All factors should be investigated in terms of their links to stress and biopsychosocial mechanisms that lead to impaired health.
Interventions designed to reduce health differences should be evaluated, along with determining the role of health care quality in racial and ethnic differences, which may range from possible geographic variability to differences in patient compliance and the use of alternative therapies.
Cutting across these themes is the need to investigate variability across and within multiple racial and ethnic groups.
The health disadvantages of a racial or ethnic group are a particular concern when that group is of low socioeconomic status or has experienced a history of prejudice or discrimination. Research is needed to identify the reasons for particular disadvantages and to understand mechanisms of influence. An additional challenge for public health is to achieve a balance between efforts to ameliorate racial and ethnic differences in health and efforts to improve population health in general. The panel recommends work on 18 research needs:
Research Need 1: Attempt a systematic decomposition of racial and ethnic differences in mortality and morbidity among older people to determine the relative contribution of particular diseases or conditions. Try to assign differences in the prevalence of specific diseases and conditions to differences in the prevalence of major risk factors.
Research Need 2: Clarify the contrasts between mortality rankings and morbidity rankings, particularly between older whites and Hispanics, and assess the relative contributions of diseases and conditions to differences in mortality and overall health.
Research Need 3: When particular diseases are especially prevalent for specific racial and ethnic groups, collect more indicators of biological and functional performance in order to identify possibilities for intervention.
Research Need 4: Identify and quantify the various selection processes that affect health differences among racial and ethnic groups.
Research Need 5: Assess genetic and environmental factors in racial and ethnic differences in health simultaneously, in designs that permit identification of both main effects and interactions.
Research Need 6: Clarify the degree to which socioeconomic status accounts for racial and ethnic differences in health outcomes over the life course.
Research Need 7: Identify the mechanisms through which socioeconomic status produces racial and ethnic health differences in health among the elderly, and identify other factors that complicate its effects.
Research Need 8: Study how behavior risk factors act over the life course in different racial and ethnic groups.