Map of life expectancy at birth from Global Education Project.

Tuesday, February 28, 2006

Reality is on the March!

The ice isn't melting yet in New England, but maybe the figurative ice is starting to melt in the U.S.A. The schemes of the administration to turn reality into a thought crime are falling apart. It turns out that burning fossil fuels does cause global warming, that mercury is toxic, and that evolution is an established scientific fact, and discussion of these truths is again permitted.

One effort at newthink that got somewhat less attention was the attempt to make racial and ethnic inequality disappear. Political officials at HHS last year attempted to rewrite the annual report on health disparities (produced by the Health Resources and Services Administration under a Congressional mandate), so as to minimize findings of inequality and injustice. They got caught. The attempt in California to pass a ballot initiative forbidding the collection of public health data by race and ethnicity was soundly defeated. The good people of California do not agree with the proposition that what we don't know can't hurt us.

And now we have a new report from the National Committee on Vital and Health Statistics (PDF) calling for more and better data on racial and ethnic disparities in health. One of our biggest problems in this area is the official federal system for classifying the population, which is based on 19th Century concepts of biological race. We get to be White, Black, Asian, Native American, or Pacific Islander, and then we get to choose one "ethnicity": Hispanic or not Hispanic.

That's not how people identify themselves, and it's not who they are, and it's not part of what determines their health status or the quality of the health care they receive. In Massachusetts, for example, 84% of white, non-Hispanic mothers get "adequate" prenatal care (according to a common standard), and 79% of mothers of Cuban ethnicity get adequate care, but only 64% of Puerto Rican mothers do. If you lump all the "Hispanics" together, you won't know this.

Black doesn't mean African American -- people classified as Black might also be Haitian, Jamaican, or Nigerian. Just to show how reflexively people in the U.S. think in terms of race categories, the New York Times once said that every heavyweight champion since Sonny Liston has been African American. They were forced to print a correction noting that Lennox Lewis is a subject of Her Royal Highness, Elizabeth the Second, rather than our own monarch.

In order to understand health disparities, it's also important to know other information such as people's immigration history, preferred language, level of education, etc. We also need more reliable data about ethnicity, based on people's self-identity, not the guess of a hospital clerk, jammed into procrustean categories. NCVHS has now proclaimed this. Whether the administration will do anything about it, or continue to try to back into the future, that's another question.