Health researchers routinely evaluate health and illness across
subgroups defined by their sex, gender, ethnicity, and race. All too
often, these classifications are proffered as an explanation for any
differences that may be detected, for example, in access to care,
frequency of disease, or response to treatment. Relatively few
researchers, however, have examined what these classifications mean on a
theoretical level or in the context of their own research. Assume, for
example, that a researcher concludes from his or her data that African-
Americans utilize certain surgical procedures less frequently than
whites. This conclusion may mean little without an examination of the
various underlying issues. Is there such a construct as race at all? How
were whites and African-Americans classified as such? Does this finding
reflect inappropriate overutilization of the specific procedures among
whites or inappropriate underutilization among African-Americans? To
what extent are socioeconomic status and method of payment related to
the less frequent use? Are there differences in the manner in which
health care providers present the various treatment options to whites
and to African- Americans that could account for these differences in
utilization? Are there differences in health care-seeking and health
care preferences between the two groups that would explain the
difference in utilization? Is the racial classification a surrogate
measure for another variable that has remained unidentified and
unmeasured? All too often, unfortunately, such issues are ignored or
lightly dismissed with an entreaty for additional research.
