Race and health: basic questions, emerging directions
Racial categories are sociopolitical constructs and do not reflect genetic homogeneity. Nonetheless, use of racial categories captures real differences due to social inequality and racial stratification. Race is a "fundamental organizing principle of society," and, therefore, affects all aspects of peoples' lives. Williams promotes the following framework for studying the relationship between race and health: BASIC CAUSES-> SOCIAL STATUS-> SURFACE CAUSES-> BIOLOGICAL PROCESSES-> HEALTH STATUS The "basic causes" are interrelated culture, biology/geography, economic structure, and political/legal factors (as well as racism). According to Williams, social inequality will produce new intervening mechanisms, even when more proximate health causes change, to maintain the status quo. Someone else's summary: This paper aims to "(i) examine the scientific consensus on the conceptualization and meaning of race; (ii) outline why health researchers should continue to study race; and (iii) provide guidelines for future health research that can promote an enhanced understanding of the role of race" (p. 322). Williams notes that older definitions of race in the social sciences treat it primarily as a biological construct. However, more recent conceptualizations of race in the social sciences tend to reject biological definitions as unscientific. Rather, race is viewed as "a sociopolitical construct with strong cultural and ethnic components" (p. 323). Williams proceeds to claim that the scientific "consensus" on race is synonymous with the new social scientific perspective, but that the biomedical and public health view of race (apparently unscientific) maintains that there are important biological elements to racial distinctions. This is problematic, in Williams's view, because the medical view of race may lead to inappropriate diagnoses and treatments. Furthermore, the genetic characteristics which produce racial differences (e.g., skin color) do not typically correlate strongly with morbidity outcomes. Some argue that since race has been delegitimized as a biological construct in the social sciences, it should no longer be included in studies of health. Williams disagrees with such a view, since race captures inequalities inherent in American society. Race is associated with a history of exploitation and oppression in the United States, and the lingering effects of discrimination and prejudice are still present both in structural inequalities (e.g., housing discrimination) and individual attitudes and behaviors. Furthermore, race is an important concept of group allegiances, as evidenced by social psychological research on in-group and out-group formation. Race is also key to understanding the formation of individual identities, particularly in a highly racialized society like the U.S. Finally, it is essential to recognize that race is strongly correlated with morbidity and mortality outcomes in the U.S. Therefore, it should be retained as a "master status-a central determinant of social identity and obligations, as well as, of access to societal rewards and resources" (p. 326). Williams argues that health studies which use race must become more sophisticated in terms of its measurement. Care should be taken to explore the multidimensional nature of race, and to avoid simplistic categories (e.g., black, white, other). Williams also proposes a conceptual model to serve as a general guide for research on race and health. The model links race and health through a web of structural, behavioral and biological constructs. Along with SES, gender, age and marital status, race is viewed as a form of social status that is affected directly by a host of "basic causes" (i.e., culture, biology, geographic origins, racism, and economic, political and legal structures). Race has a direct effect on surface causes (e.g., health practices and stress); surface causes effect biological processes (e.g., immune function); and, of course, biological processes affect health status (e.g., morbidity, mental health). Consistent with previous sociological research, Williams argues that policies designed to reduce racial differences in health must address basic causes, since a narrow focus on surface causes cannot redress more fundamental social inequalities.