These differences reveal a complicated picture that requires careful scrutiny. Chapters 2 through 11 explore the possible causes of health differences, including the social, environmental, psychological, and biological factors that may be at the root of racial and ethnic advantage or disadvantage in health. Chapter 12 asks whether and how action can deal with health differences and what the effects might be.

We refer throughout this report to differences rather than disparities, because the latter term has recently acquired a connotation of injustice, which is not always appropriate for the differences we consider, notably but not only when a minority population is actually in better health than the majority population. Although our focus is on late life, we offer some information on group differences more broadly, as context and in the absence of data on late life.



Race is a potent social reality and an important and enduring component of personal identity. In censuses and most surveys, a designation of race is selected by individual respondents from officially specified categories. This self-identification does not mean that race is without objective basis, since it is roughly consistent with ancestral origins. Yet because of the complications of migration histories and intermarriage, as well as the vagaries of self-identification and social categorization, racial classifications diverge from strict classification by descent.

Ethnicity is similar in concept to race. But while races have often been distinguished on the basis of physical characteristics, especially skin color, ethnic distinctions generally focus on such cultural characteristics as language, history, religion, and customs (Montague, 1942). However, physical and cultural characteristics are often conflated in the identification of racial and ethnic groups. What begins as an ethnic or cultural distinction often becomes racialized, and racial groups are often identified, in the public mind, with reference to customs and behavior. We generally refer here to racial and ethnic groups, without making any sharp distinction between these terms.

Five races are currently distinguished in official U.S. government statistics (Office of Management and Budget, 1997): white, black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. An additional distinction is made between Hispanics or Latinos and all others, this being designated as an “ethnic” distinction that crosscuts the racial classification. The 2000 census followed this classification—but also allowed multiple choices—and individuals selected their

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