Is health only skin-deep?

The USA is witnessing a growing debate about the apparent disparities between the health status of white Americans and racial minorities, most notably African Americans and Hispanics. In 1993, the US government admitted that there are significant differences and responded by establishing the Minority Health Initiative to investigate and redress these discrepancies. The National Cancer Institute started the Center for Reducing Cancer Health Disparities in 2000, and last spring, the National Academies of Sciences’ Institute of Medicine (IOM) in Washington, DC, released a study sponsored by the government’s Department of Health and Human Services entitled ‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care’. More than a mere academic exercise, this research raises an important question: does race impact on the emergence and progression of disease, or is race merely skin-deep? And if race does indeed have biological correlations, should racial profiling influence a physician’s diagnosis and choice of treatment? This growing awareness has been heightened by various confounding trends, first and foremost advances in human genetics. While numerous scientists—most notably Francis Collins and Craig Venter—have declared that genetics and the sequence of the human genome prove that there is no such thing as race, another camp of experts in population genetics and pharmacogenomics point out that naturally occurring polymorphisms impact on the frequency of particular diseases in certain populations, such as diabetes in Pima Indians or breast cancer and Tay-Sachs disease in Ashkenazi Jews. Individuals of some ethnic groups also assimilate drugs differently—some drug companies are testing new and existing drugs accordingly and have started to market them to those with similar genetic backgrounds. And an increasing number of studies show that some ethnic minorities in the USA do have higher morbidity and mortality rates. According to a study conducted by the Commonwealth Fund, 77% of African Americans over 50 years old have been diagnosed with hypertension, coronary heart disease or cancer, compared with 68% of Hispanics and 64% of white Americans. In general, one in five Hispanics, one in six African Americans and one in four Asian Americans have a chronic condition compared to only one in seven white Americans. ‘The difference is even more striking when taking into account that the minority population is, on average, younger than the white population, and would therefore be expected to be healthier,’ the authors of the study commented. But whatever the reason, race cannot and should not be used for diagnosis and treatment, according to Elijah Saunders, Professor of Medicine at the University of Maryland School of Medicine in Baltimore, himself African American.