Individuals With A Heritage Of Two Or More Races: Almost One Million Have A Severe Disability

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AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY

BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON) AND MATTHEW COOKE, DDS, MD, MPH

The blurring of the traditional rigid definitions of race and ethnicity add to the complexities of providing for those individuals with disabilities who may not meet traditional standards for rigid singular attitudes of race or ethnicity.

One of the grandfathers of our colleague was white, his wife was Asian (Chinese). Their Euro-Asian daughter is our colleague’s mother. Our colleague’s father is African American. At the last census, he was asked to check off his race. Question – which box does he check off?

An estimated 8,721,800 U.S. noninstitutionized civilian residents reported for the 2010 Census that they should be listed as a member of the “two or more races category.” Other available categories in the 2010 Census included: two races, three races, four or more races, white, white alone, black alone, Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, other races and Hispanic.1

WHAT DOES MEMBERSHIP IN A PARTICULAR RACE MEAN?

Despite genetic and social science evidence to the contrary, the perception that race as biological factors are strong and pervasive in both public and academic circles. “The scientific consensus is that race is not biological…Rather, race is a social construct. This means that race is “a folk idea, a culturally invented conception about human differences.” 2,3 Members of different racial groups are thought to be inherently different from one another in crucial ways. Historically, group membership has been determined by such physical characteristics as skin color, hair texture, and facial features.

“…no serious scientist thinks these [racial] categories…have any biological grounding that could justify any claim to the status of natural kind.”4

We have been using these markers to divide ourselves into groups for so long that it seems natural to do so.  However, the physical markers that have come to obviously mark one race off from another were not always so self-evident. Rather, human beings collectively have decided, and continue to decide, which groups to divide ourselves into for so long that it seems natural to do so. Color has not always been the main marker of difference. For example, “Blackness was not universally disparaged and did not automatically mark inferiority. However, the idea of
race developed into a world view when proponents of European expansionism and New World slavery needed such an idea to maintain hierarchical relationships and power in these new social systems.” 3,5

WHAT IS ETHNICITY?

There are a few major differences between ethnicity and race, particularly as these ideas play out in the United States. The idea of race depends on ideas of biological difference. “Ethnicity refers to clusters of people who have common cultural traits that they distinguish from those of other people. People who share a common language, geographic locale or place of origin, religion, sense of history, traditions, values, beliefs, food habits, and are perceived, and view themselves as constituting an ethnic group.” 2

BUT COLLECTING DATA BY RACE/ETHNICITY IS IMPORTANT

Measurement and outcomes have become increasingly significant for demonstrating the effectiveness of health care. Evidence from past decades shows that racial, ethnic, and language-based disparities remain present in health care. The Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, issued in 2002, is one of several prominent studies documenting this problem. Similar evidence suggests that disparities also exist according to gender and disability status.6 Since passage of the 1964 Civil Rights Act, hospitals and health care organizations have been allowed to collect information on patients’ race, ethnicity, and spoken  language to improve health care quality. In addition, many health care agencies are mandated to collect this information. Today there are state and national efforts to standardize and integrate collection of race, ethnicity and language data into models of patient-centered care (including the Affordable Care Act).6

CONCERNS

The debates regarding privacy, data collection and racial profiling become a factor in the adversarial relationships between the police and communities of color. Already existing tensions between police and communities of color became heightened over the past two decades as allegations of racial profiling by law enforcement agents against people of color increased in number and frequency.7

A HERITAGE OF TWO OR MORE RACES

In 2011, it was estimated that 97% of the U.S. population were of a single race heritage; including 24% of children less than eighteen years of age. By contrast, almost half of the population (47% or 4.1 million youngsters) of two or more races heritage was less than eighteen years of age. (See a forthcoming general overview of population diversity in EP Magazine.8)

General demographics
Among the foreign born populations, 38% of the two or more races heritage, compared to 29% of the general population, was born in Asia. 52% of both the foreign born two and more races heritage and the foreign born general population was born in Latin America.
• 61% of the population 25 years and older with a two or more races heritage, compared 57% of the general population, attained an education beyond high school.
• 18% of families with a two or more races heritage, compared to 12% of families in the general, have incomes below the poverty level.
• 59% of individuals with a two or more races heritage, compared to 65% of individuals in the general population have private health insurance.1
Disabilities
• 10.9% (931,000 individuals of two or more races heritage) had one or more severe disabilities.
• 4.9% of youngsters of two or more races heritage (compared to 4.0% all U.S. children) had one or more severe disabilities.
• Compared to all reported Census Bureau population heritage categories, (except for children of American Indian/Alaska Native heritage) children of two or more races heritage and black alone heritage had the highest proportion of youngsters with one or more severe disabilities. (see Table 1)
• Among non-institutionized individuals 18-64 years of age, 13.5% with a heritage of two or more races, compared to the 10.2% of the U.S. population had one or more disabilities.
• Among non-institutionized individuals 65+ years of age, 45.3% with a heritage of two or more races, compared to the 36.6% of the U.S. population had one or more disabilities.1

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While the Census Bureau does not provide data on the number and proportion of youngsters with different disabilities for the various heritage categories, it does issue data for the overall population of children with disabilities.
• 166,500 children (0.8%) less than 5 years of age have severe hearing and/or vision disabilities.
• 2,780,200 children (5.2%) 5-17 years of age have one or more severe disabilities, including more than 2 million children with cognitive difficulties. (see Table 2)

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COMMENTS

There is evidence that an accounting by genetic ancestry would produce a higher number with multiracial ancenstries, but people live according to social and cultural identities, not DNA. Prior to the mid-20th century, many people hid their multiracial heritage because of racial discrimination against minorities. While many Americans may be technically multiracial, they often do not know it or do not identify so culturally, any more than they maintain all the differing traditions of a variety of national ancestries.9 About 15% of all new marriages in the United States in 2010 were between spouses of a different race or ethnicity from one another, more than double the share in 1980 (6.7%).
• Among all newlyweds in 2010, 9% of whites, 17% of blacks, 26% of Hispanics and 28% of Asians married out of their race/ethnicity.
• About 24% of all black male newlyweds in 2010 married outside their race, compared with just 9% of black female newlyweds. Among Asians, the gender pattern runs the other way. About 36% of Asian female newlyweds married outside their race in 2010, compared with just 17% of Asian male newlyweds. Intermarriage rates among white and Hispanic newlyweds do not vary by gender. 10
• Intermarriage varies in different sections of the country. About one-in-five (22%) of all newlyweds in Western states married someone of a different race or ethnicity between 2008 and 2010, compared with 14% in the South, 13% in the Northeast and 11% in the Midwest. At the state level, more than four-in-ten (42%) newlyweds in Hawaii between 2008 and 2010 were intermarried; the other states with an intermarriage rate of 20% or more are all west of the Mississippi River.10
• “More than one-third of Americans (35%) say that a member of their immediate family or a close relative is currently married to someone of a different race.”10
• Overall divorce rates are higher for couples who married someone of a different race/ethnicity than for those who married to someone of their race/ethnicity – but patterns vary by the racial and gender characteristics of the couples.10

The blurring of the traditional rigid definitions of race and ethnicity (if they ever were meaningful and reflected realities) add to the complexities of providing for those individuals with disabilities who may not meet traditional standards for rigid singular attitudes of race or ethnicity. Nevertheless, these individuals constitute components of the fabric of our evolving communities. The need is to document the particular conditions faced by individuals with disabilities with multiple heritages if we are to appreciate their particular circumstances and provide for their requirements.•

ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail: h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Matthew Cooke, DDS, MD, MPH is Associate Professor, Departments of Anesthesiology & Pediatric Dentistry University of Pittsburgh School of Dental Medicine Pittsburgh PA; Assistant Clinical Professor, Departments of Oral & Maxillofacial Surgery and Pediatric Dentistry Virginia Commonwealth University School of Dentistry, Richmond, VA.

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AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY

The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and  intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.


References
1. Census Bureau. 2011 American Community Survey 1-year estimates. Web site: http://factfinder2.census.gov Accessed September 16, 2013.
2. Smedley A, Smedley B. Race in North America. New York: Westview Press, 2011.
3. Cunningham B. Health Policy Institute Joint Center for Political and Economic Studies. Race and ethnicity data collection: beyond standardization. Web site: http://www.jointcenter.org/sites/default/files/upload/research/files/Race%20and%20Ethnicity%20Data%20Collection.pdf Accessed September 17, 2013.
4. Dupre J. What genes are and why there are no genes for race. In Koenig BA, Soo-Jin Lee S, Richardson S. (Eds.). Revisiting Race in a Genomic Age. New Brunswick, NJ: Rutgers University Press, 2008.
5. Smedley A. “Race” and the construction of human identity. American Anthropologist, 1998;100(3):690-702.
6. HRET disparities toolkit. Web site: http://www.hretdisparities.org/WhyC-4154.php Accessed September 16, 2013.
7. Data Collection Resource Center. Background and current data collection efforts: History of Racial Profiling Analysis. Web site: http://www.racialprofilinganalysis.neu.edu/background/history.php Accessed September 17, 2013.
8. Waldman HB, Perlman SP. “Others” Exceptional Parent Magazine, in press.
9. Gates Jr. HL, Faces of America: How 12 Extraordinary Americans Reclaimed Their Pasts. New York: New York University Press, 2010.
10. Wang W. Pew Research Social and Demographic Trends. The rise of intermarriage rates, characteristics vary by race and gender. Web site: http://www.pewsocialtrends.org/2012/02/16/therise-of-intermarriage Accessed September 19, 2013.