Paul Hsu (
Mara C. Bryant is operations executive at Adventist Health White Memorial, in Los Angeles.
Health Aff (Millwood). 2018 Sep;37(9):1394-1399. doi: 10.1377/hlthaff.2018.0427.
The historical narrative on diversity, race, and health would predict that California's population change from 22 percent racial/ethnic minority in 1970 to 62 percent in 2016 would lead to a massive health crisis with high mortality rates, low life expectancy, and high infant mortality rates-particularly given the state's high rates of negative social determinants of health: poverty, high school incompletion, and uninsurance. We present data that suggest an alternative narrative: In spite of these negative factors, California has very low rates of mortality and infant mortality and long life expectancy. This alternative implies that racial diversity may offer opportunities for good health outcomes and that community agency may be a positive determinant. Using national-level mortality data on racial/ethnic groups, we suggest that new theoretical models and methods be developed to assist the US in achieving high-level wellness as it too becomes "majority minority."
从历史角度来看,多样性、种族和健康之间的关系表明,加利福尼亚州的人口结构从 1970 年的 22%少数族裔到 2016 年的 62%,这将导致严重的健康危机,包括高死亡率、低预期寿命和高婴儿死亡率——尤其是考虑到该州存在大量负面健康决定因素,如贫困、高中辍学和没有医疗保险。我们提供的数据表明,存在另一种解释:尽管存在这些负面因素,加利福尼亚州的死亡率、婴儿死亡率和预期寿命都非常低。这意味着种族多样性可能为良好的健康结果提供机会,社区机构可能是一个积极的决定因素。我们使用全国层面的关于种族群体的死亡率数据,建议开发新的理论模型和方法,帮助美国实现高水平的健康,因为它也将成为“多数少数族裔”国家。