Health disparities: reframing the problem.

Abstract

Health disparities are of continuing concern to the community of public health professionals. Despite concerted efforts on a number of fronts, little progress seems to have been made towards eliminating these disparities. This is due in part to a frame of reference that focuses on race and racism. While racism plays a role, continued focus on socially constructed racial groups will not lead to solutions to the problem. Humans are biological organisms and the presence of disease indicates a maladaptation between the individual human organism and its environment. Lumping together into a 'racial' group large numbers of individuals who share little in terms of phenotype, culture, and/or behavior inhibits reaching appropriate solutions. Progress will only be made when the issue of health disparities is reframed as one of phenotype/environmental mismatch. Such a frame crosscuts current racial groups. Health disparities such as hypertension, prostate cancer, low-birth-weight (LBW) infants, infant mortality, rickets, and melanoma are affected by the interactions of degree of pigmentation, amount of exposure to ultraviolet B (UVB) radiation, and levels of serum vitamin D. Reframing the problem of health disparities from one of race and racism to one of phenotype/environmental mismatch permits a solution to an otherwise intractable problem.