548003 research-article2014
WJNXXX10.1177/0193945914548003Western Journal of Nursing Research
Editorial
Looking Beyond Skin Color: Addressing Heterogeneity in Health Disparities Research
Western Journal of Nursing Research 2014, Vol. 36(10) 1307–1308 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0193945914548003 wjn.sagepub.com
As health care professionals, we strive to prevent disease and promote health. Yet, disparities in health continue for vulnerable populations in the United States. Health disparities exist when variations or gaps in health outcomes occur that are associated with social, economic, and/or environmental disadvantages. Some populations endure the burden of health disparities with higher rates of disease and death; thus, the primary goal of Healthy People has focused on health disparities. Over the last two decades, the focus has shifted from reducing health disparities to eliminating health disparities and achieving health equity, which includes the highest level of health for all people (U.S. Department of Health and Human Services, 2014). This brings to the forefront of health care, the importance of health disparities research. In an effort to address gaps in health outcomes, researchers often focus on racial disparities as health disparities are widespread among racial and ethnic minority populations. However, there is a need to look beyond skin color to understand differences in populations. Distinction of racial and ethnic groups in research is necessary to control these factors, which may affect the outcome variables being studied. When speaking of a person’s race, physical characteristics such as skin color are considered. Ethnicity, however, refers to cultural characteristics such as religion or nationality (Drevdahl, Taylor, & Phillips, 2001). There are many ethnic groups of Blacks in the United States including Haitian and African, but often Blacks and African Americans are included in the same race classification with no distinction between the ethnic subgroups in national data and research. We can no longer assume one size fits all when it comes to health outcomes without considering heterogeneity within a population. Other contributors that may affect the persistent racial disparity in health outcomes such as ethnicity, education, socioeconomic status, and rural versus urban lifestyles must be considered in health disparities research. Many challenges arise with data measurement in health disparities research. Different social, economic, and environmental inequalities can lead to health disparities among a population. Identifying these inequalities and finding the best way to measure them among a specific sample can be
1308
Western Journal of Nursing Research 36(10)
difficult. For example, does a single measure of socioeconomic status by way of yearly income indicate lifestyle of an individual? Regardless of a person’s socioeconomic status, lifestyle can be influenced by education, neighborhood, or cultural beliefs. Place of residence has accounted for racial disparities in health outcomes that were unaccounted for by individual socioeconomic status (Do et al., 2008). This indicates a closer look at specific factors of a community that affect racial disparities in health is needed. Variables that contribute to inequalities are often not modifiable. However, identifying which variable may have the greatest impact on health disparities can guide practice and policy changes to improve care provided to vulnerable populations. In addition, to affect health disparities and close the gap in health outcomes, researchers may need to move beyond a focus on inequalities and identify factors amenable to change within a population at greatest risk for poor health outcomes. A better understanding of reasons for racial disparities in health may be achieved when we look beyond skin color, consider heterogeneity as well as explicitly define the race and ethnicity of the sample, and focus on factors amenable to change. Urmeka T. Jefferson University of Missouri–Columbia References Do, D. P., Finch, B. K., Basurto-Davila, R., Bird, C., Escarce, J., & Lurie, N. (2008). Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/White health gap in the United States. Social Science & Medicine, 67, 1258-1268. Drevdahl, D., Taylor, J. Y., & Phillips, D. A. (2001). Race and ethnicity as variables in nursing research, 1952-2000. Nursing Research, 50, 305-313. U.S. Department of Health and Human Services. (2014). Healthy People 2020. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objective slist.aspx?topicId=26
WJNXXX10.1177/0193945914548003Western Journal of Nursing Research
Editorial
Looking Beyond Skin Color: Addressing Heterogeneity in Health Disparities Research
Western Journal of Nursing Research 2014, Vol. 36(10) 1307–1308 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0193945914548003 wjn.sagepub.com
As health care professionals, we strive to prevent disease and promote health. Yet, disparities in health continue for vulnerable populations in the United States. Health disparities exist when variations or gaps in health outcomes occur that are associated with social, economic, and/or environmental disadvantages. Some populations endure the burden of health disparities with higher rates of disease and death; thus, the primary goal of Healthy People has focused on health disparities. Over the last two decades, the focus has shifted from reducing health disparities to eliminating health disparities and achieving health equity, which includes the highest level of health for all people (U.S. Department of Health and Human Services, 2014). This brings to the forefront of health care, the importance of health disparities research. In an effort to address gaps in health outcomes, researchers often focus on racial disparities as health disparities are widespread among racial and ethnic minority populations. However, there is a need to look beyond skin color to understand differences in populations. Distinction of racial and ethnic groups in research is necessary to control these factors, which may affect the outcome variables being studied. When speaking of a person’s race, physical characteristics such as skin color are considered. Ethnicity, however, refers to cultural characteristics such as religion or nationality (Drevdahl, Taylor, & Phillips, 2001). There are many ethnic groups of Blacks in the United States including Haitian and African, but often Blacks and African Americans are included in the same race classification with no distinction between the ethnic subgroups in national data and research. We can no longer assume one size fits all when it comes to health outcomes without considering heterogeneity within a population. Other contributors that may affect the persistent racial disparity in health outcomes such as ethnicity, education, socioeconomic status, and rural versus urban lifestyles must be considered in health disparities research. Many challenges arise with data measurement in health disparities research. Different social, economic, and environmental inequalities can lead to health disparities among a population. Identifying these inequalities and finding the best way to measure them among a specific sample can be
1308
Western Journal of Nursing Research 36(10)
difficult. For example, does a single measure of socioeconomic status by way of yearly income indicate lifestyle of an individual? Regardless of a person’s socioeconomic status, lifestyle can be influenced by education, neighborhood, or cultural beliefs. Place of residence has accounted for racial disparities in health outcomes that were unaccounted for by individual socioeconomic status (Do et al., 2008). This indicates a closer look at specific factors of a community that affect racial disparities in health is needed. Variables that contribute to inequalities are often not modifiable. However, identifying which variable may have the greatest impact on health disparities can guide practice and policy changes to improve care provided to vulnerable populations. In addition, to affect health disparities and close the gap in health outcomes, researchers may need to move beyond a focus on inequalities and identify factors amenable to change within a population at greatest risk for poor health outcomes. A better understanding of reasons for racial disparities in health may be achieved when we look beyond skin color, consider heterogeneity as well as explicitly define the race and ethnicity of the sample, and focus on factors amenable to change. Urmeka T. Jefferson University of Missouri–Columbia References Do, D. P., Finch, B. K., Basurto-Davila, R., Bird, C., Escarce, J., & Lurie, N. (2008). Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/White health gap in the United States. Social Science & Medicine, 67, 1258-1268. Drevdahl, D., Taylor, J. Y., & Phillips, D. A. (2001). Race and ethnicity as variables in nursing research, 1952-2000. Nursing Research, 50, 305-313. U.S. Department of Health and Human Services. (2014). Healthy People 2020. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objective slist.aspx?topicId=26
