Unpacking Race and Ethnicity: Why Clear Definitions Matter in Public Health
"Navigating the Complexities of Race and Ethnicity in Health Research to Achieve Equitable Outcomes"
It's a universal truth: health and disease don't affect everyone equally. These disparities are evident across various population groups, whether defined by race, ethnicity, nationality, religion, socioeconomic status, or gender. In the United States, racial and ethnic disparities are well-documented in physical and mental health conditions, health-related risk factors, and access to quality healthcare services.
The true challenge for public health lies in understanding the root causes of these disparities. By identifying the underlying factors, we can inform effective policies and develop targeted programs aimed at reducing health inequalities. But here's the catch: how we classify population groups significantly impacts how we examine and interpret these health disparities. Over the past few decades, the theories and methods used to study racial and ethnic disparities have faced substantial criticism within public health and epidemiology.
Several comprehensive reviews have pinpointed key issues in how race and ethnicity are used in public health research. These include: a failure to differentiate between the concepts of race and ethnicity, inconsistency and lack of transparency in assessment methods, and a dearth of thoughtful interpretation of study results. Reviews in related fields like biomedicine and nursing research have echoed these concerns, highlighting the urgent need for clarity and precision.
Race, Power, and Classification
The history of race and ethnicity is tied to political and economic power, labor and class struggle, and cultural production. Historical scholarship examines how racial and ethnic categories were formed in particular places and periods, and how these classifications affected people’s lived experiences and material circumstances. The U.S. Census Bureau reports that the 1977 OMB standards treated ethnicity as distinct from race: Hispanic people may be of any race. Britannica notes that “race” began being used as a term for human beings in English in the late 16th century and was widely used by the 18th century to classify and rank peoples in the English colonies.
Race vs. Ethnicity: Untangling the Definitions
In recent anthropological and public health discourse, race and ethnicity are distinctly defined as concepts that address two separate facets of human diversity. Understanding the difference is the first step towards more accurate and meaningful research.
- The Limits of Biology: Current scientific knowledge and genetics challenge the notion that these racial groups are mutually exclusive based on biology.
- Genetic Variation: While clines and clusters exist in human genetic variation, they account for relatively little of the total variation. The three conventional racial groupings based on continental origins (Europe, Africa, and Asia) differ from each other by only 10% to 15% of their genes. Most human genetic variation is non-concordant, meaning that traits used to distinguish races have limited value in predicting other biological characteristics.
- Social Construct: Despite the dismissal of race as a purely biological concept, public health scholars propose using race as a social construct to understand social interactions and perceptions of race. The socio-cultural reality of race has biological consequences through social inequalities and embodied inequalities, perpetuating a racialized view of human biology.
Recent Research on Measurement
A systematic review examined how race and ethnicity were conceptualized, operationalized, and used in randomly selected articles from prominent epidemiology journals across five periods: 1995–1999, 2000–2004, 2005–2009, 2010–2014, and 2015–2018. Another study’s first phase used an in-depth, structured literature search to identify recommendations for addressing race in biomedical research. That search found near-complete agreement in the literature on the need to address race in biomedical research.
Problems in Research Practice
A review identified several recurring problems in research on race and ethnicity. These include failing to differentiate between race and ethnicity, using racial categories inappropriately to assign ethnicity, and providing insufficient transparency about how either concept was assessed. It also identified failures to address the limitations involved in constructing and using racial or ethnic taxonomies.
Race and Ethnicity Compared
Race and ethnicity describe different concepts, although they are often used interchangeably in everyday conversation. One source broadly describes race as categories based on perceived physical traits such as skin color, hair texture, and facial features, while ethnicity refers to shared cultural markers such as language, religion, ancestry, cuisine, and customs. Another comparison similarly distinguishes race by attributes such as skin color, build, hair, height, and eye color from ethnicity as membership in a social or cultural group connected to traditions, religion, or language.
Moving Forward: Towards More Equitable Health Research
To tackle the key problems in research related to race and ethnicity, we must first acknowledge that race and ethnicity are conceptually different. Doing so enables the appropriate selection of theories and methods to study each concept effectively, whether independently or in interaction. By recognizing the distinct nature of race and ethnicity, we can begin to address health disparities with greater precision and promote more equitable outcomes.
Improving Data Collection
Research involving human subjects requires the collection and reporting of demographic data related to race and ethnicity. Existing practices lack standardized guidelines, which can contribute to misrepresentation and biased inferences and conclusions for underrepresented populations. CMAJ encourages collecting, analyzing, and reporting race and ethnicity data to provide evidence about health effects, disparities, and inequities experienced by different racial and ethnic groups.