racial and national origin, or sociocultural groups. People may choose to report more than one race to indicate their race, such as “American Indian” and “White.” People who identify as Hispanic, Latino, or Spanish may be of any race. OMB requires five minimum categories: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander. “Race” and “ethnicity” are variable and fluid terms; there is no consensus as to what either means. Patterns of human genetic variation are not well described by concepts of “race” or “ethnicity” because these notions include socio- cultural and political factors. To be consistent with the latest research on the causes of health disparities (as well as the findings from the Human Genome Project) it is recommended that a more socio- cultural definition of race be used: Any of several extensive human populations associated with broadly defined regions of the world and distinguished from one another on the basis of inheritable physical characteristics, traditionally conceived as including such traits as pigmentation, hair texture, and facial features. Because the number of genes responsible for such physical variations is tiny in comparison to the size of the human genome and because genetic variation among members of a traditionally recognized racial group is generally as great as between two such groups, most scientists now consider race to be primarily a social rather than a scientific concept” (The American Heritage Science Dictionary, 2012). Differences in life expectancy, mortality, incidence of disease, and causes of death are well documented among racial groups. Social and economic factors as well as barriers to treatment - language, public health policy, illiteracy, health, beliefs, and coping behaviors - contribute to unequal health outcomes. the body produces abnormal red blood cells that are sickle shaped. People of African descent are not the only ones affected by this disease; it is also present in Portuguese, Spanish, French Corsicans, Sardinians, Sicilians, mainland Italians, Greeks, Turks and Cypriots, South Asians, Middle Easterners, and Caucasians from southern Europe. Today, 1 to 3 million Americans is affected by sickle cell disease (SCD). Self-reported or observed race cannot be used to predict accurately who has the sickle cell trait or disease; universal screening is now being recommended and practiced throughout the United States. The U.S. Census Bureau (2016) estimates that: ● SCD occurs among about 1 out of every 365 Black or African-American births. ● SCD occurs among about 1 out of every 16,300 Hispanic-American births. ● About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT). Economic, social, and cultural factors can influence health disparities in prevention, early detection, diagnosis, treatment, post-treatment quality of life, survival, and mortality. For example, racial disparities in asthma emergency department use, hospitalization, and death are documented. Possible explanations include a more acute asthma among racial and ethnic minorities, greater environmental obstacles in high poverty areas, a lag in
The Kaiser Commission noted the following data about health care disparities: ● Most uninsured people are in low-income working families. In 2014, 5 of 10 families had income below 200% of the poverty level, although 8 of 10 families had at least one employed member. ● Adults are more likely to be uninsured than are children, due to provisions in the Affordable Care Act (ACA). ● People of color are at a higher risk of being uninsured than non-Hispanic whites. ● In 2014, 48 percent of uninsured adults said that the main reason they were uninsured was because the cost of insurance was too high. Many people do not have access to health coverage through a job. Some individuals - particularly poor adults in states that did not expand Medicaid - remain ineligible for public coverage. ● Undocumented immigrants are ineligible for Medicaid or Marketplace coverage. ● As of 2014, the ACA expanded health coverage to millions of previously uninsured people through the expansion of Medicaid eligibility and the establishment of Health Insurance Marketplaces. The ACA also included reforms to help people maintain coverage and to make private insurance affordable and accessible. Through 2014 and the beginning of 2015, evidence has shown substantial gains in public and private insurance coverage, as well as historic decreases in uninsured rates during the first full year of ACA coverage. Racial data was derived from questions that were asked by The United States Census Bureau. The U.S. Census Bureau collects racial data based on self-identification in accordance with guidelines provided by the U.S. Office of Management and Budget (OMB). The racial categories included in the census questionnaire reflect the social definition of race recognized in this country, and is not an attempt to define race biologically, anthropologically, or genetically. In addition, it is recognized that the categories of race include Case study Adriana was a 4-year-old girl who had been experiencing pain in her joints that kept her awake at night. Upon an initial screening, she was referred to a pediatric physical therapist for treatment. She did not respond to therapy and her therapist suggested that a pediatric specialist reevaluate her. Adriana was an only child; her parents had emigrated from Greece two years before. Her parents had taken her to multiple doctors to find out what was wrong, and had become frantic. One of her physicians performed a complete blood count (CBC), hemoglobin electrophoresis, and a sickle cell test. She was found to be positive for sickle cell disease. Adriana finally received the treatment that was needed. Discussion The disease was not initially diagnosed because the child was not African American; therefore, it was thought that she would not have this disease. This demonstrated a lack of knowledge concerning race, genetics, and the disease itself: Sickle cell disease is an inherited form of anemia in which The impact of race and culture on health A person’s culture and self-identify are influenced by their race and ethnicity, religion, gender, sexual orientation, age, disability, socio-economic status, and linguistic ability. Linguistic factors - including people with limited English proficiency (LEP), low literacy skills, the hearing impaired, speech or physical or cognitive impairment - affect language and are integrally related.
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