Assessing Race, Ethnicity, and Gender in Health (review)

In health research, information about race, ethnicity, and gender is collected for reasons ranging from simple compliance with reporting requirements to hopes of alleviating disparities. Often, the same broad categories used to meet reporting requirements are expected to serve the purpose of alleviating disparities. This book exhorts researchers to consider the complexities of ancestry, cultural membership, gender identity, and sexual orientation in relation to specific scientific questions. The author argues that if we are to discover plausible and accurate causal links between these constructs and health, we must include the appropriate sociological, biological, and psychological measures in study design and data collection.

The book comprises three parts, each with two or three chapters. In the first part, the author gives an introduction to the concept of categorization, the differences between self-identification and categorization imposed by others, and ethical implications of conducting and reporting research on so-called minority groups. This section also touches on data collection and instrument/scale development and the concepts of validity, reliability, and misclassification. Although the discussion of these topics does not penetrate deeply into them, references are provided for texts on epidemiology, survey sampling, and questionnaire development.

The second part dedicates one chapter each to race and ethnicity; sex, gender, and sexual orientation; and the relation of these constructs to health. Much of the material on race and ethnicity concerns the ways these categories were defined in various time periods and countries. Likewise, in the chapter on sex, gender, and sexual orientation, extensive information is provided regarding the biomedical assignment of sex, sexual behaviors and desires, and the psychology and sociology of masculinity and femininity. There is, undoubtedly, much to be learned about how each of these constructs affects an array of health outcomes; however, no indication of how most of these variables have been or might be used in health research is provided here.

The last chapter in this part presents examples of research that has linked race, ethnicity, and sexual orientation to health care access and several health outcomes. Here we begin to see, for example, the variety of ways in which self- and investigator-defined racial and ethnic categories have been associated with variable risk of specific infectious and chronic diseases and predisposing conditions or behaviors, such as obesity and smoking. The presentation of each example is followed by the author's critique of the variables used or the way categories were combined. The reader is encouraged to consider whether, for example, Hispanic Americans with origins in many different Spanish-speaking countries could be assumed to form one homogeneous group in relation to health behaviors and beliefs. Similarly, can place of birth be used as a surrogate for cultural beliefs or practices regarding, for example, breastfeeding? In many cases, the criticisms relate to a lack of clarity in published research regarding how the particular racial or ethnic categories were chosen and how they are supposed to relate to underlying causes of disease.

The third part may be the most useful. It contains tables of instruments and scales that have been developed to measure ethnicity, acculturation, immigration status, gender roles, and sexual orientation. Combined, these tables provide references and brief descriptions for 60 instruments or scales. With notes that include sample questions or scales and strengths and limitations for some instruments, these tables are a valuable resource for developing questionnaires or interviews. For a researcher familiar only with the most commonly used racial and ethnic designations, this section illuminates the breadth of information that can provide insight into diverse communities and populations.

Some aspects of the writing style detract from the readability of the book. Much of the text seems less a coherent discussion than a collection of the author's notes. Sections containing long block quotes and little transition or analysis make it difficult to follow the flow of ideas. The author's bias against the traditional uses of race, ethnicity, and gender in health research is apparent. The text heavily emphasizes the...