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LETTER |
Nigel Mark Thomas is a student at the Mailman School of Public Health, Columbia University, New York, NY.
Correspondence: Requests for reprints should be sent to Nigel Mark Thomas, 2084 Bronx Park E, Apt 4B, Bronx, NY10462 (e-mail: nt170{at}columbia.edu).
The Jamaican population in the United States offers a cautionary example to those who argue that that we should "abandon the concept of race for the purpose of surveillance and instead use ethnicity as the appropriate classification schema for public health research and practice." There are lessons too for those who advise that we maintain race as a variable in research, else the observation that "racism is a pathogen with biological consequences" will be lost.1
According to the 2000 census, Jamaica ranks among the top 10 countries sending emigrants to the United States. Even so, there are no national health statistics for the subpopulation. Many Jamaicans resident in the United States are classified under the Office of Management and Budget's Black/African-American racial category. However, the experiences of Jamaican immigrants are distinct from those of Blacks born in the United States. Preliminary data in one study suggest that Jamaican women have higher rates of infant mortality than do US-born Black women.2 Another study concludes that babies born to Jamaican women are more likely to survive than are babies born to US-born Black women.3
Health statistics that track ethnicity rather than race may help resolve this paradox. It is plausible, though, that they may not. The heritage of Jamaicans is not restricted to West Africa; it includes China, India, and Lebanon. Are the health concerns of those born in Jamaica to Indian descendants and now resident in the United States different from the health concerns of those who trace their heritage to West Africa?
Several decades of academic scholarship have produced racial and ethnic data suggesting that Jamaican immigrants have higher median family income and are less likely to get into trouble with the law than African Americans. Policy papers cite these data as evidence that racism does not explain socioeconomic status among African Americans.4 Health data may similarly be distorted.
Among the models that move us beyond the race and ethnicity paradigms in health research are those of Gregorio et al. and those of Lillie-Blanton et al. In a 1997 study, Gregorio et al. found strong evidence that occupation-based social position has an influence on mortality rates. In that study, race and ethnicity did not modify the underlying association between variables.5 Lillie-Blanton et al. demonstrated other ways in which we might conceptualize public health research.6 In their analysis of cocaine use, they included demographic information showing that there was no significant difference in cocaine use among racial groups.
References
1. Thomas SB. The color line: race matters in the elimination of health disparities. Am J Public Health. 2001;91:1046–1048.[Medline]
2. Steinhauer J. High infant mortality rates in Brooklyn mystify experts. New York Times. February 29, 2000:A1.
3. Flood K. Women's group set to study infant mortality among blacks. New York Times. February 11, 2001:14CN.
4. Sowell T, ed. American Ethnic Groups. Washington, DC: Urban Institute Press; 1978.
5.
Gregorio DI, Walsh SJ, Paturzo D. The effects of occupation-based social position on mortality in a large American cohort. Am J Public Health. 1997;87:1472–1475.
6. Lillie-Blanton M, Anthony JC, Schuster CR. Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269:993–997.[Abstract]
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