Purpose

The Assessment Operations Group in the Washington State Department of Health coordinates the development of guidelines related to data collection, analysis and dissemination in order to promote good professional practice among staff involved in assessment activities within the Washington State Department of Health and in Local Health Jurisdictions in Washington. While the guidelines are intended for audiences of differing levels of training, they assume a basic knowledge of epidemiology and biostatistics. They are not intended to recreate basic texts and other sources of information related to the topics covered by the guidelines, but rather they focus on issues commonly encountered in public health practice and where applicable, on issues unique to Washington State.

Background

What Are Race and Ethnicity?

Concepts of race and ethnicity have changed considerably over time. Today, most scientists do not view race as a valid biological construct. Genetic changes tend to show gradual variation across geographic areas with social and cultural categories of race and ethnic group being only modest proxies for continental ancestry.^1,2,3 Researchers, such as Camara Jones, propose that “race is only a rough proxy for socioeconomic status, culture, and genes, but it precisely captures the social classification of people in a race-conscious society such as the United States. … That is, the variable ‘race’ is not a biological construct that reflects innate differences, but a social construct that precisely captures the impacts of racism.”^4(p1212) The meanings attributed to ethnicity also vary with some researchers emphasizing cultural heritage, while others emphasize social identity.⁵ As with racism, to the extent that socio-cultural contexts maintain disadvantage among members of specific ethnic groups, ethnicity also captures the experience of discrimination.

Use of Terms in This Guideline

Because race and ethnicity are not precisely defined constructs, scientific writers use a variety of approaches for referring to these terms. For example, authors sometimes place quotation marks around race and ethnicity to remind readers of the imprecision and heterogeneity within categories. Others discuss race and ethnicity as one construct capturing the ambiguity of these terms, while emphasizing their social and cultural underpinnings. The imprecision of the constructs themselves can be magnified by data collection irregularities, such as when classification is based on appearance rather than self-report.

Race and ethnicity in this guideline refer to imprecise social and cultural categories with which individuals identify or as reported by next-of-kin in the case of death records. The term “race” indicates one of the five categories specified in the United States Office of Management and Budget (OMB) 1997 Standard⁶ and “ethnicity” indicates Hispanic or non-Hispanic origin. "Subpopulation" indicates a grouping within a larger racial category, such as Chinese or Japanese within the Asian category. For the public health technical and professional audiences for whom this guideline is intended, we do not use quotation marks around these terms. We follow the conventions of the Chicago Manual of Style 15th Edition⁷ in capitalizing designations based on national and ethnic groups, but not capitalizing those based loosely on color when we use these terms in the text. The conventions used in this guideline are not intended as a recommendation. The best terminology or ways of presenting these constructs will vary with the document’s purpose and intended audience.

Why Include Analyses by Racial and Ethnic Groupings in Public Health Assessment?

In the United States and in Washington State, there are large differences in health status by self-identified racial and ethnic categories. Reducing these disparities is both a national and a state goal. We need to measure health status and associated risk factors by racial and ethnic groupings so that we understand the magnitude of the disparities and whether current gaps are increasing or decreasing. This knowledge can assist with developing interventions to decrease gaps, such as developing policies to reduce inequitable access to educational, economic and community resources that facilitate healthy ways of living; inequitable access to and quality of medical care; and inequitable exposure to environmental toxins. Additionally, health care providers and other service organizations sometimes serve people who primarily identify with one or a limited number of specific racial or ethnic categories. These providers and organizations often want to know the health status of the populations they serve. Assessing data by racial and ethnic groupings is one way to obtain this perspective.

What Racial and Ethnic Groupings Are Used Nationally?

In the early 1990s, OMB reviewed Statistical Policy Directive No. 15, the federal guidelines for reporting race and ethnicity that had been in effect since 1977. Based on that review, OMB issued a revised standard in 1997. The standard included an explicit statement that the racial and ethnic categories serve social, cultural and political purposes and should not be interpreted as indicating primarily biological or genetic differences among people. The three major changes in the OMB 1997 Standard are

• People can identify more than one racial category.




• Pacific Islanders should not be classified with Asians.



• The question on Hispanic/Latino ethnicity should be asked before the race question.

• Race
  
  
  
  • American Indian or Alaska Native (AIAN): A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
  
  
  
  • Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
  
  
  
  • Black or African American: A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."
  
  
  
  • Native Hawaiian or Other Pacific Islander (NHOPI): A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
  
  
  
  • White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
  
  
  
• Ethnic Group



• Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race. The term "Spanish origin" can be used in addition to "Hispanic or Latino."