Marsha Lillie-Blanton

Race, Ethnicity, and the Health Care System: Public Perceptions and Experiences

To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance. Views on whether the health system treats people equally were strikingly different by race. For example, most minority Americans perceive that they get lower quality care than whites, but most whites think otherwise. Nonetheless, more minority Americans were concerned about the cost of care than racial barriers. Efforts to eliminate disparities will need to improve public awareness of the problems as well as address racial and financial barriers to care.

Race/ethnicity, the social environment, and health

International and national research has documented the relations between socio-economic conditions and health. Nonetheless, racial/ethnic group comparisons of health indices frequently are presented in the United States without stratifying or adjusting for socio-economic conditions that could affect interpretation of the data. This paper examines how racial/ethnic group identifiers have been used in past research. While some studies assume biologic differences; others presume that race/ethnicity is a proxy for socio-economic race factors. One consequence of these presumptions has been an underdevelopment of knowledge about racial/ethnic minority populations that could help shape public policies and preventive interventions to reduce disparities in health. Findings from studies that examine the influence of both race and social class on health are reviewed in an effort to clarify the state-of-knowledge. Although the findings vary for particular health indices, the studies provide considerable evidence that socio-economic conditions are a powerful, although not necessarily exclusive, explanatory variable for racial disparities in health. The findings are used as the basis for encouraging more theoretically grounded and methodologically rigorous research rather than avoiding an assessment of the influence of race/ethnicity on health.

Health Care for Black Americans: The Public Sector Role

Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other federal programs supporting targeted local services have been especially effective in reducing infant mortality. But the redistributive effects have been uneven and unequal across populations; many categorical gaps remain and increasing numbers are potentially without access to essential primary care services.

The Influence of Self-Esteem on Smoking among African-American School Children

This study provides some evidence, although not very strong, that self-esteem is associated with the likelihood of smoking among African-American children. In a sample of 1,256 children, those with lowest levels of self-esteem were twice as likely to have ever smoked as those with highest level of self-esteem (95% C.I. = 1.10–7.78). Girls, more so than boys, have an increased risk of smoking at the lowest level of self-esteem. Girls with the lowest level of self-esteem were 2.8 times (95% C.I. = 3.85–16.59) as likely to have smoked when compared to girls with higher self-esteem. The findings suggest preventive interventions that seek to build self-esteem may reduce the likelihood of smoking among girls, although perhaps only modestly. Further study is needed to identify potentially effective methods for reducing the likelihood of smoking among African-American boys.

RACE AND CRACK COCAINE. REPLY

In Reply. —We are very pleased with the responses to our article in which we reported no association between race/ethnicity and prevalence of crack cocaine smoking, once neighborhood characteristics were held constant by poststratification. We agree with the comments of Dr Adebimpe that it is important to determine the role of socioeconomic and demographic factors, which can be confounded with racial and ethnic status, in order to avoid misinterpretation of the data. We believe he is correct in calling for attention to these issues whenever prevalence rates for racial and ethnic groups are presented. Gfroerer et al have expressed a belief that the methods we used in our analysis did not take into account the complex sampling procedures used in the National Household Survey, thus biasing our conclusions. We are well acquainted with these national survey procedures, and we respectfully disagree with their contention that our tabular data show any