According to the Willis et al. study from 2010 (and illustrated from the table above, reproduced from the Eeden et al. study of 2003), the neurodegenerative condition Parkinson’s disease afflicts a disproportionate number of Caucasians and Hispanics as compared to African Americans and Asians. In the Willis study in particular, whites and Hispanics developed Parkinson’s at twice the rate of blacks and Asians. Genetic variables are predicted to explain only a small fraction of the variance between groups; rather, Willis speculated that that, “Environmental factors are likely more common contributors and may include prolonged exposures to herbicides and insecticides used in farming or to metals such as copper, manganese and lead” (News Medical). Another proposed reason for the difference was presence of a gene in those of Asian or African ancestry that confers protection from the disease.

Instead of a tangible, objective biological category, race is a social construct used to justify social hierarchies and oppression, discrimination, and persecution of certain groups and the privilege afforded to others. As cited in Taz’s lecture, genetic determinism is the notion that genetic endowment dictates our temperaments, behavior, intelligence, and health; in other words, the arbitrary demarcations between ‘races’ are used as a proxy for genetics such that overarching assumptions about health and disease predispositions are inferred. This theory is used to equate biological race and genetic similarities. For instance, BiDil designed and marketed its product for hypertension based on racial bifurcations based on health disparities between ‘races’, although such inequalities in heart disease are most likely owed to extraneous variables such as SES, prejudice, differential access to healthy food, less health insurance, etc. In reality, a constellation of factors including social, cultural, behavioral, psychological, and physiological parameters determine health outcomes, though Western medicine tends to favor biological explanations for divergent health over cultural or environmental ones.

References

News Medical. Editor. 2010. 13 July 2012 < http://www.news-medical.net/news/20100128 /Epidemiological-study-shows-Parkinsons-disease-is-more-common-among-whites-and-Hispanics.aspx>.

Van Den Eeden, S.K., Tanner, C.M, Bernstein, A.L, Fross, R.D., Leimpeter, A., Block, D.A., & Nelson, L.M. (2003). “Incidence of Parkinson’s Disease: Variation by Age, Gender, and Race/Ethnicity”. American Journal of Epidemiology, 157(11): 1015-1022.

Willis, A.W., Evanoff, B.A., Lian, M., Criswell, S.R., & Racette, B.A. (2010). “Geographic and Ethnic Variation in Parkinson Disease: A Population-Based Study of US Medicare Beneficiaries”. Neuroepidemiology, 34: 143-151.

This map shows the obesity rate of African American adults in the United States according to the CDC. According to this map 40 out of 50 states have obesity rates higher than 30%.(http://www.examiner.com/article/the-growing-threat-of-obesity-for-african-americans)

I am sure there are many Americans that can relate to more than one racial or ethnic background, me being on of them.  My mother is of mixed Caucasian decent and my father is Japanese and African American.  In most situations society makes us choose one race to identify ourselves, and if an APB were put out on me I would be identified as African American or black. So that is why I chose the health disparity of obesity in African Americans.  If a person has a BMI over 25 they are considered overweight and a BMI over 30 is obese.  America as a whole is in the middle of a huge obesity epidemic, but African Americans, especially women, have much higher percentage rates. A person who is obese is at a higher risk for heart disease, high blood pressure, stroke, diabetes, cancer, sleep apnea, depression, some types of cancers, and others problems.  These are all reasons that African American men have higher mortality rates then any other group in America. According to the Office of Minority Health 4/5 Afro-American women are overweight or obese and were 70% more likely to be obese than Non-Hispanic white women; young girls were 80% more likely to be overweight.  Overall African Americans were 1.4 times more likely to be obese than Non-Hispanic whites.

I think the biggest reasons for African-Americans have greater rates of obesity are cultural and socioeconomic rather than genetic.  Culturally it is more acceptable to have a larger body type than in other groups. In some ways this is good, but when it comes to physical health it leads to problems. And according to IMDiversity.com African Americans are also less like to feel guilty about overeating. They also point out that in the environments that blacks live in they have more access to fast food and mini marts that offer more fried, sugary, and over-processed foods and drinks.  One of the biggest culprits lies within the home.  We learn our eating habits from out families, and in African American families the tradition of soul food is passed through the generations.  These foods are usually high in fats and sodium.  This tradition didn’t used to be that big of an issue, but today the same diet is partnered with less activity.  The CDC has also noticed a relationship in socioeconomic status and obesity.  Black men with higher incomes are more likely to be overweight then those with lower incomes. This ratio is opposite for women; higher incomes have lower weights than those with lower incomes.  When it comes to education, women have shown to have lower rates of obesity the more education they receive.

I think that many health disparities among races has more to do with culture and socioeconomic status than actual genetic.  In the United States, racial and ethnic minorities and low-income populations have lower rates of insurance and access to health care. 1/5 of African Americans are insured and 1/10 white Americans don’t have insurance.

– http://minorityhealth.hhs.gov/templates/content.aspx?ID=6456

– http://www.examiner.com/article/the-growing-threat-of-obesity-for-african-americans

– http://www.cdc.gov/obesity/data/adult.html

-http://www.imdiversity.com/villages/african/family_lifestyle_traditions/bpr_obesity1127.asp

-http://www.healthreform.gov/reports/healthdisparities/

People of Scandinavian descent, particularly Finnish in my experience have a predisposition towar contracting one form or another of cancer. Perhaps some nationalities has a defective genetic mututation with a tendency toward this disease.  I am Finnish myself and I have had cancer and so have various people in my family.  It appears that there is predisposition for it either in my family or in people of Finnish descent.  Perhaps there are environmental factors involved, Finland has a cold climate but I do not think that is something that would be a reason for cancer cells to re-produce. In our lecture in the Reflection Ms. Karim stated that it was something to reflect on if culture and political and economic influences spread disease.  What way would it affect cancer?  Perhaps it is diet.  This nationality makes a lot of pasties and seem to prefer and “meat and potatoes” type of diet.  This may be an environmental dietary factor in the development of cancer.  Cultural ecology examines how cultural beliefs and practices influence ecologogical relation between humans and diseases (lecture l, Chapter 2).  Cultural practices and beliefs may influence things like food choices. People that have immigrated to the United States seem to have the same tendency toward this disease, so being here in the United States seems to not have made a difference.

The ecosystem could be out of balance in this nationality. It is possible that first generations have not adapted and achieved a balance between themselves and their environment. I believe it is a combination of factors from environment, lifestyle and there may be a genetic component somewhere that we are not aware of.  In the future there may be a way of altering these affected genes if they are proven to be the culprit.  Some may say that is playing God.  That is a moral argument for philosophers and scientists.

The health disparity I chose to discuss is testicular cancer in white males.  Being a 21 year-old, white male, this is a topic not only of interest but a topic of concern.  This is because testicular cancer is the most common form of cancer in males 20-34 years of age and is 5 times more prevalent in white males than in black men and 3 times more than Asian and Native American men.  The causes of testicular cancer are relatively unknown but there are agreed upon risk factors that may increase a males risk for cancer development.  These risk factors include specific medical conditions that some patients suffer from in addition to the cancer, family history and genetics but most men
with testicular cancer do not have a family history, and a man’s occupation.  It has been shown that social determinants such as income and education may have an impact on testicular cancer development because higher rates of the cancer are seen in men that have high income and educational levels.  In addition, conditions a male faces before and after birth can play a role in potential testicular cancer development.  Conditions such as weight at birth, age of the mother during pregnancy, number of pregnancies, and hormone levels caused by natural or artifical hormones.

Biologically, there are no identifying markers that can be used to classify an individual into a specific race.  Instead, race is a socially constructed idea that is used to group those that have similar appearances.  When it comes to genetics, people of a similar ancestral background would share similar genes, such as the Pima Indian example from the lecture, but this doesn’t necessarily classify them as a separate race from other people.  Therefore, when it comes to trying to determine an individual’s health based on their race it would be better to look at the person’s social setting, where they live and how much money they make, rather than making a general assumption based on what they look like.

Sources:

http://www.cancer.org/Cancer/TesticularCancer/DetailedGuide/testicular-cancer-risk-factors

http://www.health.ny.gov/statistics/cancer/registry/abouts/testis.htm

http://www.cdc.gov/cancer/npcr/training/nets/module10/nets10_3.pdf (Graph)

Multiple Sclerosis has so far been found to be most prevalent among Caucasians, particularly those of Northern European ancestry. There are a number of studies showing that whites are most likely to get MS. Caucasians are twice as likely to suffer from MS as African-Americans. MS is also not commonly found in people of Asian, Indian, South American, and Native American descent, and particularly uncommon in people from the African sub-continent. There have also been studies that have found that there are certain ethnicities that seem to have a resistance to MS, these groups include American Inuit, the Lapps of Scandinavia, and the Maoris of New Zealand. In addition to MS being most common among Caucasians, it is also two to three times more likely to occur in white females. There are numerous studies that have been carried out to try and explain the epidemiology of multiple sclerosis. One thing the medical community has come to a consensus on is the geographical distribution of MS. It has been found that MS occurs mostly in regions away from the equator- the Northern United States, Canada, Northern Europe, Southern Australia, and New Zealand. (As shown in the map below)

There is some debate though, to what actually causes this distribution. Some believe it is climatic, others believe it is related to patterns of migration and ancestry, and still others believe it is related to socioeconomic issues that hinder awareness and diagnoses. The climatic factors are an example of medical ecology. One of these factors being studied is the relation of the amount of sun a person gets, and therefore their vitamin D levels, and the fact that the prevalence seems to occur in areas away from the equator. This is an intersection of health and environment, and one of the arguments backing this line of thought, is that African-Americans who live in these northern regions have a much higher rate of MS than Africans living on the sub-continent. The migration argument is an example of political ecology. Some researchers think that this distribution of MS backs the race or ethnicity theory because it follows the historical migration patterns of Northern Europeans- to North America, Australia, and New Zealand- in particular the patterns of the ancient Vikings and Scots. One backing of this theory is that Northern Ireland has a much higher prevalence of MS than the Irish Republic, and this area was historically, much more populated with those of Scottish descent. Lastly, is the social determinant of perhaps a lack of awareness about MS, this falls into cultural ecology. Some researchers believe this distribution of MS is an indicator of cultures that are not readily aware of MS and therefore lack the number of diagnoses found elsewhere, in more developed countries. I personally believe it is a combination of all these factors. There are probably ancestral components, as well as relationships between the patterns of migration found in the geographical areas with more prevalence. Also, there has been a lot of convincing research regarding the climatic and environmental effects on the onset and prevalence of MS, that I believe must be factored in, when discussing the patterns of multiple sclerosis.

Sources:

1-      Marrie, R. (2004). Environmental risk factors in multiple sclerosis aetiology. The Lancet Neurology, 3(12), 709-718. Retrieved from http://www.sciencedirect.com/science/article/pii/S1474442204009330

2-      The Multiple Sclerosis Trust. http://www.mstrust.org.uk/information/publications/msexplained/who_gets_ms.jsp (Photo)

3-      Compston, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502-1517. Retrieved from http://www.sciencedirect.com/science/article/pii/S0140673608616207

According to PubMed Heart Disease is referred to as a narrowing of blood vessels that supply the heart with critical nutrients such as oxygen. These arteries narrow because of the cholesterol that is produced and ingested by the individual. The fat molecules stick to each other and even the side of the blood vessel at random points. When the fats stick and form a plaque it continues to grow until it potentially blocks of a vessel, which would result in an heart attack. This is a health issue that affects many Americans overall because of the foods they are provided with a home are not extremely nutritious.

I choose to work with the heart disease a disparity because I am very much interested in Cardiology as I mention in my introduction post. Also I feel that by potentially creating some community based programs the prevalence of the disparity could be reduced. When looking at African-American culture we see that having some excess weight is considered a good thing to show that you can  afford to sustain yourself and also it is usually attractive to males of the same culture. This sort of mentality makes is more difficult to get African-Americans to go on diets, and/or exercise regularly. Foods that are normally found in an African-American household does not help to prevent heart disease either. The foods tend to be those that are high in fat, sugar, and salt (for example: cheese, shortening, etc). When foods have a high fat content it can cause a rise in cholesterol which will slowly narrow major arteries over time. Many neighborhoods on the social extremes are homogeneous therefore these poor lifestyle patterns are protected because many of those that the individual is surrounded by believe the opposite of clinicians thereby continuing the health issue.

Race, genetics, and health are definitely connected to each other in a very complicated fashion. These three things are affected by outside sources as well as affecting each other. For example depending on your race you may have either experienced or witnessed racism in a health care setting which may have put you off from receiving preventive care. Therefore it is common for you to experience a disease much further along. For example African-American men and prostate cancer, when these men are diagnosed with the affliction it is often in one of its later stages because they may not be comfortable having the routine check done. Genes can also impact the health because certain diseases are passed down through the family like sickle cell anemia. This means that environmental and other outside factors are not going to prevent someone from getting the illness.

Sources:

Photo: http://www.indiana.edu/~k562/athero.html

Info: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/

The health disparity I chose to talk about is Skin Cancer. There are many types of skin cancer, but the three most prevalent are basal cell cancer, squamous cell cancer, and melanoma. Skin cancer is also the most commonly diagnosed type of cancer. Basal and squamous cell cancer only has a .3% mortality rate, while melanoma has a 15-20% mortality rate. A much rarer form of melanoma known as malignant melanoma is responsible for 75% of all skin cancer deaths, despite being one of the least common. Skin cancer is much more prevalent among white individuals because their skin does not have as much melanin. There are actually three kinds of melanin, Eumelanin, Pheomelanin, and Neuromelanin, but Eumelanin is the one which differs most by race. (Pheomelanin is associated with red hair and the exact function of Neuromelanin is unknown) In general, individuals whose ancestors lived for long periods of time at the equator have higher levels of Melanin. It is interesting to note that while Melanin levels vary between different races, the number of melanocytes (the cells which produce melanin) hardly varies at all. Instead, the differences between races are due to the relative activity of the melanocytes. Melanin protects against the harmful effects of ionizing radiation, helping to protect against DNA mutations.

The relationship between race, genetics, and health is a complicated one. Oversimplification can often lead to grossly inaccurate conclusions; such oversimplifications have happened many times throughout recorded history. I would argue that while there are certain cases where race can have a direct effect on one’s health, the primary way in which race and health are related is actually a result of the varying social practices of the various races. This would mean that race and health share causation with social practices, but between themselves share only a correlation. (As the media is often prone to forgetting, correlation does not imply causation)

Melanoma of the Skin
Death Rates* by Race/Ethnicity and Sex, U.S., 1999–2008

Mortality source: U.S. Mortality Files, National Center for Health Statistics, CDC.
*Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). Death rates cover 100% of the U.S. population.
^†Hispanic origin is not mutually exclusive from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native).

http://www.cdc.gov/cancer/skin/statistics/race.htm

The health concern that I choose to research was Cystic Fibrosis in Caucasian Americans. The main reason that I choose this disease was because it has a large rate of occurrence in Caucasians, and because it is difficult to find a disease that more disproportionally occurs white Americans when compared to other groups.  The disease itself is inherited and primarily affects the lungs and digestive systems. It is causes by a defective gene that produces a protein that causes mucus to be abnormally thick and sticky. This can cause a number of symptoms such as salty tasting skin, constant coughing sometimes with increases mucus, shortness of breath, impaired growth,  weight loss, constipation, loss of appetite, bloating, abnormal stool, fatigue, nasal congestion, increased chance of pneumonia, sinus pain, and inflammation of the pancreas.

                Although the risk of Cystic Fibrosis is prevalent among many Americans, it is disproportionately found in Caucasian Americans with ancestry from central or northern Europe. This is mainly because of the genetic factors that determine if you will born with Cystic Fibrosis are predominant in Caucasians with European backgrounds. Although there is no cure for Cystic Fibrosis, there are multiple forms of treatment aimed at extending and increasing the quality of life of those afflicted. These treatments include antibiotics, enzyme therapy, pneumonia vaccines, oxygen therapy, special diets, vitamin supplements and lifestyle treatments such as avoiding smoke and dust and drinking more fluids than usual.  The average lifespan on someone with Cystic Fibrosis is about 35 to 40 years, which is a drastic increase as compared to the last 50 years.

                The relationship between race, genetics and health can all become readily apparent for most circumstances if you look for it, but are not present in all situations. A good example of the three relating to each other would be the malaria and sickle cell anemia that we discussed in class, but many illnesses can just as easily be a result of only one factor such as the Chernobyl accident.  In that instance, many people were made ill, but race and genetics had very little to do with the cause and prevalence rates.

http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf

http://www.cff.org/AboutCF/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001167/

http://www.meddean.luc.edu/lumen/MedEd/genetics/diseases/cf.htm

Cystic Fibrosis is a disease of the mucus glands. It commonly
has a cumulative effect on numerous body systems due to the importance of lubrication
throughout the body. Damage to the respiratory system and chronic digestive
problems are the main concerns with the disease. Essentially, individuals with
cystic fibrosis produce an abnormally viscous and sticky mucus.  This abnormal mucus blocks airways, distribution of key enzymes and hormones, and decreases pancreatic function. Another common result of Cystic Fibrosis is infertility in males. The disease
occurs in approximately 1 in every 2,500 white people. African Americans have a
less common incidence of only 1 in approximately every 15,000-17,000
individuals. In order to inherit the disease, an individual must inherit two
recessive genes, one from each parent. Often, both parents of offspring with
Cystic Fibrosis will only carry one recessive gene and therefore not express
the condition. As to why Cystic Fibrosis is prevalent in Caucasians: I believe
it is along the same lines of Sickle Cell in African Americans. Carrying the
recessive gene for Cystic Fibrosis probably protected Caucasians, primarily of European descent, from another disease or condition. I read in a non-scholarly article
that diarrheal diseases were rampant in Western Europe and that this lead to
the evolution and prevalence of the disease. Carrying the recessive gene for
Cystic Fibrosis made individuals immune to a number of diarrheal diseases.

http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf

The relationship between race, genetics and health is complex
and difficult to analyze. Race is certainly a social construct and has been
exploited to benefit a hierarchical system ever since it came into existence. It
has no relevance in treating disease. Unless you are talking about distribution
of disease, in which it can then be useful. Certain racial groups are more
likely to have specific diseases, but they are not due to skin color which is
essentially what determines race. Skin color was determined geographically.
Your proximity to the equator and exposure different levels of sunlight determined
your complexion. Genetics, which is a result of inheritance, can predispose you
to certain health issues and disorders.  For example, the Pima Indians lived in an environment in which food was often scarce.  As a result, they evolved
to process sugars and store fats at a higher rate. This obviously was very useful
in terms of survival in the past.  In today’s world, the mutation still persists but their environment has changed. The result of the mutation has become a high prevalence of Type II diabetes and obesity. In conclusion, genetics is a more valid determinant in the study of health.

Sources: http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf

http://ghr.nlm.nih.gov/condition/cystic-fibrosis

Celiac disease (CD) is a chronic intolerance to gluten, the protein found in wheat, barley, and rye.  When gluten enters the digestive tract of someone with CD, it triggers an autoimmune attack, and the resulting inflammation destroys the villi of the intestines.  Without these finger-like projections of the intestinal surface, normal nutrient absorption can’t take place and serious digestive symptoms result.

Nearly every article about celiac disease states that the condition is most frequent in people of Northern European descent.  Despite this consensus, I was hard-pressed to find a chart or set of statistics that directly compare the prevalence by racial groups, so the above graph is the best I could find.  It at least shows that the rate of celiac disease in African, Hispanic, and Asian-Americans is lower than the rate of the general population, which factors in Caucasian Americans.

One of the highest risk factors for celiac disease (CD) is a family history of the condition.  Nearly every patient diagnosed with CD has a specific form of the HLA genotype that is associated with causing the disease in conjunction with environmental factors.  Since the main gene pool of people with this mutation originated in Northern Europe, all of their descendents throughout North America, Australia, South Africa, etc. are at a higher risk for inheriting this genetic predisposition to the disease.

The medical community agrees that celiac disease is generally underdiagnosed, Another possible reason minorities have a lower prevalence of CD is that in some communities, they are less likely to have access to health care, and are less likely to undergo the intestinal biopsy that leads to a CD diagnosis.  Because of this, reported diagnoses of CD in minorities might not fully represent the true number of cases.  The processing of wheat and bread are also linked to the incidence of celiac disease, which has multiplied by four times in the past 50 years.  Certain ethnicities may not include as many wheat products in their diet as Caucasians, leading to a lower incidence of gluten intolerance.

This week’s materials helped me separate the concepts of race and genetics.  I learned that race is a socially-constructed idea that can only be determined by self-identification.  Scientists agree that race has no genetic basis.  This means that no genetic test or biological examination could distinguish one race from another.

Genetics, on the other hand, is comprised of the concrete structures of DNA that impact how the body functions.  Specific genotypes can be linked to disease, either as a direct cause of some malfunction, or as a risk factor that can predispose someone to developing a disease.

The line between genetics and race can sometimes be blurred when studying their impact on health.  For example, in the Pima Indians in the U.S. have a severely high incidence of Type II diabetes.  This is due to a specific gene preserved in their population because it once gave them a survival advantage to store energy during famines.  However, the gene has been limited to their specific ethnic group since for the most part it has not been passed on to generations outside of the Pima population.

Works cited:

http://news.medill.northwestern.edu/chicago/news.aspx?id=150813 (for information and graph)

http://emedicine.medscape.com/article/171805-overview#a0101

http://voices.washingtonpost.com/checkup/2009/07/celiac_disease_increases_sharp.html