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Critical Perspectives on Racial and Ethnic Differences in Health in Late Life
Although universally lauded as a great success story, the increase in life expectancy at older ages over the second half of the century has renewed important concerns about the existence of significant racial and ethnic differences in health. This country’s progress on race-related issues is often measured by trends in major indicators of economic and social well-being, such as income or percentage of people in poverty, but few indicators offer more dramatic social commentary than the existence of large racial and ethnic differences in life expectancy. Blacks continue to experience much poorer health than whites, both before and after age 65, even though the black-white gap has narrowed over much of the century. The most recent data available from death certificates indicate that age-adjusted death rates for blacks are 33 percent higher than for whites (NCHS, 2003). On the other hand, age-adjusted death rates for other racial and ethnic minority groups are often lower than the comparable rate for whites, although there is much misunderstanding and misreporting on this point. Age-adjusted death rates for Hispanics (to the extent that they can be considered a discrete and identifiable segment of American society) are 22 percent lower than for non-Hispanic whites (NCHS, 2003), a surprise to many given their far lower average socioeconomic position and their generally poor level of health care coverage. Furthermore, the available data from death certificates suggest that, if taken at face value, both the American Indian and Alaskan Native populations and the Asian and Pacific Islander populations enjoy relatively lower age-adjusted death rates than non-Hispanic whites.
Undoubtedly some fraction of the minority advantage is attributable to measurement errors because death rates for both these minority groups are known to be underestimated (Rosenberg et al., 1999). Even so, when researchers have attempted to adjust the data or reestimate rates using other data sources, the relative ranking described rarely changes (Chapter 3, this volume). Within these various groups, there is much heterogeneity. Among Hispanics, Puerto Ricans generally experience relatively poorer health outcomes than Cubans and Mexican Americans, while among Asians and Pacific Islanders, Samoans and Native Hawaiians generally have worse health than other Asians. Further complicating the picture of relative health is the fact that, although it is generally true that blacks fare worse than other groups, the relative ordering of the other groups is inconsistent. For example, while most studies find that Hispanics fare worse with respect to such health outcomes as diabetes, infectious diseases, and chronic liver disease, they also find a Hispanic advantage for cardiovascular disease, cancer, and pulmonary diseases (Palloni and Arias, 2003).
To date, little research on racial and ethnic differences in health has been directed specifically toward the elderly, and there is still a need for great concern about broad health disadvantages of certain subpopulations, but particularly with regard to the situation of elderly blacks relative to