9.2: Community and Public Health and Racial/Ethnic Populations

In the past, I assigned a chapter from the textbook Introduction to Community & Public Health (McKenzie, Seabert, Pinger) for its overview of health in the US in diverse ethnic or racial populations.  The book did a decent job of highlighting the health status of leading non-white racial groups (African American, Asian American, Native American, Pacific Islanders) and the Hispanic (Latino/a/x) ethnic group which encompasses people of Latin American heritage of all races. It pointed to the importance of cultural and linguistic competency, and the need to examine socioeconomic status as one major social determinant of health inequalities in the United States.

At the same time, the book sometimes fell into over-generalizations. This is a common trap when discussing differences in health status. 

More recently, I have added a few pages from an OpenStax textbook about how race and ethnicity are categorized in the US and how they can interact with health. I hope this overview is more inclusive and offers helpful concepts. 

 As you read this chapter, consider the following questions:

1. What racial and ethnic categorizations are used in the U.S. on the Census and in most national health research? How have these categories changed over time?
   • It's surprising to many people to know that the US Census - conducted every ten years - has seldom used the same list of races/ethnicities twice. Some of the categories stay the same, sometimes the term for a group of people changes, and sometimes entire groups are added or removed.
   • Currently, the Trump Administration has proposed ELIMINATING all race and ethnicity categories (as well as sexual orientation) from the US Census in 2030. What would we gain or lose by NOT collecting data that identifies US residents by race or ethnicity?
   • Also, the US Census has included all people residing in the US, regardless of citizenship or immigration status, since 1790. The Trump Administration proposes that the 2030 Census only include US citizens and permanent residents, no one else. What impact would this have on the data we use to understand public health? Any other impacts that could occur?
   • It is important to note that these are PROPOSALS at the moment and not final decisions -- the courts and possibly Congress will have a say, before the Census questions are finalized. 
      
2. How does culture affect our health behaviors and health beliefs?  Economic opportunities also have a huge effect, and are often affected by current and past racism in our society.  What would help you understand the different influences of culture and economic opportunity in working with diverse communities?
    
3. What are some of the gaps or limitations in the data collected about race and ethnicity? why might it be hard to get accurate data sometimes?
    
4. What stands out for you in the brief overviews of the health status of each of these communities or populations?

• People of Hispanic origin (Latinos/as/x)
• African Americans
• Asian Americans
• Pacific Islanders
• Native Americans and Alaskan Natives
• Immigrants and refugees (of all backgrounds)

This chapter also looks at racial and ethnic health disparities, along with public health initiatives to improve health and overcome those disparities. Among these you will find:

1. The Race & Health Initiative and its priority areas
2. Socioeconomic status and its connection to health
3. Cultural competence and the CLAS Standards for Culturally- and Linguistically-Appropriate Care
4. The importance of empowerment at the community and individual levels

In the next few pages we'll walk through a brief overview of health in diverse communities.

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