Our picture of racial and ethnic disparities in the health of older Americans is strongly influenced by the methods of collecting data on race and ethnicity. At one level there is a good deal of consistency in data collection. Most Americans and most researchers have in mind a general categorical scheme that includes whites, blacks, Asians, Hispanics, and American Indians. Most Americans and nearly all researchers are also aware that these general categories disguise significant heterogeneity within each of these major groups. To the extent possible, recent research has attempted to identify and compare subgroups within each of the major racial and ethnic groups, making distinctions by country of origin, nativity, and generation within the United States. Most researchers generally agree that these categories are primarily social constructions that have changed and will continue to change over time.
Once we begin to explore more deeply the ways in which data on the elderly population are collected, however, we discover inconsistency across data sets and time. Part of this variation is from inconsistency in the way that Americans think and talk about race and ethnicity. Race and ethnicity are words that carry heavy intellectual and political baggage, and issues surrounding racial and ethnic identities are often contested within and across groups. The debate over racial and ethnic categories prior to the 2000 Census is one of the most recent, but by no means the only, example of these contests. Several advocacy groups pressured the Office of Management and Budget (OMB) to revise its racial and ethnic categories and data collection schemes (see , and , for discussions of the controversies). This resulted in several significant changes, including the most well-known change, which allowed individuals to choose more than one racial category in the 2000 Census. Although most national and many local data collection efforts follow the federal guidelines, they vary in the way in which questions are constructed and in the order in which they appear in the questionnaire or interview schedule. Such seemingly trivial differences in measurement lead to different distributions of responses about racial and ethnic identity ().
Another inconsistency that has troubled health researchers is the collection of racial and ethnic data using different criteria across data sources. A good example of this is the mismatch between self-selected race (which is used in most data sets) and the observer-selected race that is often used for death certificates. Comparisons between next-of-kin racial identifications and death certificates have shown that a large proportion of, for example, black Hispanics are misidentified on death certificates. This leads to a significant overestimate of their life expectancy because the race-specific mortality rates are inaccurate ().
The purpose of this chapter is to examine the implications of how we measure racial and ethnic identity for our understanding of racial and ethnic disparities in health, especially among the elderly. We focus on the official classifications used to produce statistics on the health status of the elderly, and because self-identification is the fundamental tool used to assign individuals to the official categories, we explore factors associated with self-identification. Although we emphasize identification and classification involving the elderly, much of what we have to say applies to other age groups as well. We first look at what the social science literature has to say about the ways in which individuals and society construct racial and ethnic identities. Second, we examine how information on race and ethnicity is recorded in some of the major federal data sets used to study health disparities among the elderly. We then discuss some of the major problems in our national system of collecting and reporting on health disparities. We conclude with some recommendations for achieving greater consistency in the collection and reporting of racial and ethnic information.
RACIAL AND ETHNIC IDENTITY
Historical Understandings of Racial and Ethnic Identity
Over time, academic and popular understandings of racial and ethnic identities have changed dramatically. Prior to the 20th century, racial and ethnic groups were perceived as permanent, biological types. Scholars of race and ethnicity turned to Biblical passages and, later, theories of natural history to explain the origins of differences among ethnic and racial groups (). They concluded that these group differences were natural and immutable. explain that the paradigms popular among social scientists in the late 19th and early 20th centuries “conceived ethnic and racial groups as biologically distinct entities and gave to biology the larger part of the responsibility for differences in the cultures and the political and economic fortunes of these groups” (, p. 42).
The work of Franz Boas shifted the model describing racial and ethnic differences from one stressing biology to one that focused on cultural differences (). This shift implied that racial and ethnic groups were dynamic rather than static. These paradigmatic changes influenced the work on race in the emerging Chicago School of Sociology, which led to an assimilationist model of racial and ethnic identities (). In this model, the inherent flexibility of racial and ethnic identities would eventually lead to the assimilation of distinctive racial and ethnic minority groups into the mainstream culture. However, developments in the middle of the 20th century, such as strengthening ethnic and racial conflicts, forced social scientists to reconsider the question of racial and ethnic identities.
Two paradigms, primordialism and circumstantialism, emerged in the post-assimilationist era (). Proponents of primordialism asserted that for each individual “ethnicity is fixed, fundamental, and rooted in the unchangeable circumstances of birth” (, p. 48). Those favoring circumstantialism claimed that individuals and groups claim ethnic or racial identities when these identities are in some way advantageous. As more and more social scientific research investigated racial and ethnic identities, it became clear that neither model was able to fully explain the complexities of these phenomena. The most prevalent current view on racial and ethnic identities is a social constructionist model (; ; ). Within this system, “the construction of ethnicity is an ongoing process that combines the past and the present into building material for new or revitalized identities and groups” (, p. 19).
As views of racial and ethnic identities have changed over time, so have official categories and measurement procedures. The U.S. Census has classified people into racial groups since its origin in 1790. However, the list of categories and the method of measuring race or ethnicity has changed many times in the intervening decades, as the political and economic forces shaping the collection of racial data have changed. In early Censuses, enumerators answered the race question based on their perception of the individual. The earliest Censuses used slave status as a proxy for a racial category, the only race options being “free White persons, slaves, or all other free persons” (;). In later years more specific categories for those of mixed African American and white descent, such as mulatto, quadroon, and octoroon, were used (). Asian groups have been listed on the form since the late 1800s. Chinese, Japanese, and Filipino were the first Asian groups to appear on the Census; later Korean, Vietnamese, Asian Indian, and other Asian groups were added to the list. American Indians were included as a separate group beginning in 1870. The Census question measuring the Hispanic population has also varied over time. Enumerators have used a Spanish surname, the use of the Spanish language in the home, and the birthplace of the respondent or parents to indicate Hispanic ethnicity.
In 1970, racial classification on the Census changed from enumerator identification to self-identification. This change had a relatively minor impact on the count of racial and ethnic groups in 1970 compared to 1960. However, it created a situation that led to significant changes in counts during subsequent years. This methodological shift proved to be especially influential for American Indians. During the period between 1960 and the end of the 20th century, the size of the American Indian population as measured by the Census increased much more than could be accounted for by migration or births (; ). This increase was because persons whom enumerators had previously identified as being of another race began self-identifying as American Indian and, after 1970, there was increased self-identification as American Indian by those who earlier self-identified or were identified by their parents as being in some other group ().
In 1997 OMB announced new standards for federal data on race and ethnicity (). Following the OMB standards, the 2000 Census used the five suggested racial categories: White, black/African American, American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander. The Census Bureau also added a sixth category, “some other race.” The Native Hawaiian/other Pacific Islander was separated from the Asian category for the first time. A second and even more influential change allowed respondents to choose more than one racial category. Prior to the 2000 Census, the U.S. Bureau of the Census conducted several tests—including the 1996 Race and Ethnic Targeted Test—to consider the implications of changing the way in which data were collected for the counts of racial and ethnic groups in the United States. The major conclusion that came out of this test was that allowing individuals to choose more than one racial group had a very small impact on the measured racial composition of the population (;).
Based on these results, predicted that 1 to 2 percent of whites and blacks in the 2000 Census would identify with more than one race and that the numbers of respondents who identified solely as American Indian or Asian would not be significantly different from what one would find if people were constrained to pick only one race. On the other hand, they predicted that some who in the past had recorded their race as white or “some other race” would report more than one race. Their predictions turned out to be correct. In Census 2000, 97.6 percent of the U.S. population reported only one race. Of the 2.4 percent, or 6.8 million, who reported more than one race, 32 percent reported white and “some other race,” 16 percent reported white and American Indian/Alaska Native, 13 percent reported white and Asian, and 11 percent reported white and black or African American (c). Another way to look at these figures, however, is to note that the size of the population reporting two or more races is larger than the American Indian or Pacific Islander populations and about half the size of the Asian population.
The Social Constructionist Paradigm of Racial and Ethnic Identity
Changes in the U.S. Census categories over time reflect changes in the ways in which Americans think about race and ethnicity as well as political conflicts over these views. Changes in official classifications in turn helped shape the discussion of race and ethnicity in subsequent decades. Within the paradigm of social constructionism, racial and ethnic groups are understood as socially created, rather than biologically given, realities. Relatively trivial (and even overlapping) phenotypical differences or group customs are used to categorize groups, and then society proceeds to attach a socially constructed meaning to these differences. The socially constructed meaning of racial/ethnic groups most often takes an evaluative tone. Given their social origins, racial and ethnic identities continually change over time and with varying circumstances. Changes are a result of forces from both outside and within the racial/ethnic group. Cornell and Hartmann employ the terms assertion and assignment to illustrate this interaction of forces shaping identities. They conclude that racial and ethnic identities “involve not only circumstances but active responses to circumstances by individuals and groups” (, p. 77). , p. 21) agrees, stating, “ethnic identity is, then, a dialectic between internal identification and external ascription.” Of course, the relative influence of assignment and assertion varies by group. demonstrates that white ethnics have a great degree of choice about their ethnic identity. They can choose a particular identity to highlight, and this choice can fluctuate across time and situations. However, she notes that many members of racial and ethnic minority groups do not have this degree of choice. For these individuals, identity is heavily ascribed by society. This is especially the case for individuals who have “markers” that associate them with a particular racial and/or ethnic group. These markers can be physical such as skin color, or they can involve surnames or accents.
Changes in a racial or ethnic identity can occur at both the group and individual levels. In other words, the racial/ethnic categories a society accepts and utilizes can change over a period of time; in addition, the racial/ ethnic label an individual chooses can change over time. described the extensive changes in American Indian identity in the second half of the 20th century. Social factors such as the civil rights movement, World War II, and federal Indian policy led to an “ethnic renewal” among American Indians. This, in turn, led to a revised understanding of the American Indian category; it also led many individuals who previously identified as some other race to change their ethnic identity from some other category to American Indian. In this case, ethnic identity changed at both the group and individual levels. outlines the ways in which the meaning of the Asian American category has changed over time and with varying social and political circumstances.
Although all racial and ethnic identities are socially constructed, some categories are more prone to change than others. notes that the ethnic options employed by white Americans are generally not available to African Americans, Asian Americans, Native Americans, or Hispanics. Nagel notes that some racial and ethnic identities appear more rigid than others (1996, p. 26). In the United States, the racial category African American has been a relatively closed and static category. The common identity rule for this group is the rule of hypodescent, under which any amount of black ancestry, no matter how small, makes one African American. Individuals in this group have much less opportunity to claim varied identities and to have these identities socially recognized. In many cases even those biracial (African American and white) individuals with a white parent have difficulty claiming a non-black identity (; ).
Another reason for varying levels of change in racial categories over time is the varying extent of racial intermarriage for different groups. Intermarriage, however, has less of an impact on the self-identification of older Americans than on younger Americans. Native Americans have historically had high intermarriage rates, leading to a large group of persons with both white and Native American ancestry. The intermarriage rates for Asian Americans and Hispanics have been increasing and are now at significant levels. For all these groups, the most common racial group to intermarry with is white. Therefore, there are significant numbers of persons whose ancestry is partially white and partially Native American, Asian American, or Hispanic. These individuals are faced with a choice of how to identify racially or ethnically. Many factors can lead to a particular identity choice. In their study of children with one Asian and one non-Asian parent, show that factors such as the gender, national ancestry, and language patterns of the Asian parent affect the racial identity of the child. The race of the non-Asian parent also has an effect. Given these differences in racial and ethnic options across groups, it is important to examine the specific circumstances (historical and current) for each group and examine the ways in which these circumstances have affected the racial/ ethnic identity processes for the group.
African Americans
As mentioned, the African American racial category has relatively rigid boundaries in U.S. society. Inclusion in the black category is guided by the rule of hypodescent. provides a thorough outline of the ways in which this system of racial categorization evolved in U.S. society. Both African Americans and whites have largely accepted this system of racial classification. Therefore, most persons with African American ancestry have a strong socially imposed identity. If they were to choose another identity, they would likely receive little social support for this identity. The findings of support these ideas. She found that although more than half of her interview respondents were aware of non-black ancestors, none of the respondents reported that they would identify with this part of their ancestry. She concludes “the ‘one-drop rule' operates to keep non-black ancestors from mattering to black individuals' present day identifications” (, p. 68).
However, there is some evidence that this situation is changing, or at least becoming more complex, due to increased interracial marriage among African Americans and increased immigration of persons of African descent. Intermarriage rates for African Americans, though still much smaller than rates for other groups, have been increasing significantly over the past few decades. This has created a sizable population of biracial (black-white) persons. studied the experiences of this group and found important generational differences. Biracial individuals born after the civil rights movement were much more likely to identify as biracial; those born before the movement were less likely to identify in this manner, primarily because they believed this identity would not have been socially supported or recognized. found a number of different identification strategies among their sample of young biracial (black-white) respondents: Monoracial identity (as either white or black), biracial identity, situationally shifting identity, and racially transcendent identity. This wide variation in racial identity among those with the same racial parentage indicates that the one-drop rule of racial identity for African Americans may be slowly weakening.
The increased immigration of individuals of African descent (primarily from Africa and the Caribbean) further complicates the social construction of African American identity. Second-generation black immigrants face an inherent tension: Their parents, in general, hold negative stereotypes of black Americans, and yet these second-generation persons are often identified as American blacks by others because they lack the ethnic markers of their parents (e.g., accent) (). As with biracial individuals, this group shows evidence of a variety of racial identities. Among Waters' respondents, some black immigrants adopted a black American identity, others had a strong ethnic identity (e.g., Jamaican, Trinidadian), and still others embraced an immigrant identity. These recent studies suggest that although African American historically has been an extremely rigid racial category, the situation may be slowly changing.
Asian Americans
Any examination of racial identity among Asian Americans must be informed by an awareness of important subgroup differences. Several subgroups, such as Chinese, Japanese, Filipino, and Asian Indian, are usually included in the Asian racial category. In 2000, Chinese Americans continued to be the largest Asian American group, with more than 2.7 million individuals reporting Chinese alone or in combination with other racial groups. More than 2 million recorded Filipino as one of their racial identities. The groups with more than 1 million included, in order of size, Asian Indian, Korean, Vietnamese, and Japanese. These subgroups differ widely with respect to language, culture, education, income levels, and immigration history. Furthermore, many Asian Americans identify more closely with their particular subgroup than with the panethnic identity. In many cases, using the panethnic label Asian can mask important variations among subgroups.
Members of Asian subgroups arrived in America with no perception of the Asian racial category. This is true for all of the umbrella groups used in the United States. Most Europeans entered the United States with little idea of a common European identity. The same can be said for African Americans, Hispanics, and Native Americans. National identities (e.g., Chinese, Japanese, Filipino) were much more relevant to members of these Asian subgroups, influencing many aspects of everyday life. , for example, describe the Asian racial identity of recent Vietnamese and Cambodian immigrants as assigned and thin. The identity is assigned because although Vietnamese or Cambodian identity is much more salient to these immigrants, U.S. society for the most part ignores subgroup differences and groups all these individuals under the racial category Asian. The Asian identity is thin because it does not organize much of the social life and activities of these individuals. Furthermore, unlike the case for Hispanics, there is no factor such as language that unifies the Asian population as a whole.
Writing about the evolution of the Asian American panethnic label, , p. 6) notes, “the term Asian American arose out of the racist discourse that constructs Asians as a homogeneous group.” More recently, however, Asian American panethnicity has also been constructed from within the group. Specifically, focuses on the ways in which organizations have drawn on and extended the panethnic label as a way of claiming resources and gaining political influence. In her research, found that Chinese- and Korean-American respondents did have a sense of belonging to an “Asian race.” They understood that Asian groups were perceived by the dominant society as physically similar, they felt a common history of experiences resulting from being labeled Asian, and they had a sense of an Asian American culture. However, for most respondents the Chinese- or Korean-American identity was more important than Asian American identity ().
Intermarriage has a large impact on the racial identity of Asian Americans. This group has relatively high rates of outmarriage. In the 1990s, 24.2 percent of Asian American wives and 12.3 percent of Asian American husbands were married to someone in a different racial group (). The children of these intermarried couples face choices about their racial self-identification. and examined the factors that affect the racial self-identification of children with one Asian and one non-Asian parent. used data from the 1980 Public Use Microdata Sample (PUMS) from California and restricted their analyses to children of Asian-Anglo marriages. They found that the probability of the child identifying as Asian was increased for children whose Asian parent is the father as opposed to the mother, who speak a language other than English, who are first generation, who live in areas with higher concentrations of the Asian parent's ethnic group, who live in areas with less ethnic heterogeneity, and whose Asian parent is Asian Indian, Korean, Filipino, or Japanese ().
had similar findings using the 1990 PUMS for children with one Asian and one non-Asian parent. Their results show that children are more likely to be identified as Asian if they are of the first or third generation, their father (as opposed to mother) is Asian, or their Asian parent speaks a non-English language. Their results on ancestry of the Asian parent, however, contradict those of . found that those whose Asian parent is Chinese or Japanese were more likely to identify as Asian than those whose parent was Indian, Korean, or Filipino. Finally, they found that children whose non-Asian parent was African American or Hispanic were significantly less likely to identify as Asian.
Hispanic Americans
Similar to Asian Americans, there is wide variation among Hispanic subgroups. The three largest Hispanic subgroups in the United States are Mexicans, Puerto Ricans, and Cubans. The case for Hispanics is further complicated by the fact that “Hispanic” is usually considered an ethnic identity, rather than a racial one. Therefore, in the Census and most survey data, the Hispanic ethnicity and race questions are separate. Hispanics, then, can be racially identified as white, black, Asian, or Native American.
Differences among the Hispanic subgroups include median age, immigration history, geographic distribution, fertility and family patterns, health status and mortality rates, income and education levels, and occupational distribution (; ). Survey data that do not separate these subgroups run the risk of masking important variations among the groups.
Hispanics also have significant rates of intermarriage. In the 1990s, 16.1 percent of Hispanic wives and 13.1 percent of Hispanic husbands were married to non-Hispanics (). As with Asian Americans, this means that the children of these unions can potentially make choices about their self-identification. However, this is complicated by the fact that in most cases the Hispanic question is asked separately from the race question. This fact makes it much easier for children with one Hispanic and one non-Hispanic parent to identify with the race/ethnicity of both parents on a survey.
Several authors have investigated factors that lead adolescents with Hispanic ancestry to make particular racial/ethnic identity choices. investigate what factors led particular Hispanic adolescents to switch their self-identity (as measured on surveys 2 years apart) from Hispanic to non-Hispanic. Factors such as speaking Spanish, having a higher concentration of Hispanic students in the school, living in a Census tract with a concentration of co-ethnics, and having a lower socioeconomic status were related to a reduced likelihood of switching to a non-Hispanic identity. Those who spoke only English were more likely to shift to a non-Hispanic identity. The authors conclude that the results identify “linguistic assimilation and spatial deconcentration as the structural mechanisms through which experience in the United States leads to uncertainty about ethnic identification as a Hispanic” (, p. 86).
examined the use of the Hispanic panethnic label by second-generation children whose parents were born in Latin America. National origin had the strongest effects on use of the Hispanic label. Cubans were least likely to use the panethnic label, followed by Colombians, and then Mexicans. Dominicans and Nicaraguans were most likely to identify as Hispanic. Greater acculturation and greater parental status were related to a lower likelihood of adopting the panethnic identity.
This complex set of factors affecting the Hispanic population creates an uncertain future for the racial identity of Hispanics. Because Hispanic status is usually asked separately from racial group membership, Hispanic Americans can usually choose a racial identity as well. However, many Hispanics believe that they do not fit into any of the other available racial groups. The studies reviewed indicate that Hispanic identity may become less salient as structural assimilation occurs for the group. Furthermore, many Hispanics reject the panethnic label in favor of their particular national identity (e.g., Mexican or Puerto Rican).
Native Americans
Racial identity is also a complex issue for Native Americans. However, it is complex for different reasons. The history of tribal membership, Native American relations with the U.S. government, and interracial marriage are the primary factors affecting issues of racial identity for American Indians. outlines the macrolevel historical factors affecting Native American identity. The treaty system and the removal of tribes to geographically remote areas reinforced tribal identities rather than racial identities (e.g., Navajo rather than American Indian). describes the more recent emergence of a Native American panethnic identity. Factors such as experiences in World War II, the civil rights movement, and certain federal Indian policies led to the intensification and increased saliency of a racial identity as Native American.
This situation is further complicated by the many ways in which Native American identity can be defined. , p. 234) concludes that in the post-Red Power era, “Indian individual and collective identities have become increasingly problematic and contested. There are widespread ambiguities and disputes about who is an Indian, how many American Indians there are in the United States, who should be permitted to assert Indian ethnicity, and who has the right to represent Indian interests.” Unlike other racial and ethnic groups, the federal government has outlined specific methods to classify Native Americans. These definitions can be at odds with state, tribal, and individual definitions of who qualifies as Native American. In order to receive federal services, Indian tribes must be federally recognized. Lack of tribal recognition denies tribal members official Native American status in the view of the federal government. Tribal definitions of Native American identity vary widely in their required blood quantum. Some tribes require a particular percentage of ancestry or “blood quantum” in order for individuals to be considered tribal members. Of course, the Census and most surveys measure race by self-identification, so individuals not considered Native American in the previous cases would be counted as Native American in these surveys.
American Indians have racially intermarried at even greater rates than Asian Americans and Hispanic Americans. In the 1990s, 60.2 percent of Native American wives and 58.8 percent of Native American husbands were married to someone of another racial group. As with the previous groups, these high levels of intermarriage have produced a group of individuals who face choices about their racial identity. describes the ethnic renewal of American Indians in the latter half of the 20th century. Part of this renewal was the shifting of racial identities of multiracial persons with American Indian ancestry from a racial identification with their other ancestry group (usually white) to a racial identification as Native American. As the social and political atmosphere of the United States made American Indian identity more attractive, the numbers of those choosing this identity grew. found that more highly educated persons living in cities were more likely to shift to a Native American identity in the Census. Self-identification shifts such as these can initially create apparent improvements in the demographic characteristics of Native Americans as a group. When analyzing longitudinal data on outcomes such as income, education, and health, researchers should consider possible identity shifts.
Summary
Existing evidence on racial and ethnic identity suggests that the early 21st century is a time of changing notions of racial and ethnic identity as immigration continues to fuel the growth of the Asian and Hispanic populations, as intermarriage rates continue to increase, and as the federal government begins to take into account the implications of mixed racial heritage or origins. As the previous discussion shows, the way in which Americans have seen themselves and one another has been influenced by the federal racial and ethnic classification schemes. At the same time, these classification schemes have responded to changes in how people identify themselves and others. The changes between the 1990 and 2000 Censuses are only the more recent examples of these shifts.
Next we review the racial and ethnic classification schemes employed by some of the largest federal data sets used to study racial and ethnic disparities in the health of the aging population. Although we discuss only a few of the major data sets, this will help us to understand the limitations of the available data for the study of these complex racial and ethnic identities.