Читать книгу The Science of Health Disparities Research - Группа авторов - Страница 50

In this section, we discuss a conceptual model developed by LaVeist [3], modified to include ethnicity and ethnic differences. It aims to explain the influence of social and behavioral factors on racial/ethnic disparities in health (see Figure 3.1). Race and ethnicity are considered latent factors in this model, with skin color being the most commonly used indicator. Along the left side of the model is the social pathway, which illuminates how an individual engages the social world. Through this pathway, he or she is assigned to a racial/ethnic group through a process called physiognomy, literally defined as the “art of judging human character from facial features” [4]. After an individual has been labeled as a member of a particular racial/ethnic group, he or she is exposed to the social health risks associated with that group. Social health risks are variables that influence health outcomes but are commonly outside the direct control of an individual. For example, occupational health hazards, poor quality housing, exposure to discrimination or racism, and poorer quality medical care are all factors that influence the health of an individual but are rarely manageable by an individual. These social health risks have been found to differ by race and ethnicity.

Figure 3.1 Conceptual model of race or ethnicity.

Source: LaVeist et al. [3]. © 2005, John Wiley & Sons.

The right side of the model outlines the behavioral pathway, showing that there may be characteristics of the nationality or culture of an ethnic group that influence health or illness behaviors and, thus, health status downstream. These factors may account for some degree of health disparities.

The third pathway through which racial/ethnic differences in health status are produced is demonstrated by the arrow linking societal factors to health/illness behavior. Specifically, societal factors limit the ability of an individual to address health issues or adopt behaviors that protect one's health. For example, a person's race may lead to lower SES, which may lead to the under‐utilization of health services. This model explains that illness behavior is not directly associated with race or ethnicity; rather, it is associated with social class, which is an important distinction. However, considering the way that race and ethnicity are commonly explored, it is possible to inaccurately attribute illness behaviors to one's race and ethnicity rather than understanding the effects of social class on behavior. These errors lead to the assumption that there is something about a person's skin color, rather than their societal context, that makes them engage in risky behavior [3].