National vital statistics in the United States present data in terms of race, sex, and age, treated as biological variables. Some races are clearly of more interest than others: data are usually available for whites and blacks, and increasingly for Hispanics, but seldom for Native Americans or Asians and Pacific Islanders. These data indicate that white men and women generally have the best health and that men and women, within each racial/ethnic group, have different patterns of disease. Obviously, the health status of men and women differs for conditions related to reproduction, but it differs for many nonreproductive conditions as well. In national health data, patterns of disease by race and sex are emphasized while social class differences are ignored. This article discusses how race and sex became such all-important, self-evident categories in 19th and 20th century biomedical thought and practice. It examines the consequences of these categories for knowledge about health and for the provision of health care. It then presents alternative approaches to understanding the relationship between race/ethnicity, gender, and health, with reference to the neglected category of social class.
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References
1.
National Center for Health Statistics. Health, United States, 1991. DHHS Pub. No. (PHS) 92-1232. U.S. Public Health Service, Hyattsville, Md., 1992.
2.
National Center for Health Statistics. Vital Statistics of the United States—1988. Vol. I, Natality. DHHS Pub. No. (PHS) 90-1100. U.S. Government Printing Office, Washington, D.C., 1990.
3.
National Center for Health Statistics. Vital Statistics of the United States—1987. Vol. II, Mortality, Part A. DHHS Pub. No. (PHS) 90-1101. U.S. Government Printing Office, Washington, D.C., 1990.
4.
National Center for Health Statistics. Vital Statistics of the United States—1988. Vol. II, Mortality, Part B. DHHS Pub. No. (PHS) 90-1102. U.S. Government Printing Office, Washington, D.C., 1990.
5.
U.S. Department of Health and Human Services. Health Status of Minorities and Low-Income Groups, Ed. 3. U.S. Government Printing Office, Washington, D.C., 1991.
6.
KriegerN.The making of public health data: Paradigms, politics, and policy. J. Public Health Policy13: 412–427, 1992.
7.
NavarroV. Work, Ideology, and science: The case of medicine. In Crisis, Health, and Medicine: A Social Critique, edited by NavarroV., pp. 142–182. Tavistock, New York City, 1986.
8.
FeeE. (ed.). Women and Health: The Politics of Sex in Medicine. Baywood, Amityville, N.Y., 1983.
9.
TeshS.Hidden Arguments: Political Ideology and Disease Prevention Policy. Rutgers University Press, New Brunswick, N.J., 1988.
10.
KriegerN.Racism, sexism, and social class: Implications for studies of health, disease, and well-being. Am. J. Prev. Med.9(Suppl. 2): 82–122, 1993.
11.
ButterI., Sex and Status: Hierarchies in the Health Workforce. American Public Health Association, Washington, D.C., 1985.
12.
SextonP. C.The New Nightingales: Hospital Workers, Unions, New Women's Issues. Enquiry Press, New York, 1982.
13.
MeloshB.The Physician's Hand: Work, Culture and Conflict in American Nursing. Temple University Press, Philadelphia, 1982.
14.
WolfeS. (ed.). Organization of Health Workers and Labor Conflict. Baywood, Amityville, N.Y., 1978.
15.
FeldmanP. H.SapienzaA. M.KaneN. M.Who Cares for Them? Workers in the Home Care Industry. Greenwood Press, New York, 1990.
16.
KriegerN.Shades of difference: Theoretical underpinnings of the medical controversy on black/white differences in the United States, 1830–1870. Int. J. Health Serv. 17: 256–278, 1987.
17.
StantonW.The Leopard's Spots: Scientific Attitudes Towards Race in America, 1815–59. University of Chicago Press, Chicago, 1960.
18.
StepanN.The Idea of Race in Science, Great Britain, 1800–1860. Archon Books, Hamden, Conn., 1982.
19.
JordanW. D.White Over Black: American Attitudes toward the Negro, 1550–1812. University of North Carolina Press, Chapel Hill, 1968.
20.
RosenbergC. E.No Other Gods: On Science and American Social Thought. Johns Hopkins University Press, Baltimore, Md., 1976.
21.
DanielsG. H.The process of professionalization in American science: The emergent period, 1820–1860. Isis58: 151–166, 1967.
22.
RothsteinW. G.American Physicians in the 19th Century: From Sects to Science. Johns Hopkins University Press, Baltimore, Md., 1972.
23.
CartwrightS. A.Report on the diseases and physical peculiarities of the Negro race. New Orleans Med. Surg. J.7: 691–715, 1850.
24.
CartwrightS. A.Alcohol and the Ethiopian: Or, the moral and physical effects of ardent spirits on the Negro race, and some accounts of the peculiarities of that people. New Orleans Med. Surg. J.15: 149–163, 1858.
25.
CartwrightS. A.Ethnology of the Negro or prognathous race—A lecture delivered November 30, 1857, before the New Orleans Academy of Science. New Orleans Med. Surg. J.15: 149–163, 1858.
26.
ReyburnR.Remarks concerning some of the diseases prevailing among the Freed-people in the District of Columbia (Bureau of Refugees, Freedmen and Abandoned Lands). Am. J. Med. Sci. (n.s.)51: 364–369, 1866.
27.
ByronJ.Negro regiments—Department of Tennessee. Boston Med. Surg. J.69: 43–44, 1863.
28.
FonerE.Reconstruction: America's Unfinished Revolution, 1863–1877. Harper & Row, New York City, 1988.
29.
HallerJ. S.Jr.Outcasts from Evolution: Scientific Attitudes of Racial Inferiority, 1859–1900. University of Illinois Free Press, Urbana, 1971.
30.
StockingG. W.Race, Culture, and Evolution: Essays in the History of Anthropology. Free Press, New York, 1968.
31.
LorimerD.Colour, Class and the Victorians. Holmes & Meier, New York, 1978.
32.
GambleV. N. (ed.). Germs Have No Color Line: Blacks and American Medicine, 1900–1940. Garland, New York, 1989.
33.
Barker-BenfieldG. J.The Horrors of the Half-Known Life: Male Attitudes toward Women and Sexuality in Nineteenth-Century America. Harper & Row, New York, 1976.
34.
FeeE.Science and the woman problem: Historical perspectives. In Sex Differences: Social and Biological Perspectives, edited by TeitelbaumM. S., pp. 175–223. Anchor/Doubleday, New York, 1976.
35.
JordanovaL.Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries. University of Wisconsin Press, Madison, 1989.
36.
EhrenreichB.EnglishD.Complaints and Disorders: The Sexual Politics of Sickness. The Feminist Press, Old Westbury, N.Y., 1973.
37.
RussettC. E.Sexual Science: The Victorian Construction of Womanhood. Harvard University Press, Cambridge, Mass., 1989.
38.
HubbardR.The Politics of Women's Biology. Rutgers University Press, New Brunswick, N.J., 1990.
39.
FeeE.Nineteenth-century craniology: The study of the female skull. Bull. Hist. Med.53: 415–433, 1979.
40.
Smith-RosenbergC.RosenbergC. E.The female animal: Medical and biological views of woman and her role in 19th century America. J. Am. Hist.60: 332–356, 1973.
41.
GouldS. J.The Mismeasure of Man. W. W. Norton, New York, 1981.
42.
Smith-RosenbergC.Puberty to menopause: The cycle of feminity in nineteenth-century America. Feminist Stud. 1: 58–72, 1973.
43.
Smith-RosenbergC.Disorderly Conduct: Visions of Gender in Victorian America. Knopf, New York, 1985.
44.
HallerJ. S.HallerR. M.The Physician and Sexuality in Victorian America. University of Illinois Press, Urbana, 1974.
45.
AppleR. D. (ed.). Women, Health, and Medicine in America: A Historical Handbook. Rutgers University Press, New Brunswick, N.J., 1990.
46.
WilliamsR.Culture & Society: 1780–1950, revised edition. Columbia University Press, New York, 1983 [1958].
47.
MarxK.Capital, vol. I.International Publishers, New York, 1967 [1867].
48.
HofstadterR.Social Darwinism in American Thought. Beacon Press, Boston, 1955.
49.
YoungR. M.Darwin's Metaphor: Nature's Place in Victorian Culture. Cambridge University Press, Cambridge, U.K., 1985.
50.
KevlesD. J.In the Name of Eugenics: Genetics and the Uses of Human Heredity. Knopf, New York, 1985.
51.
ChaseA.The Legacy of Malthus: The Social Costs of the New Scientific Racism. Knopf, New York, 1977.
52.
DarwinC.On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. Murray, London, 1859.
53.
AndersonM. J.The American Census: A Social History. Yale University Press, New Haven, Conn., 1988.
54.
HoffmanF. L.Race Traits and Tendencies of the American Negro. American Economic Association, New York, 1896.
55.
HarrisS.Tuberculosis in the Negro. JAMA41: 827, 1903.
56.
AllenL. C.The Negro health problem. Am. J. Public Health5: 194, 1915.
57.
BeardsleyE. H.A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South. University of Tennessee Press, Knoxville, 1987.
58.
GeddesP.ThompsonJ. A.The Evolution of Sex. Walter Scott, London, 1889.
59.
LudmererK. M.Genetics and American Society: A Historical Appraisal. Johns Hopkins University Press, Baltimore, Md., 1972.
60.
HighamH.Strangers in the Land: Patterns of American Nativism, 1860–1925. Rutgers University Press, New Brunswick, N.J., 1955.
61.
HallerM. H.Eugenics: Hereditarian Attitudes in American Thought. Rutgers University Press, New Brunswick, N.J., 1963.
62.
PickensD. K.Eugenics and the Progressives. Vanderbilt University Press, Nashville, Tenn., 1968.
63.
KingM.RugglesS.American immigration, fertility, and race suicide at the turn of the century. J. Interdisciplinary Hist. 20: 347–369, 1990.
64.
DeglerC. N.In Search of Human Nature: The Decline and Revival of Darwinism in American Social Thought. Oxford University Press, Oxford, 1991.
65.
AllenG. E.Life Science in the Twentieth Century. Cambridge University Press, Cambridge, U.K., 1978.
66.
CastleW. E.The beginnings of Mendelism in America. In Genetics in the Twentieth Century, edited by DunnL. C., pp. 59–76. Macmillan, New York, 1951.
67.
WilkieJ. S.Some reasons for the rediscovery and appreciation of Mendel's work in the first years of the present century. Br. J. Hist. Sci.1: 5–18, 1962.
68.
MorganT. H.The Theory of the Gene. Yale University Press, New Haven, 1926.
69.
KrautA. M.The Huddled Masses: The Immigrant in American Society, 1800–1921. Harlan Davison, Arlington Heights, Ill., 1982.
70.
StonerG. W.Insane and mentally defective aliens arriving at the Port of New York. N. Y. Med. J.97: 957–960, 1913.
71.
Solis-CohenS. T.The exclusion of aliens from the United States for physical defects. Bull. Hist. Med.21: 33–50, 1947.
72.
LudmererK., Genetics eugenics, and the Immigration Restriction Act of 1924. Bull. Hist. Med.46: 59–81, 1972.
73.
BarkanE.Reevaluating progressive eugenics: Herbert Spencer Jennings and the 1924 immigration legislation. J. Hist. Biol.24: 91–112, 1991.
74.
KrautA. M.Silent travelers: Germs, genes, and American efficiency, 1890–1924. Soc. Sci. Hist.12: 377–393, 1988.
75.
FarleyJ.Gametes & Spores: Ideas About Sexual Reproduction, 1750–1914. Johns Hopkins University Press, Baltimore, Md., 1982.
76.
AllenG.Thomas Hunt Morgan and the problem of sex determination. Proc. Am. Philos. Soc.110: 48–57, 1966.
77.
BrushS.NettieM.Stevens and the discovery of sex determination by chromosomes. Isis69: 163–172, 1978.
78.
StarlingE.The Croonian lectures on the chemical correlation of the functions of the body. Lancet2: 339–341, 423–425, 501–503, 579–583, 1905.
79.
Lane-ClayponJ. E.StarlingE. H.An experimental enquiry into the factors which determine the growth and activity of the mammary glands. Proc. R. Soc. London [Biol.]77: 505–522, 1906.
80.
MarshallN.The Physiology of Reproduction. Longmans, Green and Co., New York, 1910.
81.
OudshoornN.Endocrinologists and the conceptualization of sex. J. Hist. Biol.23: 163–187, 1990.
82.
OudshoornN.On measuring sex hormones: The role of biological assays in sexualizing chemical substances. Bull. Hist. Med.64: 243–261, 1990.
83.
BorrellM.Organotherapy and the emergence of reproductive endocrinology. J. Hist. Biol.18: 1–30, 1985.
84.
LongD. L., Biology sex hormones and sexism in the 1920s. Philos. Forum5: 81–96, 1974.
85.
CobbI. G.The Glands of Destiny (A Study of the Personality). Macmillan, New York, 1928.
86.
AllenE. (ed.). Sex and Internal Secretions: A Survey of Recent Research. Williams & Wilkins, Baltimore, Md., 1939.
87.
FrankR.The Female Sex Hormone. Charles C Thomas, Springfield, Ill., 1929.
88.
LathropA. E. C.LoebL.Further investigations of the origin of tumors in mice. III. On the part played by internal secretions in the spontaneous development of tumors. J. Cancer Res. 1: 1–19, 1916.
89.
Lane-ClayponJ. E.A Further Report on Cancer of the Breast, With Special Reference to its Associated Antecedent Conditions. Reports on Public Health and Medical Subjects, No. 32. Her Majesty's Stationery Office, London, 1926.
90.
WainwrightJ. M.A comparison of conditions associated with breast cancer in Great Britain and America. Am. J. Cancer15: 2610–2645, 1931.
91.
ChavkinW. (ed.). Double Exposure: Women's Health Hazards on the Job and at Home. Monthly Review Press, New York, 1984.
92.
EhrenreichB.EnglishD.For Her Own Good: 150 Years of the Experts' Advice to Women. Anchor Books, Garden City, N.Y., 1979.
93.
StarrP.The Social Transformation of American Medicine. Basic Books, New York, 1982.
94.
FeeE.Disease and Discovery: A History of the Johns Hopkins School of Hygiene and Public Health. Johns Hopkins University Press, Baltimore, Md., 1987.
95.
FeeE.AchesonR. M. (eds.). A History of Education in Public Health: Health that Mocks the Doctors' Rules. Oxford University Press, Oxford, 1991.
96.
MeckelR.Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850–1920. Johns Hopkins University Press, Baltimore, Md., 1990.
97.
RodinJ.IckovicsJ. R.Women's health: Review and research agenda as we approach the 21st Century. Am. Psychol.45: 1018–1034, 1990.
98.
HealyB.Women's health, public welfare. JAMA266: 566–568, 1991.
99.
KirchsteinR. L.Research on women's health. Am. J. Public Health81: 291–293, 1991.
100.
LewontinR.Human Diversity. Scientific American Books, New York, 1982.
101.
KingJ. C.The Biology of Race. University of California Press, Berkeley, 1981.
102.
CooperR.DavidR.The biological concept of race and its application to epidemiology. J. Health Polit. Policy Law11: 97–116, 1986.
103.
CooperR.Celebrate diversity—or should we?Ethnicity Dis. 1: 3–7, 1991.
104.
CrewsD. E.BindonJ. R.Ethnicity as a taxonomic tool in biomedical and biosocial research. Ethnicity Dis. 1: 42–49, 1991.
105.
MullingsL.Ethnicity and stratification in the urban United States. Ann. N.Y. Acad. Sci.318: 10–22, 1978.
FeaginJ. R.The continuing significance of race: Anti-black discrimination in public places. Am. Sociol. Rev.56: 101–116, 1991.
108.
EssedP.Understanding Everyday Racism: An Interdisciplinary Theory. Sage Publications, Newbury Park, Calif., 1991.
109.
KriegerN.BassettM.The health of black folk: Disease, class and ideology in science. Monthly Review38: 74–85, 1986.
110.
NavarroV.Race or class versus race and class: Mortality differentials in the United States. Lancet2: 1238–1240, 1990.
111.
KriegerN.FeeE.What's class got to do with it? The state of health data in the United States today. Socialist Rev. 23: 59–82, 1993.
112.
PolackS.GrozuczakJ.Reagan, Toxics and Minorities: A Policy Report. Urban Environment Conference, Washington, D.C., 1984.
113.
Commission for Racial Justice, United Church of Christ. Toxic Wastes and Race in the United States: A National Report on the Racial and Socioeconomic Characteristics of Communities with Hazardous Waste Sites. United Church of Christ, New York, 1987.
114.
MannE.L.A.'s Lethal Air: New Strategies for Policy, Organizing, and Action. Labor/Community Strategy Center, Los Angeles, 1991.
115.
KriegerN.Racial and gender discrimination: Risk factors for high blood pressure?Soc. Sci. Med.30: 1273–1281, 1990.
116.
ArmsteadC. A.Relationship of racial stressors to blood pressure and anger expression in black college students. Health Psychol. 8: 541–556, 1989.
117.
JamesS. A.John Henryism and blood pressure differences among black men. II. The role of occupational stressors. J. Behav. Med.7: 259–275, 1984.
118.
DressierW. W.Social class, skin color, and arterial blood pressure in two societies. Ethnicity Dis. 1: 60–77, 1991.
119.
FruchterR. G.Cervix and breast cancer incidence in immigrant Caribbean women. Am. J. Public Health80: 722–724, 1990.
120.
KleinmanJ. C.FingerhutL. A.PragerK.Differences in infant mortality by race, nativity, and other maternal characteristics. Am. J. Dis. Child.145: 194–199, 1991.
121.
CabralH.Foreign-born and US-born black women: Differences in health behaviors and birth outcomes. Am. J. Public Health80: 70–72, 1990.
122.
TaylorR. J.ChattersL. M.Religious life. In Life in Black America, edited by JacksonJ. S., pp. 105–123. Sage, Newbury Park, Calif., 1991.
123.
LivingstonI. L.LevineD. M.MooreR. D.Social integration and black intraracial variation in blood pressure. Ethnicity Dis. 1: 135–149, 1991.
124.
EngE.HatchJ.CallanA.Institutionalizing social support through the church and into the community. Health Ed. Q.12: 81–92, 1985.
125.
LoweM.Social bodies: The interaction of culture and women's biology. In Biological Woman—The Convenient Myth, edited by HubbardR.HenefinM. S.FriedB., pp. 91–116. Schenkman, Cambridge, Mass., 1982.
126.
DevesaS. S.DiamondE. L.Association of breast cancer and cervical cancer incidence with income and education among whites and blacks. J. Natl. Cancer Inst. 65: 515–528, 1980.
127.
KriegerN.Social class and the black/white crossover in the age-specific incidence of breast cancer: A study linking census-derived data to population-based registry records. Am. J. Epidemiol.131: 804–814, 1990.
128.
KriegerN.The influence of social class, race and gender on the etiology of hypertension among women in the United States. In Women, Behavior, and Cardiovascular Disease, proceedings of a conference sponsored by the National Heart, Lung, and Blood Institute, Chevy Chase, Md., September 25–27, 1991. U.S. Government Printing Office, Washington, D.C., 1994, in press.
129.
U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Black & Minority Health, Volume IV: Cardiovascular and Cerebrovascular Disease, Part 2. Washington, D.C., 1986.
130.
Martinez-MaldonadoM.Hypertension in Hispanics, Asians and Pacific Islanders, and Native Americans. Circulation83: 1467–1469, 1991.
131.
CaralisP. U.Hypertension in the Hispanic-American population, Am. J. Med.88(Suppl. 3b): 9s–16s, 1990.
132.
HaffnerS. M.Decreased prevalence of hypertension in Mexican-Americans. Hypertension16: 255–232, 1990.
133.
StavigG. R.IgraA.LeonardA. R.Hypertension and related health issues among Asians and Pacific Islanders in California. Public Health Rep. 103: 28–37, 1988.
134.
AngelA.ArmstrongM. A.KlatskyA. L.Blood pressure among Asian Americans living in Northern California. Am. J. Cardiol.54: 237–240, 1987.
135.
AlpertJ. S.Heart disease in Native Americans. Cardiology78: 3–12, 1991.
136.
WaldronI.Sex differences in illness, incidence, prognosis and mortality: Issues and evidence. Soc. Sci. Med.17: 1107–1123, 1983.
137.
WingardD. L.The sex differential in morbidity, mortality, and lifestyle. Annu. Rev. Public Health5: 433–458, 1984.
138.
GoldE. (ed.). Changing Risk of Disease in Women: An Epidemiological Approach. Colbamore Press, Lexington, Mass., 1984.
139.
LeviatanV.CohenJ.Gender differences in life expectancy among kibbutz members. Soc. Sci. Med.21: 545–551, 1985.
140.
SymeS. L.BerkmanL.Social class, susceptibility and sickness. Am. J. Epidemiol.104: 1–8, 1976.
141.
AntonovskyA.Social class, life expectancy and overall mortality. Milbank Mem. Fund Q. 45: 31–73, 1967.
142.
TownsendP.DavidsonN.WhiteheadM.Inequalities in Health: The Black Report and The Health Divide. Penguin, Harmondsworth, U.K., 1988.
143.
MarmotM. G.KogevinasM.ElstonM. A.Social/economic status and disease. Annu. Rev. Public Health8: 111–135, 1987.
144.
RobertsH. (ed.). Women's Health Counts, Routledge, London, 1990.
145.
DaleA.GilbertG. N.ArberS.Integrating women into class theory. Sociology19: 384–409, 1985.
146.
DukeV.EdgellS.The operationalisation of class in British sociology: Theoretical and empirical considerations. Br. J. Sociol.8: 445–463, 1987.
147.
CharlesN.Women and class—A problematic relationship. Sociol. Rev.38: 43–89, 1990.
148.
MorganM.Measuring social inequality: Occupational classifications and their alternatives. Community Med. 5: 116–124, 1983.
149.
MoserK. A.PughH.GoldblattP.Mortality and the social classification of women. In Longitudinal Study: Mortality and Social Organization. Series LS, No. 6, edited by GoldblattP., pp. 146–162. Her Majesty's Stationery Office, London, 1990.
150.
KriegerN.Women and social class: A methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J. Epidemiol. Community Health45: 35–42, 1991.
151.
RiesP.Health characteristics according to family and personal income, United States. Vital Health Stat. 10(147). DHHS Pub No. (PHS) 85-1575. National Center for Health Statistics. U.S. Government Printing Office, Washington, D.C., 1985.
152.
KriegerN.Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. Am. J. Public Health82: 703–710, 1992.
153.
CarovanoK.More than mothers and whores: Redefining the AIDS prevention needs of women. Int. J. Health Serv. 21: 131–142, 1991.
154.
PANOS Institute. Triple Jeopardy: Women & AIDS. Panos Publications, London, 1990.
155.
AnastosK.MarteC.Women—The missing persons in the AIDS epidemic. HealthPAC, Winter 1989, pp. 6–13.
156.
Centers for Disease Control. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR41: 961–962, 1992.
157.
KanigelR.U.S. broadens AIDS definition: Activists spur change by Centers for Disease Control. Oakland Tribune, January 1, 1993, p. A1.
158.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Rep. 5: 1–19, July 1993.
159.
DruckerE.Epidemic in the war zone: AIDS and community survival in New York City. Int. J. Health Serv. 20: 601–616, 1990.
160.
FreudenbergN.AIDS prevention in the United States: Lessons from the first decade. Int. J. Health Serv. 20: 589–600, 1990.
161.
FeeE.KriegerN.Thinking and rethinking AIDS: Implications for health policy. Int. J. Health Serv. 23: 323–346, 1993.
162.
FeeE.KriegerN.Understanding AIDS: Historical interpretations and the limits of biomedical individualism. Am. J. Public Health83: 1477–1486, 1993.
