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标题：Minority Women and Advocacy for Women's Health
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作者：Shiriki K. Kumanyika ; Christiaan B. Morssink ; Marion Nestle 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2001
卷号：91
期号：9
页码：1383-1392
语种：English
出版社：American Public Health Association
摘要：US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered. WOMEN'S HEALTH ADVOCACY in the United States does not consistently address problems specific to women in ethnic and socioeconomic subgroups. Numerous differences in the health concerns of minority and majority women have been documented. 1 ^- 6 As shown in Table 1 ▶ , Black women have a shorter life expectancy than White women by 5 years, 50% higher all-cause mortality rates, and death rates from major causes such as heart disease, cerebrovascular diseases, and diabetes that are often 2 to 3 times higher than those for White women. Breast cancer incidence is similar for Black and White women, but Black women have higher breast cancer mortality. Among younger and reproductive-aged women, maternal mortality and homicide rates are 4 times higher for Black women than for White women, and the rate of HIV-related deaths is 12 times higher for Black women. The complexity of women's health advocacy emanates, in part, from the fact that the inequities at issue do not carry over into mortality disparities vis-à-vis men. This is generally true across ethnic groups (Table 1 ▶ ). In contrast, minority health advocacy has been organized primarily around attempts to leverage the data that show striking ethnic disparities in mortality. Thus, taking a minority perspective on women's health may “confuse the issue” to the extent that it draws attention to the favored health status of White women relative to Black women or other women of color. TABLE 1— Gender and Ethnic Comparisons of Selected Health Indicators for US Blacks and Whites Females Males Gender Difference or Ratio^a,b Indicator White Black Black–White Difference or Ratio^c,d White Black Black–White Difference or Ratio^c,d Black Males vs White Females Black Males vs Black Females Life expectancy at birth, 1998^e 80.0 74.8 –5.2 74.5 67.6 –6.9 –5.5 –7.2 Life expectancy at 65 y, 1998^e 19.3 17.4 –1.9 16.1 14.3 –1.8 –3.2 –3.1 Years of potential life lost before 75 y, 1998, 4751 9283 2.0 8352 16626 2.0 1.8 1.8 age adjusted, all causes, per 100 000 population^e All-cause mortality (per 100 000), age adjusted, 358 549 1.5 576 921 1.6 1.6 1.7 all ages, 1996–1998^e Cause-specific mortality (per 100 000) within age group, 1997^f Homicide, 15–24 y^f 3.2 13.3 4.2 13.2 113.3 8.6 4.2 8.5 Suicide, 15–24 y^f 3.7 2.4 0.6 19.5 16.0 0.8 5.3 6.7 Motor vehicle accidents, 15–24 y^f 18.4 11.3 0.6 39.8 32.7 0.8 2.2 2.9 HIV related, 25–44 y^f 2.4 29.3 12.2 13.2 76.7 5.8 5.5 2.6 Diseases of the heart, 45–64 y^f 92.2 224.6 2.4 249.0 455.5 1.8 2.7 2.0 Malignant neoplasms, 45–64 y^f 213.3 276.6 1.3 247.0 416.8 1.7 1.2 1.5 Breast neoplasms, all ages, age adjusted^g 19.0 26.2 1.4 … … … … … Breast neoplasms, 35–44 y^g 12.6 23.6 1.9 … … … … … Cerebrovascular disease, 45–64 y^f 19.7 56.3 2.9 25.4 87.9 3.5 1.3 1.6 Diabetes, 45–64 y^f 17.2 52.9 3.1 21.3 57.3 2.7 1.2 1.1 Maternal mortality (deaths per 100 000 live births), 4.2 16.1 3.8 … … … … … all ages, age adjusted, 1998^e Hypertension (%), 20–74 y, age adjusted, 1988–1994^e 19.3 33.8 1.8 24.3 34.9 1.4 1.3 1.0 Osteoporosis (%), females ≥50 y, 1988–1991^g 21.0 10.0 0.5 … … … … … Low-birthweight infants (% of live births), 1998^e 6.5 13.1 2.0 … … … … … Cancer incidence (new cases/100 000 population), all ages, age adjusted, 1996^e Lung and bronchus 43.7 47.2 1.1 68.4 101.4 1.5 1.6 2.1 Breast 113.3 100.3 0.9 … … … … … Colon and rectum 35.5 41.8 1.2 50.7 50.9 1.0 1.4 1.2 Open in a separate window ^aLife expectancy from birth or 65 y is difference in years for males minus years for females. ^bIndicators other than life expectancy are ratios (males divided by females). ^cLife expectancy from birth or 65 y is difference in years for Blacks minus years for Whites. ^dIndicators other than life expectancy are ratios (Black divided by White). ^eData are from the National Center for Health Statistics.¹ ^fData are from Hoyert et al.³ ^gData are from the Third Nutrition Monitoring Report.² At issue, then, is how to increase awareness of the special health concerns of minority women within the women's health movement and to ensure that the concerns of minority women are incorporated as integral components of the larger women's health agenda. Although some authorities now argue that the minority health perspective must be included in any discussion of the health of women in the United States, 4 ^- 6 the dilemmas that minority women confront in embracing “women's” health may not be generally recognized. 7 ^, 8 In this commentary, we describe these dilemmas. Our objective is to help advocates for both minority health and women's health to serve their constituents.