INTRODUCTION

One of the most important challenges facing contemporary Western societies concerns increasing ethnocultural diversity. Three interrelated, big, slow-moving trends are dramatically transforming Western societies: (1) the increasing ethnic and racial heterogeneity of the population; (2) the increasing politicization of ethnocultural identities, and the rise of “identity politics” or “recognition politics”; and (3) partly in response to the first two trends, the increasing adoption of “multiculturalism” policies to accommodate politicized ethnocultural groups. In short, there are diversity-related changes in demographic composition, in political mobilization, and in public policies.

The implications of these trends for population health are potentially enormous. Studies often reveal significant inequalities in health outcomes across ethnic and racial groups, and even though the precise causal explanations remain debated, there is growing evidence for the importance of social factors, alongside more traditional genetic or economic explanations. Only a small fraction of these variations are explained by differences in gene frequency across groups, such as the greater genetic disposition of Ashkenazi Jews toward Tay-Sachs disease or of Caucasian people with light skin pigmentation toward melanoma. These disease-specific genetic idiosyncrasies – which are as likely to affect dominant groups as subordinate ones – do not explain the tendency of ethnic and racial minorities to have worse health across a broad range of illnesses.