Race and Ethnicity: A Compelling Research Agenda

Abstract

IN RESPONSE: Dr. Bauer misunderstands my reference to affirmative action and by extension reveals a misunderstanding of the reality of racial and ethnic minorities in the United States. In my view, Dr. Bauer makes at least two mistakes. First, my comment did not so much express support for affirmative action as point out that our society is currently engaged in a fierce debate about affirmative action; one of the core disagreements in that debate is whether race or ethnicity is still a relevant way to distinguish among persons or whether our society has become race-blind. The three articles on which my editorial commented made it clear that with regard to medical outcomes, race is clearly still a relevant, and indeed powerful, way to distinguish among persons. Second, race as a medical reality and race as a sociopolitical reality are not apples and oranges; Dr. Bauer is creating a false dichotomy. The contribution of genetically based racial differences to health status differentials is trivial compared with the contribution of differences that are driven by sociopolitical realities: Disparate educational attainment, income levels, and access to health care and ongoing discrimination are all powerful sociopolitical drivers of medical outcomes. Moreover, it is race as a sociopolitical construct that creates the well-documented, persistent, and pervasive racial differences in the use of medical services and procedures even after adjustment for financial barriers and prevalence of disease [1, 2]. Finally, the last sentence of Dr. Bauer's letter requires comment. The juxtaposition of scientific integrity and political policy is, once again, a false dichotomy. The reductionistic view that science can somehow be artificially set apart from society or politics is manifestly false, especially when the object of study is minority health status. In looking at hypertension, for example, one may prefer to examine arterioles rather than the experience of discrimination, but integrating both the biological and the social is likely to produce more profound insights [3]. We cannot begin to understand minority health status unless we accept the complex interactions between biology and sociology.