Abstract
An abundance of research has documented health inequalities by race and socioeconomic position (SEP) in the United States. However, conceptual and methodological challenges complicate the interpretation of study findings, thereby limiting progress in understanding health inequalities and in achieving health equity. Fundamental to these challenges is a lack of clarity about what race is and the implications of that ambiguity for scientific inquiry. Additionally, there is wide variability in how SEP is conceptualized and measured, resulting in a lack of comparability across studies and significant misclassification of risk. The objectives of this review are to synthesize the literature regarding common approaches to examining race and SEP health inequalities and to discuss the conceptual and methodological challenges associated with how race and SEP have been employed in public health research. Addressing health inequalities has become increasingly important as the United States trends toward becoming a majority-minority nation. Recommendations for future research are presented.
Highlights
Several papers have documented health inequalities by socioeconomic position (SEP) and race in the United States
Conceptual and methodological challenges complicate the interpretation of study findings, thereby limiting progress in understanding health inequalities and in achieving health equity
To examine current trends in the use of race and SEP in public health research, we reviewed articles published over the past four years in the American Journal of Epidemiology (AJE) and the American Journal of Public Health (AJPH) (2013–2016)
Summary
Several papers (empirical and review) have documented health inequalities by socioeconomic position (SEP) and race in the United States. Some studies use one or the other as primary exposures with the goal of investigating how the social meaning, and positioning, of individuals and groups in society based on race and/or SEP determines health inequities. This approach may often and likely unintentionally, reify social stratification (present company not excluded) through the at times problematic use of social statistics, the statistical analysis of social (e.g., racial) classification (see the sidebar titled Social Statistics) [128]. Extending the theories of Galton and Pearson, though not endorsing eugenics, Yule’s analysis is an early example of applying these ideas to statistics for the purpose of social analysis He notes, “High average values of the former correspond to higher average values of the latter” We describe the utility, conceptual assumptions, and methodological challenges associated with these common uses of race and SEP, with a focus on issues related to measurement, causality, and validity
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