Gender, Ethnicity, and Health Research

Health researchers routinely evaluate health and illness across subgroups defined by their sex, gender, ethnicity, and race. All too often, these classifications are proffered as an explanation for any differences that may be detected, for example, in access to care, frequency of disease, or response to treatment. Relatively few researchers, however, have examined what these classifications mean on a theoretical level or in the context of their own research. Assume, for example, that a researcher concludes from his or her data that African- Americans utilize certain surgical procedures less frequently than whites. This conclusion may mean little without an examination of the various underlying issues. Is there such a construct as race at all? How were whites and African-Americans classified as such? Does this finding reflect inappropriate overutilization of the specific procedures among whites or inappropriate underutilization among African-Americans? To what extent are socioeconomic status and method of payment related to the less frequent use? Are there differences in the manner in which health care providers present the various treatment options to whites and to African- Americans that could account for these differences in utilization? Are there differences in health care-seeking and health care preferences between the two groups that would explain the difference in utilization? Is the racial classification a surrogate measure for another variable that has remained unidentified and unmeasured? All too often, unfortunately, such issues are ignored or lightly dismissed with an entreaty for additional research.

This text examines the basic constructs of gender, sex, ethnicity, and race. These constructs are routinely used in the analysis of data in a number of fields, including epidemiology, health services research, sociology, and medical anthropology. Despite the widespread use of these terms, little thought has been given to what they really mean. What does it mean, for instance, to say that African Americans are at a higher risk of AIDS than other groups? Is this really a surrogate for sexual behavior? For access to medical care? For an unknown genetic difference in the immune system? Since ethnicity/race is not a mutable characteristic, are we accomplishing anything by focusing on it as a risk factor or risk marker, or should we be examining its underlying meaning? Should we continue to utilize these constructs and, if so, how? What are the implications for intervention programs and intervention research? This text addresses these constructs of gender and ethnicity in a manner that challenges the conventional wisdom within the health sciences. Additionally, the text will provide a good review of these constructs, as well as socioeconomic status, access to care, and quality of care.

Christopher Loffredo

This book is an overview of the complex issues of gender, race, and ethnicity as they are applied in biomedical research, particularly in the context of disease disparities and access to healthcare. The purpose is to provide a multidisciplinary approach to defining gender, race, and ethnicity in health research and to encourage critical thinking about these issues. Rather than providing solutions, the author seeks to raise awareness of the problems and provides an ethics based framework. The book is written mainly for health researchers and social scientists, including both students and professionals. A background in medicine, public health, or allied disciplines would be helpful to the reader. The book centers on the state of affairs in the U.S., with occasional comments on other regions. This work is organized into three main sections: foundations of the problems, the current health of specific communities, and case studies. In Chapter 1 ethical principles of health research are summarized. Chapter 2 is a review of types of study designs, and in Chapters 3 and 4 the historical development and current usage of the concepts of race and gender are introduced. In subsequent chapters the past and present state of health among African Americans, Asians and Pacific Islanders, Hispanics, Native Americans, women, and persons of varied sexual orientation are described. The final chapters are in-depth case studies of gender and race issues in HIV/AIDS and diabetes. There are few graphics and illustrations in this work, all in Chapter 2 and of dubious value, but otherwise the technical quality is high. This is a readable, enjoyable book. While studiously avoiding suggesting answers to thecomplex issues raised in the book, the author succeeds admirably in providing an overview of the problem and a framework for critical thinking. Each chapter is well researched and historical quotations and an extensive bibliography are provided. Concepts of acculturation, gender identity, and culture-specific beliefs about disease causes are handled sensitively and objectively. Some readers may find the introductory chapters overly ambitious.

"This text examines the basic constructs of gender, sex, ethnicity, and race. These constructs are routinely used in the analysis of data in a number of fields, including epidemiology, health service research, sociology, and medical anthropology. Despite the widespread use of these terms, little thought has been given to what they really mean. What does it really mean, for instance, to say that African-Americans are at a higher risk of AIDS than other groups? Is this really a surrogate for sexual behavior? For access to medical care? For an unknown genetic difference in the immune system? This text addresses these constructs of gender and ethnicity in a manner that challenges the conventional wisdom within the health sciences. Additionally, the text will provide a good review of these constructs, as well as socioeconomic status, access to care, and quality of care."--BOOK JACKET. Prologue: Understanding Social Constructs....Pages 1-10 Front Matter....Pages 11-11 Ethical Principles Governing Research Involving Human Participants....Pages 13-25 Principles of Research Design....Pages 27-46 Race and Ethnicity....Pages 47-57 Sex, Gender, and Sexual Orientation....Pages 59-66 Health Care Utilization and Access....Pages 67-83 Front Matter....Pages 85-85 African-American Health....Pages 87-100 Asian and Pacific Islander Health....Pages 101-116 Hispanic Health....Pages 117-132 The Health of Native Americans....Pages 133-145 Women and Health....Pages 147-157 Sexual Orientation and Health....Pages 159-170 Front Matter....Pages 171-171 Case Study One Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS)....Pages 173-183 Case Study Two Diabetes Mellitus....Pages 185-191 What does it mean to say that African Americans are more at risk of AIDS than others? Is this a surrogate for sexual behaviour, access to medical care, or unknown genetic differences in the immune system? This text challenges conventional wisdom on ethnicity and gender in the health sciences The ethical conduct of research is grounded in the principles of respect for persons, justice and fairness, beneficence, and nonmaleficence.