The Meaning of Race in Medical
and Public Health Research
Thomas A. LaVeist, Ph.D.
Associate Professor
Johns Hopkins School of Public Health
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
Biogenetic Factor?
 Cultural Factor?
 Social Factor?

The Prominence of Race in Health Research
Percent of articles using race
AJE
HSR
JHSB
64%
64%
53%
Source:
AJE Jones, LaVeist, and Lillie-Blanton 1991
HSR Williams (1994)
JHSB LaVeist, Williams, Jones and Lillie-Blanton 1992
How Race is Typically Used
Sample Selection
 Stratification
 Binary Variables in Regression to
“Control” for Race Effect

Assigning Racial Status: Pre-1989
USA
FATHER
MOTHER
CHILD
White
White
White
Black
Black
Black
Japanese
Japanese
Japanese
White
Black
Japanese
White
Black
Japanese
White
Black
Japanese
White
Black
Japanese
Black
Black
Black
Japanese
Japanese
Japanese
Assigning Racial Status: Pre-1985
Japan
FATHER
MOTHER
CHILD
White
Japanese
White
Black
Japanese
Black
Japanese
White
Japanese
Japanese
Black
Japanese
Assigning Racial Status
Brazil
FATHER
MOTHER
CHILD
White
Black
Mulatto
Black
White
Mulatto
Black
Black
Black
White
White
White
Mulatto is Divided Based on
Darkness of Skin Color





Preto Retinto (dark Black)
Pretos (Black)
Cabra (slightly less Black)
Cabo Verde (slightly less
Black)
Mulatto Esuro (dark
Mulatto)





Mulatto Claro (light
Mulatto)
Moreno
Sararas
Blanco
Blanco de Terra
Race Defined
Persons who are relatively
homogeneous with respect to
biological inheritance.
A Dictionary of Epidemiology (1988)
Race Defined
1) An ethnic stock, or division of mankind; in a
narrower sense, a national or tribal stock; in a
still narrower sense, a genealogical line of
descent; a class of persons of a common
lineage. In genetics, races are considered as
populations having different distributions of
gene frequencies. 2) a class or breed of
animals; a group of individuals having certain
characters in common, owing to a common
inheritance; a sub-species.
Dorland’s Illustrated Medical Dictionary (1988)
Race Defined
Applied to human beings, the term race
implies a blood related group with
characteristics and common heredity
traits… Primary races or sub-species--the
Caucasian, the Mongoloid, and the Negro-are generalized racial types, hypothetical
stocks, rather than living races.
Psychiatric Dictionary (1981)
Race Defined
A subspecies or other division or subdivision of a species.
Human races are generally defined in terms of original
geographic range and common hereditary traits which may
be morphological, serological, hematological,
immunological, or biochemical. The traditional division of
mankind into several well-recognized racial types, such as
Caucasoid (White), Negroid (Black), and Mongoloid (yellow)
leaves a residue of populations that are of problematical
classification, and its focus on a limited range of visible
characteristics tends to over simplify and distort the picture
of human variation.
International Dictionary of Medicine and Biology (1986)
Race Defined
A phenotypically and/or geographically
distinctive sub-specific group, composed of
individuals inhabiting a defined geographical
and/or ecological region, and possessing
characteristic phenotypic and gene frequencies
that distinguish it from other such groups. The
number of racial groups that one wishes to
recognize within a species is usually arbitrary
but suitable for the purposes under
investigation.
A Dictionary of Genetics (1990)
Race Defined
An ethnic classification, subdivision in the US into
five categories, according to origin: 1) White, not
Hispanic (Europe, North Africa, Middle East); 2)
Black, not Hispanic (Africa), 3) Hispanic; 4)
American Native (Indians, Eskimos); 5) Asian and
Pacific Islanders. Stratification by race is of interest
in several areas of medicine for a number of specific
reasons:
The Dictionary of Modern Medicine (1992)
TRANSFUSION MEDICINE
Certain red cell antigens may be relatively uncommon
in a particular race and knowledge of race reduces the
labor required to find a suitable unit for transfusion.
The Dictionary of Modern Medicine (1992)
TRANSPLANTATION
Human leukocyte antigens (HLA) differ
somewhat according to race and may be used to
identify potential recipients for organ
transplantation.
The Dictionary of Modern Medicine (1992)
PUBLIC POLICY
The Civil Rights Act of 1964 mandated equality in
employment and educational policy and knowledge of
race favors minority candidates.
The Dictionary of Modern Medicine (1992)
CLINICAL MEDICINE
Some HLAs are more common in certain racial
groups and may be associated with particular
diseases, thus helping to diagnose and manage
difficult cases.
The Dictionary of Modern Medicine (1992)
The Dictionary of Modern Medicine
(1992)
Transfusion
HLA Differences
Transplantation
HLA Differences
Public Policy
Affirmative Action
Clinical Medicine
HLA Differences
Sickle Cell
In 1988 35.4% (93,577) of the 264,019 total
deaths among African Americans were considered
to be excess deaths. Only 731 (.78%) of these
deaths were caused by all anemias, sickle cell or
otherwise.
Measurement Differs by Data Collection
Method




Birth Certificates - assigned mother’s race based
on visual assessment of mother
Death Certificates - assigned based on visual
assessment of the body
Telephone/Mail Survey - Respondent self-report
Face-to-face Survey - Interviewer’s visual
assessment
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
WHAT IS RACE?
CONSTRUCT VALIDITY
POVERTY
Poor
Housing
Access to
Health Care
Poor
Nutrition
Environmental
Hazards
HEALTH
STATUS
CONCEPTUAL MODEL OF RACE
RACE
LATENT (UNOBSERVED) FACTOR
MANIFEST INDICATOR
(skin color)
PHYSIOGNOMY
SOCIETAL
EXTERNAL
RISK EXPOSURE
CULTURE
ETHNICITY
HEALTH/ILLNESS
BEHAVIOR
RACE DIFFERENCES
IN HEALTH STATUS
CATEGORIZATION INTO
RISK/BEHAVIOR GROUPS
RISK EXPOSURE
OBSERVED HEALTH
OUTCOMES
USING RACE
Indicate how race was measured
 Provide a scientifically valid rationale for
including race
 Provide a Scientifically valid rationale for
excluding race

USING RACE
Develop explicit measures for factors believed to
be measured by race binary variables
 Always provide an interpretation for findings of
a significant race effect in your analysis
 Treat the race variable with the same degree of
caution as other variables

The Meaning of Race in Medical
and Public Health Research
Thomas A. LaVeist, Ph.D.
Associate Professor
Johns Hopkins School of Public Health