Drawing the Line

How the debate over terminology effects global health research and policy.
The recent custody battle between actress Halle Berry and her ex-husband provides a neat example of the blurred definition of race and ethnicity in the United States. In an attempt to justify the classification of her daughter as “black,” Berry invoked the “one-drop rule” – a racial concept connoting years of controversy and racial tension – in an interview: “I feel like she’s black. I’m black and I’m her mother, and I believe in the one-drop theory.”
Halle Berry’s experience with race parallels that of the health research academia. A surge in research on domestic health disparities among minority citizens in the U.S. has teetered on the same blurred concept of race since its conception. When reviewing the growing literature on health disparities one can’t help but ask: What is race?
Although most health disparity studies are designed to allow participants to self-identify their racial or ethnic background, the uncertain distinction between race and ethnicity can leave conclusions drawn from such data in doubt. The use of skin-tones such as “white” or “black” as population categories (that are intermittently exchanged for race/ethnic distinctions) adds another level of obscurity to the discussion. And, as indicated by Harvard Professor Dr. Nicholas Christakis, the meaning of race and ethnicity in such studies has long been a contested point among academicians. The ongoing discussion on this topic, therefore, underlies the effect of such socially constructed categories on the way researchers choose to dissect or approach problems of public health.
A similar conundrum exists in the sphere of global health.The categorization of countries as either developed or developing has had a dramatic effect on the kinds of  health interventions proposed and undertaken. However, the definitions of these categories are anything but cemented. Far more significant, the categories of developed or developing often determine the assumptions made when modeling or implementing such interventions.
An inherent risk in the application of such categories is the tendency to generalize. A study designed to find differences in cardiovascular disease risk between “black” and “white” 40-year old men in Atlanta, Georgia should not be used to extrapolate differences in these trends among geographically distinct groups supposedly belonging to the same race. Similarly, an intervention designed for one developing country does not always translate into an effective intervention for another country of the same development category.
The struggle over defining socioeconomic categories is a struggle that has preeminent consequences for global health research. Therefore, great care must be taken when conclusions are drawn from data segmented by such fluid classifications.
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