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May 3, 2005

Racial and ethnic disparities in health in Latin America

Recent studies show social programs do improve health in minorities.

Are Afro-descendants and indigenous peoples in better or worse health than Latin Americans of European descent? Four new studies on race, ethnicity and health in Latin America produced some unexpected and sometimes contradictory results.

In poor rural villages in Mexico, for instance, indigenous groups report being in better health than non-indigenous groups, said Ashu Handa, a professor at the University of North Carolina at Chapel Hill. He took data from the PROGRESA cash transfer program for the poor and compared it with the National Health Survey findings.

Indigenous groups in Mexico are the largest in Latin America in absolute numbers, although not in percentage, noted Handa. Of the 25,000 households in 505 villages participating in the PROGRESA program, at least one third self-identified as indigenous based on language.

The main purpose of his study was to identify factors outside the household that affect health and to assess the impact of the PROGRESA program on indigenous groups, especially on the growth of children from birth to age five. The study found that indigenous groups do not report being worse off than others and that preventive health monitoring for children has an equally positive effect on both indigenous and non-indigenous groups.

Raquel Bernal, a professor at Northwestern University, conducted a study on indigenous and Afro-descendent groups in her native Colombia. The two groups together represent 9.2% of the total population and generally are of lower socioeconomic status than Colombians on average.

Based on data from the 1983 Living Standards Survey of some 83,000 individuals, Bernal found that health disparities disappeared after controlling for socioeconomic factors, employment status and geographic location. Interestingly, indigenous groups were more likely than other minorities to have health insurance because they are eligible for a state program for tribal lands ( resguardos ).

She concluded that the health status of minorities can and should be improved through employment, education and publicly funded health care plans similar to those in resguardos .

A third study also found that ethnic disparities in health could be explained by socioeconomic factors. David Mayer-Foulkes, a professor at the Center for Economic Research and Teaching (CIDE) in Mexico City, conducted a study on four Latin American countries that have large ethnic populations: Bolivia, Brazil, Guatemala and Peru.

Using demographic and health surveys on education, housing, household assets, employment, socioeconomic status and health indicators for children and women, Mayer-Foulkes found that indigenous groups were worse off than non-indigenous groups, especially indigenous women. For children's health, however, external factors, such as household assets (whether the family owned a cow, for example), education, access to health services and sanitation, were more important than genetic factors, as in the study on Mexico.

Mayer-Foulkes concluded that cash transfer programs are effective in reducing inequity and can also generate data for further studies to be conducted. Ethnic and racial disparities exist but are a complex reality, he noted, with problems that tend to be very local and specific.

Antonio Trujillo, a professor at the University of Central Florida, agreed. He studied racial disparities among the urban elderly in Brazil, using data from the Health, Welfare and Aging Survey conducted in Sao Paulo. He found that overall, whites were healthier than blacks, although whites had higher rates of cancer and heart disease. However, while socioeconomic factors accounted for some of the disparities in his study, they could not explain 52% of the differences.

Other factors could include biology, geographic marginalization, access to care, the quality of care and racism, for instance, being treated differently by doctors, Trujillo said. The study also showed that factors affecting health status during a person's childhood, such as coming from a poor family, living in remote rural areas, or often going hungry, have a considerable impact on the health of seniors in all income groups. Trujillo recommended improving the geographic availability of health care and the quality of care for seniors of all races.

Acknowledging that the studies came to opposite conclusions, the researchers concluded that further studies are necessary, with better data. All four papers are to be published in a forthcoming IDB book.

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