Health and the social status of blacks in the United States.

Inequalities in health status among various racial and ethnic groups form a prominent chapter in the history of public health in the United States. Inequalities are observed for a wide range of specific conditions, and evolve over time. Little evidence is available to support the contention that any sizable proportion of this overall inequality is caused by genetic factors operating at the population level. On the other hand, social status, as measured by proxy variables like income and education, does provide important information about the black-white differential in health status when used in standard epidemiologic analyses. What is often neglected in these analyses, however, is an attempt to define underlying pathogenic mechanisms that incorporate social processes. Causal explanations based on the broader observation that inequality determined by the structure of social relations is associated with health differentials in all populations offer a plausible theoretic framework. At the same time, the unique character of the experience of specific ethnic subpopulations must be accounted for. Any attempt to account for the impact of race with greater precision will require an attempt to define this demographic variable within the context of social class relations.