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OSO version 0. University Press Scholarship Online. Sign in. Not registered? Sign up. Publications Pages Publications Pages. Search my Subject Specializations: Select Users without a subscription are not able to see the full content. Exposed Science: Genes, the Environment, and the Politics of Population Health Sara Shostak Abstract At the center of Defining Vulnerabilitiesare the interlinked puzzles of why and how environmental health scientists have rallied around research on gene-environment interaction.

More At the center of Defining Vulnerabilitiesare the interlinked puzzles of why and how environmental health scientists have rallied around research on gene-environment interaction. Authors Affiliations are at time of print publication. Print Save Cite Email Share. Show Summary Details. Subscriber Login Email Address. Library Card. Hoke et al. There is a controversy regarding race as a method for classifying humans. Different sources argue it is purely social construct [74] or a biological reality reflecting average genetic group differences.

New interest in human biological variation has resulted in a resurgence of the use of race in biomedicine. The main impetus for this development is the possibility of improving the prevention and treatment of certain diseases by predicting hard-to-ascertain factors, such as genetically conditioned health factors, based on more easily ascertained characteristics such as phenotype and racial self-identification.

Genetic Approaches to Health Disparities

Since medical judgment often involves decision making under uncertain conditions, [76] many doctors consider it useful to take race into account when treating disease because diseases and treatment responses tend to cluster by geographic ancestry. Race in medicine is used as an approximation for more specific genetic and environmental risk factors. Race is thus partly a surrogate for environmental factors such as differences in socioeconomic status that are known to affect health.

It is also an imperfect surrogate for ancestral geographic regions and differences in gene frequencies between different ancestral populations and thus differences in genes that can affect health. This can give an approximation of probability for disease or for preferred treatment, although the approximation is less than perfect. Taking the example of sickle-cell disease , in an emergency room , knowing the geographic origin of a patient may help a doctor doing an initial diagnosis if a patient presents with symptoms compatible with this disease.

This is unreliable evidence with the disease being present in many different groups as noted above with the trait also present in some Mediterranean European populations. Definitive diagnosis comes from examining the blood of the patient.

In the US, screening for sickle cell anemia is done on all newborns regardless of race. The continued use of racial categories has been criticized.

Apart from the general controversy regarding race, some argue that the continued use of racial categories in health care and as risk factors could result in increased stereotyping and discrimination in society and health services. Since the 19th century, blacks have been thought to have thicker bones than whites have and to lose bone mass more slowly with age. Men were also significantly less likely to be treated compared with women.

This discrepancy may be due to physicians' knowledge that, on average, African Americans are at lower risk for osteoporosis than Caucasians. It may be possible that these physicians generalize this data to high-risk African-Americans, leading them to fail to appropriately assess and manage these individuals' osteoporosis.

David Williams argued, after an examination of articles in the journal Health Services Research during the —90 period, that how race was determined and defined was seldom described. At a minimum, researchers should describe if race was assessed by self-report, proxy report, extraction from records, or direct observation. Race was also often used questionable, such as an indicator of socioeconomic status. There is general agreement that a goal of health-related genetics should be to move past the weak surrogate relationships of racial health disparity and get to the root causes of health and disease.

This includes research which strives to analyze human genetic variation in smaller groups than races across the world. One such method is called ethnogenetic layering. It works by focusing on geographically identified microethnic groups. Better still may be individual genetic assessment of relevant genes. Some doctors and scientists such as geneticist Neil Risch argue that using self-identified race as a proxy for ancestry is necessary to be able to get a sufficiently broad sample of different ancestral populations, and in turn to be able to provide health care that is tailored to the needs of minority groups.

One area in which population categories can be important considerations in genetics research is in controlling for confounding between population genetic substructure, environmental exposures, and health outcomes. Association studies can produce spurious results if cases and controls have differing allele frequencies for genes that are not related to the disease being studied, [88] [89] although the magnitude of its problem in genetic association studies is subject to debate.

Population genetic substructure also can aid genetic association studies. For example, populations that represent recent mixtures of separated ancestral groups can exhibit longer-range linkage disequilibrium between susceptibility alleles and genetic markers than is the case for other populations. Association studies also can take advantage of the contrasting experiences of racial or ethnic groups, including migrant groups, to search for interactions between particular alleles and environmental factors that might influence health.

The Human Genome Diversity Project has collected genetic samples from 52 indigenous populations. In a report by the Institute of Medicine called Unequal Treatment, three major source categories are put forth as potential explanations for disparities in health care: patient-level variables, healthcare system-level factors, and care process-level variables. There are many individual factors that could explain the established differences in health care between different racial and ethnic groups. First, attitudes and behaviors of minority patients are different.

They are more likely to refuse recommended services, adhere poorly to treatment regimens, and delay seeking care, yet despite this, these behaviors and attitudes are unlikely to explain the differences in health care. Health system-level factors include any aspects of health systems that can have different effects on patient outcomes. Some of these factors include different access to services, access to insurance or other means to pay for services, access to adequate language and interpretation services, and geographic availability of different services.

Three major mechanisms are suggested by the Institute of Medicine that may contribute to healthcare disparities from the provider's side: bias or prejudice against racial and ethnic minorities; greater clinical uncertainty when interacting with minority patients; and beliefs held by the provider about the behavior or health of minorities. From Wikipedia, the free encyclopedia. Race and ethnicity Racism in the United States.

Main article: Race human categorization. See also: Genetic disorder. See also: Pharmacogenomics. See also: Environmental racism and Race and health in the United States. See also: Heterozygote advantage. See also: Race classification of humans and Race and genetics. See also: Genetic association. Journal of Clinical Epidemiology. The American Journal of the Medical Sciences. American Sociological Association.

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European Review of Social Psychology. Centers for Disease Control. Retrieved The determinants of health.

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Understanding Sickle Cell Disease. University Press of Mississippi, Chapter 2. Reproductive fitness and selection". American Journal of Human Genetics. Journal of Dental Education.

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International Sociology. Pathophysiology of Hypertension in Blacks. Clinical Physiology Series. Springer, New York, NY. Annals of Anthropological Practice. Annals of Internal Medicine. Jones, , What's the Use of Race? Page Chapter 9. Chapter 5. Journal of Public Health Medicine. Journal of General Internal Medicine. Health Services Research. Annals of Human Biology.

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