument about process, primarily, but not exclusively, in the provision of health care (Deaton, 2002; Sen, 2001). The extent to which health care contributes to health status is debated, but it is reasonable to suppose that some part of the variation in individuals’ health status is attributable to variations in health care. If access to or quality of health care is unfairly linked to racial or ethnic identity, it deserves a remedy. This would be true even if the role of health care in maintaining health or improving longevity could not be conclusively demonstrated. Unfairness is not eliminated because its consequences are hard to demonstrate. Racial and ethnic differences in health care could be a social problem even if there were no differences in health across racial and ethnic groups, or if, for some other reason, the group that was adversely affected had superior health outcomes. Some Americans are also denied access to jobs, or housing, or are treated disrespectfully because of their race or ethnicity. These differences are of concern in their own right, and, like unequal health care, may also affect health, although the evidence that discrimination is involved in the variation in care and produces health differences remains uncertain and controversial.
These two arguments imply that black-white health differences and American Indian and Alaska Native-white health differences may be of particular concern. This is in part because blacks and American Indians and Alaska Natives have suffered, and in some cases continue to suffer, other deprivations that make their relatively poor health. There is reason to suspect that differences in health care may contribute to their inferior health, either because areas where blacks and American Indians and Alaska Natives live are served less well, or because of medically different treatment. But individual differences in preferences and choices may also be contributing factors. The health differences of other racial or ethnic groups may also be of particular concern: examples might include American Indian and Alaska Native on reservations, Native Hawaiians, and Puerto Ricans. These arguments apply to health inequalities in general, in addition to those involving