Sociocultural Influences on Health
Caroline A. Macera
Centers for Disease Control and Prevention
Cheryl A. Armstead
University of South Carolina
Norman B. Anderson
National Institutes of Health
The health experience of Americans has improved enormously over the course of the 20th century. Communicable and infectious diseases, the major causes of premature death in the United States prior to 1930, have been replaced by chronic illnesses such as heart disease and cancer. Furthermore, age-adjusted mortality from heart disease has decreased from 307.2 per 100, 000 in 1950 to 138.3 per 100, 000 in 1995. Similarly, infant mortality has decreased from 12.6 per 1, 000 live births in 1980 to 7.6 per 1, 000 live births in 1995. These changes mean that a majority of people in this country can expect to live a long and productive life. In fact, a child born in 1995 could expect to live 75.8 years compared to 47.3 years for a child born in 1900 (National Center for Health Statistics, 1997).
Unfortunately, these astounding improvements in health status have not affected all Americans equally. Lagging behind are many of the underserved and minority populations (Kington & Smith, 1997; Liao & Cooper, 1995). The ethnic composition of the U.S. population has changed from being primarily White to include a large percentage of African Americans (or Blacks), Hispanics, and Asian and Pacific Islanders. This cultural diversity will continue to increase because of high immigration and birth rates among minority populations. Each ethnic group views health within its own cultural context, which complicates the decision to seek and continue treatment, and to use preventive measures. Additionally, social conditions may put minorities at higher risk for specific health problems. The purpose of this chapter is to first present basic demographic and health characteristics of the major ethnic groups in this country, and then to describe a contextual model of hypertension in Blacks as an example of how ethnic disparities in health status may occur and be understood.
Although there is a great deal of diversity within ethnic groups, this chapter uses the five general categories as collected and reported by the National Center for Health Statistics (1997): White, Black, American Indian or Native Alaskan, Asian and Pacific Islander, and Hispanic origin. When possible, data is presented by non-Hispanic White and non-Hispanic Black groups. Because there is no consistent agreement on terminology, this chapter uses African American and Black interchangeably throughout.
African Americans, or Blacks, the largest minority group in the United States, number almost 34 million and represent 12.8% of the population (U.S. Bureau of the Census, 1995). During 1994, the African American population grew at a faster rate than the White population (1.5% compared to only 0.8%), but not as fast as the Hispanic population (3.5%). Blacks are projected to be the second largest minority group in this country by 2025 (Fig. 24.1).