The influence of each of these factors can cumulate over the life course, so that the health status of older cohorts reflects their entire life experiences. Research increasingly suggests that even early life experiences can contribute to late-life morbidity and age at mortality. Understanding health differences in old age therefore requires understanding influences across the life course.
Although deliberate interventions can affect individual health behaviors, interventions aimed at improving population health may exacerbate racial and ethnic differences, at least initially. For example, people with the most education and income may to be the first to quit smoking, lose weight, or start exercising in response to population-level interventions or when physicians recommend these changes, so that interventions targeted to particular groups may be needed to effect changes.
Understanding the various factors that produce racial and ethnic group health differences in late life is important in the development of health policy. To date, what is known about the origins of racial and ethnic differences in health points in many directions, with findings coming from a variety of disciplines. And much of the research on particular determinants comes from work that does not focus specifically on older people. Consequently, researchers are still a long way from being able to construct a model that integrates all potential factors.
To advance the field, research is needed in each of the areas touched on above. The panel’s list of research needs starts with the need to partition differences in morbidity and mortality in older populations to determine how much can be attributed to particular diseases or conditions and in turn how much of the differences in diseases and conditions can be assigned to major risk factors. Such analysis has been done to some extent for the general population, but not specifically for the elderly. If such partitioning can be accomplished, it should be possible to refine the research agenda to focus on the most critical areas. The list of research needs then focuses on verifying apparent health differences in cases where there are uncertainties, and on improving our understanding of the operation of and interaction among the major factors that contribute to racial and ethnic differences in health.
Three main themes underlie the panel’s recommended research:
The roots of health differences have to be examined across the life course, taking a longitudinal view and integrated account of the effects of such factors as socioeconomic status, behavior risk factors, and prejudice and discrimination, as well as the effects across cohorts and periods of selection processes and social policy.