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Cultural Diversity

CULTURAL DIVERSITY

Cultural diversity, as it relates to aging, connotes variety among the older adult population in racial, gender, social, economic, religious, health, and other characteristics. The present discussion focuses primarily on the demographic characteristics of race, ethnicity, and national origin as they relate to selected aspects of the aging process. The U.S. Bureau of the Census recognizes four distinct race/ethnicity groupswhites, African Americans, Native Americans (including Eskimos and Aleuts), and Asian/Pacific Islandersas well as one national origin group, Hispanics (whose members can be of any race). Unless otherwise noted, population statistics cited below come from Census Bureau sources.

Like the United States, other nations of the world have expanding older populations that are growing culturally more diverse. These trends challenge governments to provide all qualifying individuals with an income stream that is continuous and adequate, sustains purchasing power, and maintains the socioeconomic position of older, retired persons. This is certainly true for the more industrialized countries of the world, yet the greatest increases in the elderly population are occurring in less developed countries many of which are less prepared and less able to address the needs of multiple racial and ethnic groups within their borders.

Within the United States, in 1980 non-Hispanic whites comprised 88 percent of all persons age sixty-five and older. By 2000, this percentage had dropped to 83.5 percent, and by 2050 it is expected that no more than 64.2 percent of the older adult population within the United States will be non-Hispanic whites.

These figures point to the increasing proportion of older adults who will come from minority populations. The largest gain is projected to occur among Hispanics. Currently estimated to number 1.9 million persons, by 2050 Hispanic older adults are expected to exceed 13 million. Minorities will constitute a larger proportion of the older population in the future because minorities have had higher fertility than whites and because a disproportionate number of immigrants have been members of minority populations.

Lifelong processes

The United States is peopled by groups that arrived in search of economic opportunity or political refuge, as well as by populations who were conquered, enslaved, or subordinated. To understand the social position and characteristics of today's minority elders, one must appreciate the lifelong processes and historical experiences that have brought them to their current stage of life. A life course perspective highlights the ways in which earlier life circumstances significantly channel people's later opportunities, outcomes, and quality of life decades later. For instance, the persistent racism, economic inequality, and residential segregation experienced by many African Americans early in life have had harmful effects on later development and life chances. These effects accumulate over the life span and can widen disadvantages in health, survival, and economic well-being (Jackson et al., 1993).

Today's elders have been shaped by their membership in birth cohorts that have lived through particular historical periods. Contemporary minority elders, born in the United States prior to 1940, have experienced a very different social context than those who will be elders in the future, born after the mid-1950s. For one thing, these later cohorts have had the benefit of more education than earlier cohorts, who often came from poor, rural backgrounds. Later, younger cohorts not only have had more years of formal education, but also have had a better quality of education by receiving part, if not most, of their education in desegregated schools. Later cohorts have had the historical benefits of better health care, and more economic and employment opportunities in the wake of the civil rights movement.

Lifelong processes produce racial differences in survival to older ages. Members of minority groups who live to be old are more highly "selected" than their white peers. For example, for every 100,000 black and white men born alive, 17,000 more white men than black men will reach age sixty-five. Similar differences are found for women, though not as dramatic 10,100 fewer black women will reach age sixty-five (Williams and Wilson, 2001). Exposure to risk factors and stress hastens the early onset of chronic disease and premature death, which lower the probability that African Americans will live to be old.

Observers have speculated that inequalities over the life course are further compounded when adults reach later life. A "double jeopardy" hypothesis posits that minority elders face the dual burden of racial and age discrimination The result is that these elders are doubly disadvantaged in their health and economic well-being, and this accentuates the disparities between minorities and whites. One can even conceive of multiple jeopardy, such as being a women and old and a minority. An alternative hypothesis is that age acts as a "leveler," narrowing differences between majority and minority elders. Minorities may become relatively less disadvantaged as they age because, having dealt with racial discrimination over their entire lives, they are prepared to cope with age discrimination; because health problems in later life cut across racial lines; and because welfare state programs such as Social Security and Medicare have given minority elders greater access to health care and income security. Research has not settled whether either of these two perspectivesdouble jeopardy and age-asleveleris a more accurate depiction than a state of persistent inequality for minority elders (Ferraro and Farmer, 1996; Pampel, 1998).

Mortality patterns of African Americans support a leveling hypothesis. Over most of the life span, age-specific death rates for African Americans are higher than those of their majority group counterparts. But mortality rates increase more slowly with age for African Americans than for whites in later life, and after the late eighties there is a "crossover" so that white majority group members have higher mortality rates than African Americans. However, this apparent crossover pattern is controversial. Some argue that it is a function of selective survival, in which the hardiest African Americans reach late life. Others argue that the observed phenomenon is an artifact of age misreporting for African Americans whose births went unregistered in the South early in the twentieth century (Williams and Wilson, 2001).

Elders from minority groups are likely to have benefited from remarkable extended family support networks (Stoller and Gibson, 2000). Racial and ethnic groups are characterized by family-centered cultures with traditions of mutual aid in the form of practical, emotional, and material exchanges. Closer kin bonds also foster affection across age groups. The patterns of giving and receiving in these social support "convoys" are born of ethnic cultures and rural backgrounds where family remains a strong feature of social organization. The nature of family is also a strategy for meeting economic need, sharing scare resources of time and money. African Americans have tended to have open kin networks that allow both blood relatives and non-kin within the family. Asian and Hispanic groups tend to limit family support to persons with close blood ties (Dilworth-Anderson and Burton, 1999). An often noted feature among Asian peoples is the norm of filial piety or children's duty, a tradition of respect and deference toward parents and grandparents that is rooted in Confucian culture.

Strong familism can aid elders when they need physical assistance, help with household chores, or a place to live. Minority elders have thus been less likely to turn to formal support systems, such as government services or nursing homes. At the same time, familism does not excuse elders from giving when other dependent family members are in need, for example, accepting grandchildren into their households. Elders also assume an obligation to be the conservators of cultural heritage for younger kin. As economic forces and acculturation threaten to dissolve the solidarity of extended family networks, one important question is whether the next generation will continue to maintain family support for tomorrow's elders.

Hispanics

Looking forward to the middle of the twenty-first century, it will become more difficult to characterize any racial or ethnic group with a simple description. Such is the case for Hispanics and Latinos, the nation's largest minority group, numbering one of every eight Americans in 2000. Most Hispanics are of Mexican (58 percent), Puerto Rican (10 percent), or Cuban descent (4 percent); the remainder are from Central and South America. Hispanics made up 5.6 percent of the older adult population in 2000, but are projected to be 16.4 percent of the older adult population by 2050. Sometime before 2030, the Hispanic population age sixty-five and older will likely outnumber African-American elders.

The diversity of the Hispanic population is mainly due to different immigration histories of the various national-origin groups. Some Mexican Americans' residence in the Southwest predates the formation of the United States. Many others migrated to the United States in order to harvest crops, encouraged by the bracero program of the 1940s and 1950s. These native-born and earlier immigrant Mexicans are now the majority of those reaching old age. The future growth of the Hispanic and Latino elderly population (it will triple by 2050 as a share of all minority elders) will be propelled by larger, recent cohorts of immigrants from Mexico.

If Mexican Americans are still a comparatively young group, the population of Cuban Americans is considerably older. Comprising only 4 percent of the Hispanic population overall, they are 17 percent of the population of older Hispanics. Older Cubans now include the cohort of political refugees who fled the Castro regime in the 1960s. Elderly Puerto Ricans add other special circumstances to the mix of Hispanic seniors. They are a substantial population (11 percent of all Hispanic elders) that does not reside primarily in the South or the West, and their U.S. citizenship allows them to move easily back and forth between the island and the mainland United States (Siegel, 1999).

African Americans

According to the 2000 census, African Americans are the second largest minority group, making up 12.3 percent of the resident population of the United States. (The Census Bureau changed its method of reporting racial categories for the 2000 census. Figures presented here count those who reported only one race. Individuals had the option of choosing more than one racial category. Adding those who chose African American in combination with some other category, the total African-American population was 12.9 percent.) African Americans in 2000 made up 8.4 percent of all persons age sixty-five and older, and are projected by 2050 to be 13.2 percent of older adults.

Studies of African-American older adults are now forsaking habitual black/white comparisons in favor of studies that explore the variety and depth of experience among people of African descent. All too often, researchers have taken a simplistic view of older African Americans and failed to note the considerable heterogeneity that exists among this population. A comparative disadvantage to whites is one legacy of generations of social, economic, political, and legal discrimination, but there are also traditions of cultural strength and resilience in kinship networks and black churches. At present, it is clear that African-American older adults tend to have higher morbidity and mortality rates than those of non-Hispanic whites. For many this is an outcome of lifelong poverty, poor educational resources, underemployment or unemployment, and inadequate access to health care. The cumulative effect is that many have reached older age with poor health and inadequate resources.

Yet, there is also considerable and growing variation among African-American older adults. Improvements in health care access since the 1960s and the emergence of a viable African-American middle class have produced a diversity among African Americans that parallels the variety observed in other population groups within the United States. Older African Americans display a wide range of social, economic, and cultural patterns.

Native Americans, Aleuts, and Eskimos

Native Americans make up just less than 1 percent of the total population and only about 0.50 percent of older adults within the United States. Small population size and a shifting self-identification of race have made it difficult to obtain stable demographic estimates for these peoples. The Native American population is distributed among several hundred federally recognized tribes and entities (including American Indians, Eskimos, and Aleuts). Many of these subgroups have different cultures, histories, and degrees of self-identification, and a wide range of economic and social characteristics. Two-thirds of Native American older adults reside in ten states, and there is a further divide along rural-urban lines. Considerable American Indian migration to cities during and following World War II has left roughly half of these people dispersed among the U.S. urban population. Elders in cities forgo the support of tribal communities that is available to their rural and reservation counterparts who live in cultural enclaves (John, 1999).

Asian and Pacific Islanders

The Asian/Pacific Islander (API) grouping was 3.7 percent of the total population in 2000 and 2.4 percent of the older adults in the United States. This population includes Chinese, Filipino, Japanese, Vietnamese, Asian Indian, and Korean Americans; as well as native Hawaiians and other Pacific Islanders. The API population has considerable linguistic and cultural variation in addition to different histories of immigration. The comparative recency of immigration strongly influences the composition of groups of Asian elders. Chinese and Japanese people have a longer history of migration to the United States. Today's elders from these ethnic groups (they make up over half of all API elders) are more likely to be the native-born children of earlier immigrants or were young immigrants themselves. They have had a lifetime of acculturation and participation in the American economy. In 1965 changes in federal law governing national origin quotas allowed new Asian migration streams of Korean, Asian Indian, and Vietnamese people, often in a family context that brought older relatives to the United States. These immigrants are now taking their place in the older population (Siegel, 1999).

Poverty

There is considerable variation in socioeconomic status among the different racial/ethnic and national origin groups. One way to measure this is to examine the proportion of elders who fall below federal poverty thresholds. Although poverty rates have fallen for all groups since 1980, comparison of historical poverty rates for adults age sixty-five and older by race reveals that non-Hispanic white older adults have consistently had the smallest proportion of older adults in poverty, with Asian/Pacific Islanders having a slightly larger proportion who are poor. African Americans and Hispanics consistently have proportions that are much larger. In fact, Hispanics tend to have poverty rates twice as large as non-Hispanic whites, and poverty rates for African Americans have historically been triple those for non-Hispanic whites.

Several characteristics of older minority populations partially explain why they have higher poverty rates. In general, married people are less likely than unmarried people to be poor, and high school graduates are less likely than those who did not complete high school to be poor. Older minorities are less likely than older whites to be married and to be high school graduates. When examining the educational patterns of older adults, one finds that 28 percent of whites and 35 percent of Asian/Pacific Islanders have less than a high school education. Among older African Americans, 56 percent have failed to complete high school; among Hispanic older adults, 71 percent have not completed high school (Federal Interagency Forum on Aging Related Statistics, 2000). These disparities in educational attainment stem from minority elders' origins in social backgrounds with fewer educational opportunities, whether in the rural South or the underdeveloped nations from which they migrated. Following a life course perspective, lower education has adverse effects on the prospect for better jobs and pay, promotions, and wealth building.

Health

As noted earlier, minority older adults who survive to age sixty-five and beyond tend to be in poorer health than age peers who are white (though it is important to note that some ethnic subgroups have a higher life expectancy than the undifferentiated category of whites). Minority older adults are also more likely to suffer from multiple illnesses that further complicate treatment regimens (Markides and Miranda, 1997). Yet there are some commonalities across racial and national origin groups for adults age sixty-five and older. For instance, for both men and women across all groups, heart disease and cancer are the two leading causes of death. Strokes and chronic obstructive pulmonary disease (COPD), also known as lung disease, tend to be either the third or fourth leading cause of death, with the exception of Native Americans and Hispanics, both of whom have diabetes mellitus as the fourth leading cause of death. Alzheimer's disease is the eighth leading cause of death among white men, and the sixth leading cause among white women, age sixty-five and older. Alzheimer's disease is also the tenth leading cause of death among African-American women, the ninth leading cause of death for Native American women, and the seventh leading cause death among Hispanic women.

Older adults on the lower rungs of the socioeconomic ladder often lack adequate private insurance to supplement Medicare, and do not have resources to meet out-of-pocket costs. This especially affects African-American and Hispanic older adults, who experience high rates of poverty. Without adequate resources to pay for medical care, they tend to receive inferior services. They must depend on Medicaid and hospital emergency rooms, rather than a regular physician, for care.

Virgil H. Adams III David J. Ekerdt

See also Genetics: Ethnicity; Immigrants; Life Course; Poverty.

BIBLIOGRAPHY

Dilworth-Anderson, P., and Burton, L. "Critical Issues in Understanding Family Support and Older Minorities." In Full-Color Aging: Facts, Goals, and Recommendations for America's Diverse Elders. Edited by T. P. Miles. Washington, D.C.: Gerontological Society of America, 1999. Pages 93106.

Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key Indicators of Well-Being. Washington, D.C.: U.S. Government Printing Office, 2000.

Ferraro, K. F., and Farmer, M. M. "Double Jeopardy: Aging as Leveler, or Persistent Health Inequality? A Longitudinal Analysis of White and Black Americans." Journal of Gerontology: Social Sciences 51B (1996): S319S328.

Jackson, J. S.; Chatters, L. M.; and Taylor, R. J., eds. Aging in Black America. Newbury Park, Calif.: Sage, 1993.

John, R. "Aging among American Indians: Income Security, Health, and Social Support Networks." In Full-Color Aging: Facts, Goals, and Recommendations for America's Diverse Elders. Edited by T. P. Miles. Washington, D.C.: Gerontological Society of America, 1999. Pages 6592.

Markides, K., and Miranda, M. R. Minorities, Aging, and Health. Thousand Oaks, Calif.: Sage, 1997.

Pampel, F. C. Aging, Social Inequality, and Public Policy. Thousand Oaks, Calif.: Pine Forge Press, 1998.

Siegel, J. S. "Demographic Introduction to Racial/Hispanic Elderly Populations." In Full-Color Aging: Facts, Goals, and Recommendations for America's Diverse Elders. Edited by T. P. Miles. Washington, D.C.: Gerontological Society of America, 1999. Pages 119.

Stoller, E. P., and Gibson, R. C. Worlds of Difference: Inequality in the Aging Experience, 3d ed. Thousand Oaks, Calif.: Pine Forge Press, 2000.

Williams, D. R., and Wilson, C. M. "Race, Ethnicity, and Aging." In Handbook of Aging and the Social Sciences, 5th ed. Edited by R. H. Binstock and L. K. George. San Diego: Academic Press, 2001. Pages 160178.

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