differences are in fact responsible for health differences between groups is an urgent research priority.

Ethnic differences in health also generate a basic research agenda. Currently, researchers are far from agreement on the causes of health differences. A good example of such an issue is the Hispanic health paradox (the high levels of Hispanic health relative to their incomes) and the effects on health of the length of time that Hispanics remain in the United States. While these may not be first-order issues given the relatively good health of Hispanics in general, they are fundamental scientific questions concerning the social determinants of health.

These arguments have a number of implications for thinking about reducing health differences. First, it is important to see reductions of health inequalities within a context of improving health more generally. Some health innovations that are clearly a good thing might exacerbate racial health differences. Thus evaluating health policies exclusively on the basis of their impact on racial and ethnic health differences would obviously be a mistake. But to say that we care about these health differences also means that, at least along the race or ethnic dimension, we should as a society be willing to devote significant additional resources to reducing the black-white gap in health outcomes.



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