How vague racial categories mask health vulnerabilities

Good health care decisions depend on good data—whether you’re making federal health policy or treating a single patient.

But the data is often incomplete—particularly when it comes to defining a group that still makes up the majority of the U.S. population—a “non-Hispanic white” person. That’s the primary reference category used in health data.

“Nobody questions who’s white, but they should,” said Jen’nan Read, a Duke sociologist and lead author of new research recently published in the journal Demography. “The white category contains diverse ethnic subgroups, but because we lump them all together, we miss important health vulnerabilities for millions of Americans.”

Read and co-author Fatima Fairfax, a Duke doctoral student in sociology, analyzed data from the 2000 to 2018 waves of the National Health Interview Survey to compare the health of white adults born in the U.S., Europe, the Middle East, and the Former Soviet Union.

Separating groups collapsed into the white category, they found that foreign-born whites have a smaller health advantage over U.S.-born whites than is commonly assumed, and immigrants from the Former Soviet Union are particularly disadvantaged. Those immigrants report worse health, including higher rates of high blood pressure, compared to U.S.-born whites as well as people from Europe and the Middle East.

These findings illustrate how global events, such as the wars in the Ukraine and Syria, have contributed to changes in the composition of white immigrants over time.

Understanding these changes—and the distinct experiences of white immigrant subgroups—is vital to understanding long-term patterns in health disparities within the broad white category, the authors argue.

“If we truly care about reducing health disparities in this country, we need to know where the disparities are. And they get hidden when people are lumped into broad categories,” Read said. “Ukrainian immigrants, for example, we see in the news what they’re leaving. Death, destruction, their kids may have gone years now without education.

“This has lifelong impacts on their well-being. The physical consequences from stress are enormous—we know stress increases all sorts of physical health problems. High blood pressure, cholesterol, the list goes on.”

And the science is clear. The more accurate the information health care providers have on their patients, the better the outcomes.

“We’re missing health patterns here,” Read said. “Our country is extremely diverse, and not talking about diversity doesn’t change that fact. Health inequality costs us a lot—it costs the health care system and society as a whole.”

“Health is arguably the most important indicator of how a society is doing, and paying more attention to diversity within broad categories will allow us to do better.”

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