Promoting ethnic parity in health, leaving behind “race”: a challenge for the global community in 2020

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Research snapshot¹

Promoting parity is central to both medicine and public health, whether we refer to sex, age or population group. Beyond age and sex, it has long been recognised that nutritional status often differs on average between what are usually referred to as “racial” or “ethnic” groups. This article proposes that evaluating health and nutritional status relative to children of similar “race/ethnicity” increases the accuracy of the assessment, moving away from the idea that there is a single nutritional norm represented by any one population. In acknowledging such population differences, the language used to describe them profoundly affects how they are conceptualised. This is not simply a semantic issue but also influences how clinical and public health practices affect health outcomes.

The editors of the American Journal of Clinical Nutrition recognise the complexity of this issue and their current instructions aim to help authors to describe which aspect is under consideration: “use ‘race’ to describe racial categories based on physical appearance, ‘ethnicity’ to describe traditions, lifestyle, language, diet and values and ‘ancestry’ to describe ancestry informative markers based on genetic or genomic data.” As soon as we try to apply these instructions, however, multiple problems manifest. If “race” refers to physical appearance, what characteristics should we look at and who is given the role of looking? When it comes to traditions, lifestyle and diet, are these selected by preference or are they imposed by socioeconomic constraints? At the level of genes, there are no discrete, objective racial groups.

Ethnicity is a very different concept from race and offers a much richer framework through which to explore and understand population variability. Ethnicity varies between countries due to historical circumstances, for example those who identify as “black” in the United Kingdom may differ in several ways from their African American counterparts in the United States. No such references adequately capture the full range of ethnic variability in contemporary societies and therefore any clinical benefits may be unequally distributed. Ethnic-specific reference data are to be welcomed but, if they are genuinely to promote parity in health, they must be used prudently.

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