Thought Questions
These questions are intended to interactively expand our thinking, broaden our views, and to prompt us to ask more questions.

1. In an article on “indoctrinologists,” (1) scientific journalist Sally Satel quotes Clinton as having said, “Nowhere are the divisions of race and ethnicity more sharply drawn than in the health of our people.”
Based on your readings, studies, and personal experience, is this a valid statement? Why or why not? What does the statement imply about the entities of race, ethnicity, and the American society?
If Clinton’s statement is indeed true, what might the reasons behind the division be? What are the implications of such a division for both social relations and the future development of public health care (e.g., treatment of diseases)? What are possible solutions for overcoming this division?

2. Satel suggests that the healthcare profession should limit its concentration to the prevention of physical, rather than social, distress.
According to other authors you have read, how are physical and social stresses related? What do you consider the relationship between physical and social stress to be? Substantiate your answer. Is it possible to separate physical and social stress?
How might you devise an experiment to further investigate the relationship between social, physical, and emotional stresses and its implications on social relations and health care?

3. Is it possible to “rank” or place more/less emphasis on the impact of different human experiences (such as discrimination) on different people? Is it possible to quantify the effects of human experience on emotional status or health? How can you quantify or evaluate subjective “self-reported” impact? Who is qualified to define what experience is more detrimental than another? How much weight can you place upon studies that attempt to quantify these experiences, and why? How might you make these experiments better?

4. Kiel, et al, (“Skin Color and Mortality” in The American Journal of Epidemiology) (2) assert that “from a public health perspective, it would be more appropriate to focus attention on the rather substantial and modifiable effect of socioeconomic status on disease and mortality [than on a genetic/skin color relationship].”
How does this proposed focus this relate to the arguments of Satel and of Krieger and Sidney [authors of “Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults” (3)]? How might the socioeconomic status of the population be “substantially modified” and how might this affect diseased and mortality? Where does the responsibility for personal health sit: with the community, the government, the individual? What actions might we as individuals take to improving the socioeconomic status of the underprivileged, and should we even undertake these endeavors? Why or why not?

5. How much certainty is needed to positively assert the existence of a relationship between two elements (such as blood pressure and skin color; cholesterol level and skin color)? Is it enough to explain a cause/effect relationship as “at least to a certain extent” (4)? What is the difference between causation and correlation? How do these concepts relate to the research you have studied? How much statistical significance is necessary to validate the racial/disease relationships you have encountered? Are modern statistical methods sufficient to evaluate these relationships? What might other options be?

6. How might (unconscious or conscious) biases of both examiners and examinees affect the outcome of the results (e.g., in studies relating hypertension to skin color)? What might these biases be and from where might they arise? How significant of an influence does the expected result have on the interpretation of the data? Cite possible examples from studies that you have encountered.
In addition to personal biases, how might testing conditions influence the outcome of a study? (For example, a test for blood pressure or for “self-reported” data such as incidences of discrimination or unfair treatment.) What elements (e.g., word choice) of a self-administered questionnaire might unintentionally influence the answers of the examinees? Have Satel, Krieger and Sidney, and other researchers you have studied taken these elements into full consideration when evaluating the validity of their work? What would the implications of faulty evaluation be, for example, after the media publishes the reports?

References Suggested Readings
(1) Satel, Sally. “The Indoctrinologists are Coming.” The Atlantic Monthly. January 2001. Vol. 287, No. 1. <http://www.theatlantic.com/issues/2001/01/index/htm> (15 February 2001).
(2) Keil, J. E.; et al. “Skin Color and Mortality.” American Journal of Epidemiology. December 1992. Vol 136 (11), pp. 1295-1302.
(3) Krieger, Nancy; Sidney, Stephen. “Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults.” The American Journal of Public Health. October 1996. Vol 86(10), pp. 1370-1378.
(4) Després, Jean-Pierre; et al. “Race, Visceral Adipose Tissue, Plasma Lipids, and Lipoprotein Lipase Activity in Men and Women: The Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study.” Ateriosclerosis, Thrombosis, and Vascular Biology. August 2000. pp. 1932-1935.

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