Health Policy$ense

The Hispanic Problem (and more) in Health Services Research

What is your race? That might not seem like a difficult question to answer. It’s easy enough to just check a box, right? You would think that something that has been associated with your genes wouldn’t change throughout your life. But it does, sometimes drastically, as you become more aware of what it means to check one of those boxes. It can also change as the politics surrounding Race (with a capital R) change.

Sergio Gonzales
Sergio Gonzales, a senior majoring in Health, Medicine and Human Values at the University of New Mexico, is spending the summer at the University of Pennsyvlania as a scholar in the Summer Undergraduate Minority Research (SUMR) program.

Between the 2000 Census and 2010 Census, a net 1.2 million “Hispanics" changed their racial identification from “Other” or “no answer” to “White.” One impetus for this change is that the 2010 Census asked separate questions about Hispanic “origins” and race. It specified that “Hispanic” was not a race and that one of the race boxes needed to be filled.

'Detribalized person'
I was one of those Hispanics who thought that Hispanic was a race in 2000. I said yes, I was “Hispanic,” checked “Mexican, Mex. American, Chicano, etc.” and stopped right there; that was my race, or so I thought. I do not feel that I share an experience with any other race. I consider myself a Chicano or Genízaro person, a detribalized indigenous person and the product of mestizaje (loose translation: racial mixture) with the Spanish Empire. That’s very different from the experience of a person who is a part of a federally recognized American Indian tribe (without extended history with Spain) and certainly nothing like being White.

Because the Federal Government doesn’t recognized detribalized people as American Indian (it asks for the “enrolled” tribal affiliation), in 2010, I ended up choosing “Other,” which isn’t exactly helpful to researchers. Other doesn’t say much about what kinds of social networks I’m a part of and can also be interpreted as though I am struggling with internalized racism and thus embarrassed to declare my race.

The 'in-between' race
Regardless of what this might mean for Hispanics as a population, the wide shift in reported race suggests that we need to change the way we collect data about race, at least for Hispanics, to understand what’s really going on. Hispanic identity is inherently politicized. Many Ethnic Studies scholars describe us as the “interstitial” or the in-between race, residing between White, Aboriginal Americans, Black, and even Asian. It can be a very divisive statement to declare yourself one or a mix of races, White being the least confrontational and most apolitical. In fact some people predict, or at least hope, that Hispanics will assimilate into American Whiteness like the Irish and Italians. And for some groups, that has been the case – some Cubans, for example. But unlike the Irish or Italians, people of Hispanic heritage cannot be associated with one nationality or one history. While Hispanic Whites might find the preceding “Hispanic” to be less and less important as the years go on, other Hispanics are faced with different negotiations that are not often described by academics and public commentators. Not much has been predicted about Hispanic blacks, Hispanic aboriginal peoples, Hispanic Asians and mixed race Hispanics, probably because as a society we struggle to celebrate heterogeneity in all its complicated manifestations.

The Census Bureau is thus faced with several very important questions that Ethnic Studies has been asking for many years: (1) What is a race? (2) What is the process for deciding what is and is not a race? (3) Who is involved in that process? (4) And what do you do when the “accepted” definition of Race doesn’t actually describe peoples’ social groups?

In an obscure FAQ the Bureau states that the race categories used “generally reflect a social definition of race recognized in this country, and not an attempt to define race biologically, anthropologically or genetically.” First, I find it hard to believe that data collection about Race (or race) can be objectively separated from its origins and continued use in Biology, Anthropology, and Genetics. And despite its use of “social definitions,” the Bureau decided it was necessary to explain that Hispanic was not a race even though there is reason to believe that a large social group defined it as their race. Secondly, many Hispanics, like me, would describe Chicano as their race (mixed blood Aboriginal American) but the Bureau considers it an ethnicity and includes it with Mexican and Mexican-American.

Dataset issues
While the Hispanic problem is particularly relevant to me, Hispanic is not the only problematic category. While performing a literature review for one of my projects, I came across an article published in the American Journal of Public Health that found notable disparities in stroke mortality between American Indian/Alaskan Natives in the Southwest and American Indian/Alaskan Natives in Alaska. Based on the way these data were collected, we can only say that a geographic disparity was observed. We can’t say that there’s disparity between Alaskan Natives and other American Indians because the data cannot be separated. Intra-racial/ethnic disparities often get little attention because of these dataset issues.

But to be fair, the problem hasn’t gone wholly ignored. The Census Bureau is conducting a research project intended to improve the accuracy and reliability of its race and ethnicity data. It is considering combining the race and ethnicity question in 2020 in an attempt to reduce the “other” category. The possibility that Hispanics and others would have more freedom to self-describe makes me excited, relieved, but still cautious.

Ethnic Studies scholars, as well as Women’s and Queer Studies scholars, have spent many years describing the politics of oppression and the impact it has on marginalized communities. Despite the potential applicability of their works to our lives, many Ethnic Studies scholars (myself included) rarely see scholarship make waves outside the ivory tower (usually it’s dismissed as pseudo-academics wasting everyone’s time with political correctness). Yet, as I continue to move through the SUMR program, I see more and more ways for Ethnic Studies to be incorporated into health services research. Better methods of describing marginalized communities and social groups would improve health disparities research and provide new insights into how to address those disparities.

Confounding or masking variables
Ethnic Studies often makes use of testimonios, personal narratives, to understand the social conditions that people experience and how social/ethnic groups see themselves in the world and in relation to other social/ethnic groups. These testimonios would naturally change from community to community. Qualitative analysis can help us understand the daily realties of oppressed people as well as any tension they have with other dominating narratives. These kinds of analyses might be helpful in directing research and in controlling for confounding or masking variables.

Although the way the federal government collects data about race/ethnicity is still being debated, as we move forward in health services research, it might be useful to change the way we collect data or the way we interpret oversimplified data as indicators of social environments. Is it enough to just mention that “race is social construction" in our manuscripts even though those social constructions were never accurately described? Creating a better methodology for describing the race of the subjects in health services research will not only produce higher quality results, but also inform policy in more effective and direct ways. Ethnic Studies has an essential role to play development of that methodology.