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Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda
effect on health; or education, in which case equality of educational opportunity, or affecting the outcomes of education—improving individual access to information and the ability to process it effectively—become long-term priorities. That identical levels on the same indicators may have different implications across groups also requires attention.
Variability in the effect of socioeconomic status over the life course is an additional complication. In late life, which aspects of status have the most influence on health? At the start of the life course, socioeconomic status is acquired from one’s parents, who not only provide financial support but also influence the education of their children. Children may also acquire from their parents habits and personal characteristics that directly affect health. How intergenerational transmission of all these factors is patterned by race or ethnicity may be important, given the influence of early life factors on late-life health. Reciprocal causation between socioeconomic status and health is an important aspect of the lifelong effect of status, and whether it operates similarly across the life course for different racial and ethnic groups needs study.
Research Need 7: Identify the mechanisms through which socioeconomic status produces racial and ethnic differences in health among the elderly, and identify other factors that complicate its effects.
Socioeconomic status may have an effect because of its links to commonly recognized health behaviors, other psychosocial factors, multiple dimensions of access to health care, geographic residence, environmental conditions, and nativity and duration of residence, especially for Hispanics and other immigrant groups. In what circumstances, or for which subgroups, are racial and ethnic differences robust to controls for such variables? Which controls are most important and why? If none of them adequately explain the effects of status, how does it come to modify health outcomes?
This analysis will require attending not just to socioeconomic variation in disease prevalence but to variation in the disease process: the onset of conditions, their severity, duration, and effects on survival (Crimmins et al., 2004). The relevant mechanisms may differ at each stage.
Whether macrolevel mechanisms are important is another aspect worth studying. Can aggregate effects be verified, and is income inequality the most appropriate aggregate indicator? If such aggregate effects exist, how do they work—at the local, regional, or societal levels, or even at the workplace level, and through what mechanisms? How are such aggregate macromarkers related to other aggregate variables, such as social capital and group cohesion, and how do such factors vary by race and ethnicity?