Whaley Arthur L
Department of Community Health and Social Medicine, City University of New York Medical School, New York, NY 10031, USA.
J Natl Med Assoc. 2003 Aug;95(8):736-42.
Ethnicity/race is a much-studied variable in epidemiology. There has been little consensus about what self-reported ethnicity/race represents, but it is a measure of some combination of genetic, socioeconomic, and cultural factors. The present article will attempt to: 1.) Elucidate the limitations of contemporary discourse on ethnicity/race that emphasizes the genetic and socioeconomic dimensions as competing explanatory frameworks; 2.) Demonstrate how considerable attention to the cultural dimension facilitates understanding of race differences in health-related outcomes; and 3.) Discuss interpretations of disparities in health status of African Americans versus European Americans from an ethical perspective. A major challenge to the discourse on ethnicity/race and health being limited to socioeconomic and genetic considerations is the lack of attention to the third alternative of a cultural perspective. The combined cultural ideologies of individualism and racism undermine the utility of epidemiologic research in health promotion and disease prevention campaigns aimed at reducing the racial gaps in health status. An ethical analysis supplements the cultural perspective. Ethics converge with culture on the notion of values influencing the study of ethnicity/race in epidemiology. A cultural approach to the use of ethnicity/race in epidemiologic research addresses methodological limitations, public health traditions, and ethical imperatives.
种族在流行病学中是一个被广泛研究的变量。关于自我报告的种族代表什么，人们几乎没有达成共识，但它是遗传、社会经济和文化因素某种组合的一种度量。本文将试图：1）阐明当代关于种族的论述的局限性，这种论述强调遗传和社会经济维度作为相互竞争的解释框架；2）展示对文化维度的大量关注如何有助于理解与健康相关结果中的种族差异；3）从伦理角度讨论对非裔美国人和欧裔美国人健康状况差异的解释。将种族与健康的论述局限于社会经济和遗传考量的一个主要挑战是缺乏对文化视角这第三种选择的关注。个人主义和种族主义的综合文化意识形态削弱了流行病学研究在旨在缩小健康状况种族差距的健康促进和疾病预防运动中的效用。伦理分析补充了文化视角。在影响流行病学中种族研究的价值观概念上，伦理与文化相契合。在流行病学研究中使用种族的文化方法解决了方法学局限性、公共卫生传统和伦理要求。
