an individual or community/neighborhood level. Other social determinants, including acculturation, social environment, and physical environment, can also influence health independent of SES. Assessing such factors, in addition to SES, can elucidate relationships that have previously gone unobserved. The examples above represent some of the leading research related to race, ethnicity, and social determinants of health.
In addition to disaggregating racial/ethnic groups, the opportunity to link social determinants of health to biological mechanisms will advance research addressing minority health and health disparities. Future research should also consider integrating race/ethnicity, SES, and other social determinants into the healthcare setting, as well as into the emerging areas of precision medicine, clinical trials, sexual and gender minority research, and workforce diversity.
3.8 Key Points
Race and ethnicity are complex constructs and incorporate aspects of skin color, societal influences, nationality, and culture, which all impact racial/ethnic differences in health status.
Racial/ethnic minority populations in the United States experience significant morbidity, mortality, and decreased life expectancy compared to the White population.
Lower SES, income inequality, and other factors such as poorer physical and social environments are social determinants that impact health, particularly for racial/ethnic minority groups.
Several innovative studies have been designed and conducted, especially to understand complex issues in health disparities research and intricate aspects of the culture and life of racial/ethnic populations.
More research is needed to link the social determinants of health to biological mechanisms and to understand the nuances of social determinants in understudied and under‐served populations.
Disclaimer
The views and opinions expressed in this chapter are those of the authors only and do not necessarily represent the views, official policy, or position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies.
References
1 1 Marmot, M., Friel, S., Bell, R. et al. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet 372 (9650): 1661–1669.
2 2 Marmot, M. and Allen, J.J. (2014). Social Determinants of Health Equity. American Journal of Public Health 104 (Suppl4): S517–S519.
3 3 LaVeist, T.A. (2005). Conceptual issues in race/ethnicity and health. In: Minority Populations and Health, 15–29. San Francisco, CA: Jossey‐Bass.
4 4 Houghton Mifflin Harcourt Publishing Company (2017). American Heritage Dictionary of the English Language, 5e. Boston, MA: Houghton Mifflin Harcourt.
5 5 LaVeist‐Ramos, T.A., Galarraga, J., Thorpe, R.J. et al. (2012). Are black Hispanics black or Hispanic? Exploring disparities at the intersection of race and ethnicity. Journal of Epidemiology and Community Health 66 (7): e21.
6 6 National Center for Health Statistics (2016). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: National Center for Health Statistics.
7 7 Gardner, J.W. and Sanborn, J.S. (1990). Years of potential life lost (YPLL) – what does it measure? Epidemiology 1 (4): 322–329.
8 8 Xu, J., Murphy, S.L., Kochanek, K.D., and Arias, E. (2016). Mortality in the United States, 2015. Hyattsville, MD: National Center for Health Statistics.
9 9 Brown, A.F., Ettner, S.L., Piette, J. et al. (2004). Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiologic Reviews 26: 63–77.
10 10 Berkman, L.F., Kawachi, I., and Glymour, M.M. (2014). Social Epidemiology. Oxford: Oxford University Press.
11 11 Chen, E. and Miller, G.E. (2013). Socioeconomic status and health: mediating and moderating factors. Annual Review of Clinical Psychology 9: 723–749.
12 12 Krieger, N., Williams, D.R., and Moss, N.E. (1997). Measuring social class in US public health research. Annual Review of Public Health 18: 341–378.
13 13 Saez, E. and Zucman, G. (2014). Wealth Inequity in the United States since 1913: Evidence from Capitalized Income Tax Data. Cambridge, MA: National Bureau of Economic Research.
14 14 Kondo, N., Sembajwe, G., Kawachi, I. et al. (2009). Income inequality, mortality, and self rated health: meta‐analysis of multilevel studies. The BMJ 339: b4471.
15 15 Pickett, K.E. and Wilkinson, R.G. (2015). Income inequality and health: a causal review. Social Science & Medicine 128: 316–326.
16 16 Diez Roux, A.V. and Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences 1186: 125–145.
17 17 Cuéllar, I., Arnold, B., and Maldonado, R. (1995). Acculturation rating‐scale for Mexican Americans‐II: a revision of the original ARSMA scale. Hispanic Journal of Behavioral Sciences 17 (3): 275–304.
18 18 Marín, G., Sabogal, F., Marín, B.V. et al. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences 9 (2): 183–205.
19 19 Suinn, R.M., Rickard‐Figueroa, K., Lew, S., and Vigil, P. (1987). The Suinn‐Lew Asian self‐identity acculturation scale: an initial report. Educational and Psychological Measurement 47 (2): 401–407.
20 20 Ryder, A.G., Alden, L.E., and Paulhus, D.L. (2000). Is acculturation unidimensional or bidimensional? A head‐to‐head comparison in the prediction of personality, self‐identity, and adjustment. Journal of Personality and Social Psychology 79 (1): 49–65.
21 21 Lillie‐Blanton, M. and Laveist, T. (1996). Race/ethnicity, the social environment, and health. Social Science & Medicine 43 (1): 83–91.
22 22 Williams, D.R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the New York Academy of Sciences 896: 173–188.
23 23 Siegler, V. (2014). Measuring National Well‐being: Measuring Social Capital Consultation Response. London: Office for National Statistics.
24 24 Sampson, R.J., Raudenbush, S.W., and Earls, F. (1997). Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 277 (5328): 918–924.
25 25 National Research Council (2013). US Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: National Academies Press.
26 26 LaVeist, T., Pollack, K., Thorpe, R. et al. (2011). Place, not race: disparities dissipate in southwest Baltimore when blacks and whites live under similar conditions. Health Affairs 30 (10): 1880–1887.
27 27 LaVeist, T., Thorpe, R., Bowen‐Reid, T. et al. (2008). Exploring health disparities in integrated communities: overview of the EHDIC study. Journal of Urban Health 85 (1): 11–21.
28 28 Kershaw, K.N., Giacinto, R.E., Gonzalez, F. et al. (2016). Relationships of nativity and length of residence in the U.S. with favorable cardiovascular health among Hispanics/Latinos: The Hispanic Community Health Study/Study
