A Compelling Research Agenda

Two articles in this issue [1, 2] and another published recently in Annals [3] remind us that race and ethnicity are powerful predictors of health-related outcomes [1-3]. The reminder is ironic at this point in the history of the United States, when fierce battles are being waged against affirmative action; the essential thrust of opponents of race-conscious strategies is that race is not a relevant way of distinguishing persons from one another. Yet these articles argue otherwise. Carter and coworkers [1] show that in all racial and ethnic minority groups, except Alaska Natives, prevalence of non–insulin-dependent diabetes mellitus is two to six times greater than that in white persons. Moormeier [3] found that black women are less likely to survive breast cancer even though they have a lower incidence of this condition. Although the lower survival rate partially results from diagnosis in the latter stages of disease, black women also have lower stage-specific survival rates. Burns and colleagues [2] show that elderly black women, including those in the highest income quintile, have a substantially lower rate of mammography use than white women, even after adjustment for the number of visits made to primary care providers.

Into what context should we place these articles? One relevant context is that of history. Ten years ago, three articles related to the health of minority groups would not have been clustered in one journal. In my view, a landmark event leading to the current level of attention to minority health was the 1985 Report of the Secretary of the U.S. Department of Health and Human Services (DHHS) Task Force on Black and Minority Health. Most of the staff for the 3000-page report was drawn from the National Institutes …