Race and health: Basic questions, emerging directions
Abstract
Purpose This paper examines the scientific consensus on the conceptualization of race, identifies why health researchers should analyze racial differences in morbidity and mortality and provides guidelines for future health research that includes race. Methods Examines scientific dictionaries and reviews the social science, public health and medical literature on the role of race in health. Results First, this paper reviews the evidence suggesting that race is more of a social category than a biological one. Variation in genotypic characteristics exists, but race does not capture it. Second, since racial categories have historically represented and continue to reflect the creation of social, economic, and political disadvantage that is consequential for well-being, it is important to continue to study racial differences in health. Finally, the paper outlines directions for a more deliberate and thoughtful examination of the role of race in health. Conclusions Race is typically used in a mechanical and uncritical manner as a proxy for unmeasured biological, socioeconomic, and/or sociocultural factors. Future research should explore how clearly delineated environmental demands combine with genetic susceptibilities as well as with specified behavioral and physiological responses to increase the risk of illness for groups differentially exposed to psychosocial adversity.
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By creating unequal access to resources and opportunity, racism is a fundamental cause of racial inequities in health.
“By creating unequal access to resources and opportunity, racism is a fundamental cause of racial inequities in health [10,11].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [11]
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The neglected epidemic: road traffic injuries in developing countries
NANTULYA, V. M., & Reich, M. R. (2002) · BMJ · doi:10.1136/bmj.324.7346.1139 · Cited by 783 · see citing works
Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth
Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.1.44 · Cited by 766 · see citing works
Issues of Race, Ethnicity, and Culture in Caregiving Research: A 20-Year Review (1980-2000)
Dilworth‐Anderson, P., Williams, I. C., & Gibson, B. E. (2002) · The Gerontologist · doi:10.1093/geront/42.2.237 · Cited by 757 · see citing works
Bor, J., Venkataramani, A. S., Williams, D. R., & Tsai, A. C. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31130-9 · Cited by 746 · see citing works
Self-citationOptimal Indicators of Socioeconomic Status for Health Research
Duncan, G. J., Daly, M. C., McDonough, P., & Williams, D. R. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.7.1151 · Cited by 735 · see citing works
Self-citationUnderstanding Racial-ethnic Disparities in Health: Sociological Contributions
Williams, D. R., & Sternthal, M. (2010) · Journal of Health and Social Behavior · doi:10.1177/0022146510383838 · Cited by 744 · see citing works
Self-citationInequalities in health: definitions, concepts, and theories
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015) · Global Health Action · doi:10.3402/gha.v8.27106 · Cited by 696 · see citing works
Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample
BRESLAU, J., AGUILAR-GAXIOLA, S., KENDLER, K. S., SU, M., WILLIAMS, D., & KESSLER, R. C. (2006) · Psychological Medicine · doi:10.1017/s0033291705006161 · Cited by 673 · see citing works
Self-citationLifetime risk and persistence of psychiatric disorders across ethnic groups in the United States
BRESLAU, J., KENDLER, K. S., SU, M., GAXIOLA-AGUILAR, S., & KESSLER, R. C. (2005) · Psychological Medicine · doi:10.1017/s0033291704003514 · Cited by 642 · see citing works
The Social Environment and Health: A Discussion of the Epidemiologic Literature
Yen, I. H., & Syme, S. L. (1999) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.20.1.287 · Cited by 634 · see citing works
Race/Ethnic Difference in Diabetes and Diabetic Complications
Spanakis, E. K., & Golden, S. H. (2013) · Current Diabetes Reports · doi:10.1007/s11892-013-0421-9 · Cited by 636 · see citing works
Use of race and ethnicity in biomedical publication
Kaplan, J. B. (2003) · JAMA · doi:10.1001/jama.289.20.2709 · Cited by 609 · see citing works
Understanding and addressing racial disparities in health care.
Williams, D. R., & Rucker, T. D. (2000) · PubMed Central · Cited by 581 · see citing works
Self-citationViruell-Fuentes, E. A. (2007) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2007.05.010 · Cited by 577 · see citing works
RACE AND ETHNICITY IN PUBLIC HEALTH RESEARCH: Models to Explain Health Disparities
Dressler, W. W., Oths, K. S., & Gravlee, C. C. (2005) · Annual Review of Anthropology · doi:10.1146/annurev.anthro.34.081804.120505 · Cited by 541 · see citing works
Invited commentary: “Race, racism, and the practice of epidemiology”
Jones, C. P. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.4.299 · Cited by 532 · see citing works
Rosenfield, S., & Mouzon, D. M. (2012) · Handbooks of sociology and social research · doi:10.1007/978-94-007-4276-5_14 · Cited by 553 · see citing works
Physiological responses to racism and discrimination: An assessment of the evidence
Harrell, J. P., Hall, S., & Taliaferro, J. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.2.243 · Cited by 517 · see citing works
Racial-Ethnic Disparities in Stroke Care: The American Experience
Cruz‐Flores, S., Rabinstein, A. A., Biller, J., Elkind, M. S. V., Griffith, P. A., Gorelick, P. B., Howard, G., Leira, E. C. C., Morgenstern, L. B., Ovbiagele, B. I., et al. (2011) · Stroke · doi:10.1161/str.0b013e3182213e24 · Cited by 508 · see citing works
Miles to Go before We Sleep: Racial Inequities in Health
Williams, D. R. (2012) · Journal of Health and Social Behavior · doi:10.1177/0022146512455804 · Cited by 507 · see citing works
Self-citationCaprio, S., Daniels, S. R., Drewnowski, A., KAUFMAN, F. R., Palinkas, L. A., Rosenbloom, A. L., & Schwimmer, J. B. (2008) · Diabetes Care · doi:10.2337/dc08-9024 · Cited by 495 · see citing works
Reconceptualizing Native Women's Health: An “Indigenist” Stress-Coping Model
Walters, K. L., & Simoni, J. M. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.4.520 · Cited by 466 · see citing works
Myers, H. F. (2008) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9181-4 · Cited by 464 · see citing works
Swim, J. K., Hyers, L. L., Cohen, L., Fitzgerald, D. C., & Bylsma, W. H. (2003) · Journal of Black Psychology · doi:10.1177/0095798402239228 · Cited by 442 · see citing works
The Incidence of Traumatic Brain Injury Among Children in the United States
Langlois, J. A., Rutland-Brown, W., & Thomas, K. E. (2005) · Journal of Head Trauma Rehabilitation · doi:10.1097/00001199-200505000-00006 · Cited by 428 · see citing works
Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs
Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-052620-103528 · Cited by 426 · see citing works
Lutfey, K., & Freese, J. (2005) · American Journal of Sociology · doi:10.1086/428914 · Cited by 425 · see citing works
Santelli, J. S., Lowry, R., Brener, N. D., & Robin, L. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.10.1582 · Cited by 420 · see citing works
Harris, R. B., Tobias, M. I., Jeffreys, M., Waldegrave, K., Karlsen, S., & Nazroo, J. Y. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.04.009 · Cited by 407 · see citing works
Reducing Racial Inequities in Health: Using What We Already Know to Take Action
Williams, D. R., & Cooper, L. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16040606 · Cited by 415 · see citing works
Self-citationGolden, S. H., Brown, A., Cauley, J. A., Chin, M. H., Gary-Webb, T. L., Kim, C., Sosa, J. A., Sumner, A. E., & Anton, B. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-2043 · Cited by 405 · see citing works
Commentary: Considerations for Use of Racial/Ethnic Classification in Etiologic Research
Kaufman, J. S. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.4.291 · Cited by 405 · see citing works
Lathan, C. S., Cronin, A. M., Tucker‐Seeley, R. D., Zafar, S. Y., Ayanian, J. Z., & Schrag, D. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.63.2232 · Cited by 399 · see citing works
The Mental Health of Black Caribbean Immigrants: Results from the National Survey of American Life
Williams, D. R., Haile, R., González, H. M., Neighbors, H. W., Baser, R. E., & Jackson, J. S. (2006) · American Journal of Public Health · doi:10.2105/ajph.2006.088211 · Cited by 397 · see citing works
Self-citationHarris, K. M., Gordon‐Larsen, P., Chantala, K., & Udry, J. R. (2006) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.160.1.74 · Cited by 389 · see citing works
Harris, R. B., Tobias, M. I., Jeffreys, M., Waldegrave, K., Karlsen, S., & Nazroo, J. Y. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68890-9 · Cited by 387 · see citing works
The cost of color: Skin color, discrimination, and health among African-Americans
Monk, E. P. (2015) · American Journal of Sociology · doi:10.1086/682162 · Cited by 386 · see citing works
Analytical epidemiology of periodontitis
Borrell, L. N., & Papapanou, P. N. (2005) · Journal Of Clinical Periodontology · doi:10.1111/j.1600-051x.2005.00799.x · Cited by 379 · see citing works
Racial and Ethnic Disparities in Emergency Department Analgesic Prescription
Tamayo‐Sarver, J. H., Hinze, S. W., Cydulka, R. K., & Baker, D. W. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.12.2067 · Cited by 367 · see citing works
Racial/Ethnic Variations in Women's Health: The Social Embeddedness of Health
Williams, D. R. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.4.588 · Cited by 353 · see citing works
Self-citationHicken, M. T., Lee, H., Ailshire, J., Burgard, S. A., & Williams, D. R. (2013) · Race and Social Problems · doi:10.1007/s12552-013-9095-9 · Cited by 355 · see citing works
Self-citationBorrell, L. N., Kiefe, C. I., Williams, D. R., Roux, A. V. D., & Gordon‐Larsen, P. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.04.008 · Cited by 345 · see citing works
Self-citationRegensteiner, J. G., Golden, S., Huebschmann, A. G., Barrett-Connor, E., Chang, A. Y., Chyun, D., Fox, C. S., Kim, C., Mehta, N., Reckelhoff, J. F., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000343 · Cited by 334 · see citing works
Classification of Race and Ethnicity: Implications for Public Health
Mays, V. M., Ponce, N. A., Washington, D. L., & Cochran, S. D. (2003) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.24.100901.140927 · Cited by 333 · see citing works
Segregation and Mortality: The Deadly Effects of Racism?
Collins, C., & Williams, D. R. (1999) · Sociological Forum · doi:10.1023/a:1021403820451 · Cited by 326 · see citing works
Self-citationHuman Population Genetic Structure and Inference of Group Membership
Bamshad, M. J., Wooding, S., Watkins, W. S., Ostler, C. T., Batzer, M. A., & Jorde, L. B. (2003) · The American Journal of Human Genetics · doi:10.1086/368061 · Cited by 330 · see citing works
Gadson, A. K., Akpovi, E., & Mehta, P. (2017) · Seminars in Perinatology · doi:10.1053/j.semperi.2017.04.008 · Cited by 323 · see citing works
Agyemang, C., Bhopal, R., & Bruijnzeels, M. (2005) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2005.035964 · Cited by 319 · see citing works
Racism and Cardiovascular Disease in African Americans
Calvin, R., Winters, K., Wyatt, S. B., Williams, D. R., Henderson, F. C., & Walker, E. R. (2003) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200306000-00003 · Cited by 313 · see citing works
Self-citationBoehmer, U. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.7.1125 · Cited by 311 · see citing works
Link, B. G., & Phelan, J. C. (2012) · Handbooks of sociology and social research · doi:10.1007/978-94-007-4276-5_25 · Cited by 304 · see citing works
The Social Psychology of Health Disparities
Schnittker, J., & McLeod, J. D. (2005) · Annual Review of Sociology · doi:10.1146/annurev.soc.30.012703.110622 · Cited by 292 · see citing works
Barrett, A. E., & Turner, R. J. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01296.x · Cited by 292 · see citing works
Gender equity and socioeconomic inequality: a framework for the patterning of women's health
Moss, N. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00115-0 · Cited by 289 · see citing works
Barrett, A. E., & Turner, R. J. (2005) · Journal of Health and Social Behavior · doi:10.1177/002214650504600203 · Cited by 283 · see citing works
Stansbury, J. P., Jia, H., Williams, L. S., Vogel, W. B., & Duncan, P. W. (2005) · Stroke · doi:10.1161/01.str.0000153065.39325.fd · Cited by 271 · see citing works
Racial Discrimination, Ethnic-Racial Socialization, and Crime
BURT, C. H., Simons, R. L., & Gibbons, F. X. (2012) · American Sociological Review · doi:10.1177/0003122412448648 · Cited by 273 · see citing works
Contrada, R. J., Ashmore, R. D., Gary, M. L., Coups, E. J., Egeth, J. D., Sewell, A., Ewell, K., Goyal, T. M., & Chasse, V. (2001) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2001.tb00205.x · Cited by 263 · see citing works
Primary Open-Angle Glaucoma in Blacks: A Review
Racette, L., Wilson, M. R., Zangwill, L. M., Weinreb, R. N., & Sample, P. A. (2003) · Survey of Ophthalmology · doi:10.1016/s0039-6257(03)00028-6 · Cited by 261 · see citing works
MULTIPLE PATHWAYS LINKING RACISM TO HEALTH OUTCOMES
Harrell, C. J. P., Burford, T. I., Cage, B. N., Nelson, T. M., Shearon, S., Thompson, A., & Green, S. (2011) · Du Bois Review: Social Science Research on Race · doi:10.1017/s1742058x11000178 · Cited by 257 · see citing works
Travassos, C., & Williams, D. R. (2004) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2004000300003 · Cited by 256 · see citing works
Self-citationFood Insufficiency and Physical and Mental Health in a Longitudinal Survey of Welfare Recipients
Siefert, K., Heflin, C. M., Corcoran, M. E., & Williams, D. R. (2004) · Journal of Health and Social Behavior · doi:10.1177/002214650404500204 · Cited by 251 · see citing works
Self-citationINTERSECTIONALITY AND WOMEN’S HEALTH: CHARTING A PATH TO ELIMINATING HEALTH DISPARITIES
Weber, L., & Parra-Medina, D. M. (2005) · Advances in gender research · doi:10.1016/s1529-2126(03)07006-1 · Cited by 249 · see citing works
Ethnic Differences in the Association between Body Mass Index and Hypertension
Bell, C. (2002) · American Journal of Epidemiology · doi:10.1093/aje/155.4.346 · Cited by 250 · see citing works
Subramanian, S. V., Acevedo‐García, D., & Osypuk, T. L. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.08.040 · Cited by 240 · see citing works
Refiguring “Race”: Epidemiology, Racialized Biology, and Biological Expressions of Race Relations
Krieger, N. (2000) · International Journal of Health Services · doi:10.2190/672j-1ppf-k6qt-9n7u · Cited by 239 · see citing works
Conceptual Approaches to the Study of Health Disparities
Roux, A. V. D. (2012) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031811-124534 · Cited by 241 · see citing works
Lamas, G. A., Bhatnagar, A., Jones, M. R., Mann, K. K., Nasir, K., Tellez‐Plaza, M., Ujueta, F., Navas‐Acien, A., & the American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Council on the Kidney in Cardiovascular Disease (2023) · Journal of the American Heart Association · doi:10.1161/jaha.123.029852 · Cited by 238 · see citing works
Lin, S. S., & Kelsey, J. L. (2000) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a018032 · Cited by 237 · see citing works
Education and the Gender Gaps in Health and Mortality
Ross, C. E., Masters, R. K., & Hummer, R. A. (2012) · Demography · doi:10.1007/s13524-012-0130-z · Cited by 237 · see citing works
Mitigating ethnic disparities in covid-19 and beyond
Razai, M. S., Kankam, H. K. N., Majeed, A., Esmail, A., & Williams, D. R. (2021) · BMJ · doi:10.1136/bmj.m4921 · Cited by 231 · see citing works
Self-citationRacial Categories in Medical Practice: How Useful Are They?
Braun, L., Fausto-Sterling, A., Fullwiley, D., Hammonds, E. M., Nelson, A., Quivers, W., Reverby, S. M., & Shields, A. E. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040271 · Cited by 236 · see citing works
Schulz, A. J., Israel, B. A., Williams, D. M., Parker, E. A., Becker, A., & James, S. A. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00084-8 · Cited by 232 · see citing works
Self-citationOkechukwu, C. A., Souza, K., Davis, K. D., & de Castro, A. B. (2013) · American Journal of Industrial Medicine · doi:10.1002/ajim.22221 · Cited by 238 · see citing works
The Health of U.S. Racial and Ethnic Populations
Williams, D. R. (2005) · The Journals of Gerontology Series B · doi:10.1093/geronb/60.special_issue_2.s53 · Cited by 223 · see citing works
Self-citationFood Insufficiency and the Physical and Mental Health of Low-Income Women
Siefert, K., Heflin, C. M., Corcoran, M. E., & Williams, D. R. (2001) · Women & Health · doi:10.1300/j013v32n01_08 · Cited by 222 · see citing works
Self-citationThe Contribution of Maternal Age to Racial Disparities in Birthweight: A Multilevel Perspective
Rauh, V., Andrews, H., & Garfinkel, R. S. (2001) · American Journal of Public Health · doi:10.2105/ajph.91.11.1815 · Cited by 216 · see citing works
Bécares, L., Shaw, R. J., Nazroo, J. Y., Stafford, M., Albor, C., Atkin, K. M., KIERNAN, K. E., Wilkinson, R. G., & Pickett, K. E. (2012) · American Journal of Public Health · doi:10.2105/ajph.2012.300832 · Cited by 214 · see citing works
Lee, C., Ayers, S. L., & Kronenfeld, J. J. (2009) · PubMed · doi:10.13016/h7o5-zl06 · Cited by 203 · see citing works
Krieger, N., & Birn, A. (1998) · American Journal of Public Health · doi:10.2105/ajph.88.11.1603 · Cited by 202 · see citing works
Yerger, V. B., Przewoznik, J., & Malone, R. E. (2007) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2007.0120 · Cited by 202 · see citing works
Kapilashrami, A., Hill, S., & Meer, N. (2015) · Social Theory & Health · doi:10.1057/sth.2015.16 · Cited by 200 · see citing works
Lee, C. (2009) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.12.036 · Cited by 199 · see citing works
- Authors
- Williams, D. R.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Williams, David R.
- ORCID
- Williams, David R.
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 1997-07
- Volume
- 7
- Issue
- 5
- Pages
- 322-333
- ISSN
- 1047-2797 (ISSN-L)
- OpenAlex
- W1977518943
- Cited by
- 825
- References
- 120
- Citations by year
- 2026: 11 · 2025: 23 · 2024: 25 · 2023: 35 · 2022: 31 · 2021: 31 · 2020: 26 · 2019: 23 · 2018: 20 · 2017: 61 · 2016: 26 · 2015: 24 · 2014: 21 · 2013: 27 · 2012: 25
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- race, racial differences in health, social construction of race, genetic variation, socioeconomic deprivation, psychosocial adversity
- MeSH terms
- Culture, Female, Health Status, Humans, Male, Population Surveillance, Prejudice, Research Design, Risk Factors, Social Class, Socioeconomic Factors, United States, Racial Groups
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