Spiritual_Wellness_Holistic_Health_and_the_Practic

322 Philosophical Foundations of Health Education
suggested that race independently influences access to health services that can reduce
morbidity and mortality and prevent disability.
Disparities also exist in the prevalence of risk factors. For example, racial and
ethnic minorities have higher rates of hypertension, tend to develop hypertension at
an earlier age, and are less likely to undergo treatment to control their high blood
pressure. From 1988 to 1994, 35 percent of black males ages 20 to 74 had hypertension
compared with 25 percent of all men. When age differences are taken into account,
Mexican American men and women also have elevated blood pressure rates. However,
the results of recent studies (Morisky & Ward, 1999; Ward, Morisky, Lees, & Fong in
press) have demonstrated that both African American and Hispanic populations can
benefit dramatically from community - based educational programs that utilize targeted
and tailored approaches to blood pressure control.
Similarly, although significant effort has been made to reduce the overall U.S.
infant mortality rate, a significant indicator of a nation ’ s overall health status, marked
disparities between minority groups and Caucasians persist. Puerto Rican, Hawaiian,
American Indian, and African American infants suffer higher mortality rates, 26%,
33%, 55%, and 112% respectively, compared to Caucasian infants.
While the mechanism by which race and ethnicity influence health status may not
be clear, it is entirely possible that perceived systematic discrimination may play an
important causative role in diseases such as hypertension. Ren, Amick, and Williams
(1999) have noted that the experiences of discrimination tend to have a strong negative
association with health and that much more work needs to be done to specify the
social distribution of discrimination and assess its consequences for health status in
people of color.
Socioeconomic Status
The contribution of socioeconomic status to health disparities has been well documented
(Adler, Boyce, Chesney, Folkman, & Syme, 1993; Pappas, Queen, Hadden, &
Fisher, 1993). Socioeconomic factors, including education, income, and occupation,
are strongly associated with health and trends in health status in both individuals and
populations (Kaplan, 1998). For example, maternal education and family income both
inversely affect infant mortality (Singh & Yu, 1995). In addition, income inequality is
not only a major determinant of infant mortality, but also life expectancy at birth
(Smith, 1996).
Navarro (1997) states that differences in morbidity and mortality rates are related to
social class and, in fact, these differentials are much larger by class than by race. For
example, blue - collar workers ’ mortality rate for heart disease has been found to be 2.3 times
higher than that of Caucasian - collar professionals. However, mortality rates for heart disease
in African American males and females were respectively 1.2 and 1.5 times higher
than their Caucasian counterparts. Those making $ 10,000 or less per year encountered
4.6 times more morbidity than those making over $35,000, while African Americans ’
morbidity rate was 1.9 times higher than that of Caucasians (Navarro, 1997).