What do race and ethnicity mean?
The terms "race" and "ethnicity" can both be used to refer to people of similar cultural, religious, tribal, or geographic ancestry, yet they are both notoriously difficult to define. Scientists have called for using other forms of classification that are more strongly based in biology.1, 2 Despite these troubled terms, health disparities do exist along the blurry lines of "racial" or "ethnic" groups.3, 4
How do doctors classify racial or ethnic groups?
One of the difficulties of tracking health differences by race is that racial groups are defined in many different ways. The American Heart Association uses the US government definition of Hispanics as persons who trace their ancestry to Spain, Mexico, the Spanish-speaking countries of Central or South America, Puerto Rico, Cuba, the Dominican Republic, or other Spanish-speaking cultures, regardless of race. It does not include people from Brazil, Guyana, Suriname, Trinidad, Belize, and Portugal, because Spanish isn't their first language. Many American studies limit their Hispanic population to Mexican Americans.5
White or Caucasian people are considered to be those of European descent but often there is no distinction made between Eastern and Western European descent. The term “Asian” may or may not incorporate those in Southeast Asia, the Pacific Islands, and those in Western Asia and the Middle East. South Asian is sometimes used to refer to people from India, Pakistan, or Bangladesh.
The US government recommends using, at a minimum, the following classification system for race:6
- American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
- Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
- Black or African American. A person having origins in any of the black racial groups of Africa.
- Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, Dominican Republic, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin" can be used in addition to "Hispanic" or "Latino."
- Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
For ethnicities, the government recognizes two categories: "Hispanic or Latino" and "Not Hispanic or Latino."
Should I tell my doctor about my racial or ethnic background?
Yes. Telling your doctor about your racial and ethnic background will help him or her to better estimate your disease risks. It is important to include this information on the social and family history section of the patient information form you fill out when you visit a particular doctor for the first time. Visual clues such as facial features or skin color have only a slim correlation with our race,7 so it is more helpful to tell your doctor where your ancestors are from than to have the doctor guess if you belong to some broad category such as black, white, or Asian.2 It is also important to let your doctor know how long you and your family have been living in the US because where you live now can sometimes reveal more about your health risks than your racial or ethnic background. For example, a study of Japanese and Japanese Americans living in Hawaii found that Japanese Americans had higher total cholesterol, a greater incidence of diabetes, and had more fatty plaque in their arteries than their counterparts still living in Japan.8, 9
