BRIAN LOUIS LIPSHY AND FERNANDO M. TORRES-GIL
UNDERSTANDING DIVERSITY IN AGING AND ETHNIC1TY
Book Review Essay 1989 Mid-Life and Older Women in Latin America and the Caribbean Washington, D.C.: American Association of Retired Persons and Pan American Health Organization, X + 424 pp. $20.00. Zev Harel, E.A. McKinney and M. Williams, eds. 1990 Black Aged: Understanding Diversity and Service Needs. Newbury Park, CA: Sage Publications, 264 pp. $36.00 (hardback), $17.95 (paperback). Kyriakos S. Markides, ed. 1989 Aging and Health: Perspectives on Gender, Race, Ethnicity and Class. Newbury Park, CA: Sage Publications, 255 pp. $35.00 (hardback), $16.95 (paperback). Health, health status and health care are common topics of debate and study in this country today. How to deliver health services to a multi-ethnic community has not been explored as much, yet it is a growing problem. "Minority gerontology," a growing sub-field in gerontology, attempts to examine issues pertinent to older persons in ethnically, racially and linguistically diverse populations. As such, this sub-field has grown considerably in this country and abroad. The three works presented in this article are examples of in-depth investigations on issues of health, health status and health care, as well as the delivery of health services. Aging and Health: Perspectives on Gender, Race, Ethnicity and Class, an edited work, provides an excellent basis from which critical study of the roles of age, gender, class, race/ethnicity and health, including health status and health care, evolve. Black Aged: Understanding Diversity and Service Needs, another edited work, provides an in-depth case study of how one ethnic group has fared in the social services arena and provides an understanding of how a targeted service delivery system can miss minorities if that system does not understand the norms of the culture. Mid-Life and Older Women in Latin America and the Caribbean is a series of articles that provides regional perspectives on the health and psychosocial status of women and provides a review of formal and informal social systems, including the social status of women in specific countries. This essay is divided into two parts. Part I reviews the three noted works and concentrates primarily on the individual works. Part II is a discussion of the works and the broader arenas in which these works are situated.
Journal of Cross-Cultural Gerontology 7: 97-103, 1992. © ! 992 Kluwer Academic Publishers. Printed in the Netherlands.
98
BRIANLOUISLIPSHYAND FERNANDOM. TORRES-GIL PART I
Aging and Health: Perspectives on Gender, Race, Ethnicity and Class Aging and Health provides fundamental information on the interrelationships of health, aging, gender, class and, to a limited extent, ethnicity. The purpose of this book is not to provide answers. Rather, it is to organize and present available data that will "facilitate and stimulate research on aging and health that goes beyond the collection and analysis of relatively simple data based on selfreports (p. 8)." The conceptual overview, written by the editor, Kyriakos S. Markides, is perhaps the best chapter of the book. He summarizes the critical information and evidence brought forth by the other authors and provides a coherent overview of the factors affecting aging and health. He states that traditional risk factors in health are not as predictable in old age and that concentrations of health problems and demands on health care resources are increasing. Furthermore, sex, like age, is fundamentally a biological variable; yet it is also a social variable that needs to be better understood and investigated in terms of its relationship with health. In addition, significant class associations with diseases or illnesses are too numerous to mention; yet little attention has been given to class and socioeconomic status. Finally, Markides acknowledges that race/ethnicity must be understood independently of the effects of social class. This book succeeds in providing the fundamental information upon which we can better understand the interrelationship of health and aging. The need for understanding the effects of race/ethnicity is clearly identified, as are the health differences between ethnic groups. However, there is more to understanding the effects of ethnicity than looking at racial mortality, morbidity and "crossover" tables, which are used extensively in the book. Comparisons of ethnic groups do little to promote the study of ethnic groups. What is lacking in discussing race/ethnicity is an analysis of race/ethnicity independent of the effects of social class. The selection of three ethnicities and the in-depth descriptions of those ethnicities fall short of truly understanding race/ethnicity. The discussions of these groups do not separate the effects of social class from the effects of race/ethnicity nor do they attempt to do so. Nonetheless, the book does provide the most up-to-date overview of information available on aging, health, gender and class in a well-organized manuscript that will facilitate and stimulate further research on aging and health. This book is highly recommended for both researchers as a reference tool and instructors who wish to provide a firm foundation in aging and health to their students.
Black Aged: Understanding Diversity and Service Needs Black Aged is based on a conference at Cleveland State University. The book's chapters were derived from presentations made at that conference. The book is divided into two parts: "Understanding Diversity" and "Social
BOOKREVIEWESSAY
99
Forces and Understanding Service Need and Use." The book is structured in such a manner that it is necessary to understand the underlying information presented in Part I in order to understand the needs and usage pattem and problems described at length in Part II. In the chapter "Diverse Black Aged," E. Percil Stanford provides a basis for understanding the diversity of any ethnic group. "Collectively, Black older persons should be viewed from the perspective of their own history, without having to suffer the indignity of being compared with those older persons who have, for the most part, had entirely different social, political and economic experiences (p. 41)," he writes. In the chapter "Diversity Among Aged Black Males," Cary S. Kart acknowledges the contributions made by minority scholars in promoting double jeopardy as a concept. Yet he shows that this terminology is comparative in nature, and that these comparisons are not appropriate in understanding minority groups. He states, "Recognition of the diversity within the population should lead us away from the comparisons of double jeopardy and toward a sharper focus on minority aging itself. Efforts at teasing out how race interacts with age, cohort and period effects may provide a greater understanding of the minority aging experience (p. 112)." Kart and Stanford both state that comparisons between ethnic groups alone do not explain racial differences. Each culture is unique and must be treated as such. It is disappointing, then, that Part II does not follow the suggestions of these two authors. Part II is filled with comparisons of Blacks' use of federal programs, health care, family and caregiving responsibilities with that of Whites. In his chapter on the use of Title II (Social Security Act), Michael Williams states that, while 93% of all elderly derive some of their income from Title II, the needs of the Black elderly are not being met and that 50% of the Black elderly are still living in poverty. Williams calls for comprehensive changes to Title II, stating that, given the current projections of employment, Title II will continue to be inadequate in reducing the likelihood of poverty for the Black elderly, and our Supplemental Security Income program (SSI) assures elders little more than a "starvation diet." In another chapter, John H. Skinner states that targeting efforts of Older Americans Act have failed and that funding formulas are as responsible for that failure as the implementation procedures. Although specifically written about Black elderly, Skinner's chapter shows the ramifications for all minority groups and seems to expound upon Stanford and Kart's statements about understanding the minority aging experience. Skinner offers an understanding of why targeting minority groups has thus far failed and offers his own solutions to the problem. He argues for targeting efforts that focus primarily on functional status rather than on demographics. He states that no single demographic indicator nor any combination of indicators can adequately represent the needs for which they are intended. Furthermore, using demographic indicators as a basis for targeting is misleading and inappropriate, because targeting formulas utilize aggregate data
100
BRIAN LOUISLIPSHYAND FERNANDOM. TORRES-GIL
in which the net result is an erroneous estimate, and inappropriate emphasis is given to factors that do not truly represent need (p. 176). A model that he originally proposed in 1981 and expanded in 1985 focuses on the functional ability and functional needs of people. Targeting services known to have an impact on need status were matched with persons possessing specific needs patterns. This concept has been tested by Skinner using a secondary analysis of a 1977 study by the General Accounting Office. Although Skinner's analysis is limited because it was performed on a small scale in Cleveland, it has vast policy implications because of its reliance on functional assessments instead of demographic indicators. Two chapters in Part II of this book look at health care utilization and health status, both concluding that Blacks needs more, but have less access to, health care than Whites. A chapter on family caregiving cites a lack of information and referral as a key problem. It points out that the Black family structure is very diverse, and that the informal support network has been the central form of support in the culture. In their chapter, "Clinical Social Work Practice," Gerace and Noelker state that "practitioners need to understand Black culture so that misdiagnosis of client problems and inappropriate treatment do not result (p. 238)." This reinforces the first part of the book and brings into practice the suggestions of Stanford and Kart. It is only through an understanding of the diversity of the Black culture and its functional needs that the effective targeting discussed by Skinner can be achieved. This understanding would help in restructuring other governmental benefits, including access to health care, Social Security and SSI, by addressing diverse functional needs rather than political interests. It is this understanding of diversity that the book hopes to accomplish. The book, although limited by its constant comparisons of Black vs. White, contains a wealth of information. The concepts proposed by Stanford, Kart and Skinner are welcome contributions to the field of minority gerontology. It is these new approaches in understanding diversity that makes this book a must for all gerontologists. The situations exposed and solutions proposed in this book can work with other ethnic groups. It may be entitled Black Aged, but it is really about understanding the diversity and service needs of all minority ethnic groups. Mid-Life and Older Women in Latin America and the Caribbean Mid-life and Older Women in Latin America and the Caribbean is a pioneer publication. A joint effort between two large organizations, it is the culmination of a project to promote a better understanding of middle-aged and older women in Latin America and the Caribbean. Both the project and the book are divided into two parts. The first part is a background report that includes review of available statistical data and literature. The second part consists of papers presented at the first "Consulting Group Meeting on Mid-Life and Older
BOOKREVIEWESSAY
101
Women in Latin America and the Caribbean: Current Research and Policy Implications." Lee Sennott-Miller, author of the background report, suggests that women at mid-life and older play such a key role in the region that if their productive resources and caregiving roles were suddenly withdrawn, the effects on the region's economy would be devastating. Sennott-Miller provides an in-depth discussion of the region from a demographic perspective. Descriptions of that region's sub-regions, compared with other sub-regions such as the Andean Area, Southern Cone, Brazil, Central America, Mexico, Latin Caribbean and Caribbean, as well as the diversity of the entire region, is addressed throughout the report. The most intriguing aspect of the report is the justification for the study of older women. High fertility levels are expected to continue, while the infant mortality rate is slowing due to "child survival efforts." The result is a population explosion that will produce the largest increase in the absolute numbers of older persons over the next 50 years. Sennott-Miller cites Guatemala as an example where the number of persons over age 65 is expected to increase by 375%. She further states that it are these types of countries that are least prepared for the special needs of elderly. With elderly women outnumbering elderly men, the social, economic and health problems of the aging population will be largely the problems of women. The urgency to tackle the "population explosion" in Latin America and the Caribbean is the theme throughout the book. The first step is for the countries within the region to acknowledge the demographic realities and diversity of older persons. In her chapter on the aging female population and economic issues, Gloria L.N. Scott states, "In 1984, for the first time, Caribbean Ministers of Health considered the problems of the aged as a group with specific health care needs. Although women face the same health problems as men, they suffer from many additional health risks due to their lower socioeconomic status, their limited access to basic resources, the time and energy demands of a double workday that combines the household maintenance and economic production .... " A positive, albeit limited, beginning has occurred. Equal access to health services as a principle has been adopted by all the countries covered in the report, and most have assigned priority to vulnerable groups, including the elderly and women, although not necessarily elderly women. The major contributions of this book lie not just with acknowledging that aging and the plight of older women are crucial issues. It also points out that these populations face many of the circumstances that affect ethnic minorities in the United States. To that extent, we can learn from each other. While there are similarities in the regions, there is also great diversity. Unless there is a solid understanding of this diversity, problems in service delivery may develop. The Latin American and Caribbean countries have the opportunity to try new and bold measures in service delivery to vulnerable groups. But like the United States, the problems in service delivery may lie more in the highly politicized bureaucracies than anywhere else.
102
BRIAN LOUIS LIPSHY AND FERNANDOM. TORRES-GIL
This book provides a unique opportunity to gain insight and understanding of our own country by looking at another region of the world. The background essay is one of the most comprehensive pieces of literature on the region available and provides the reader with a solid foundation upon which the second part of the book is built. With vast amounts of information on a number of countries and an even greater number of cultures in an easy to read format, this book is a must for those interested in race/ethnicity and aging. PART II If there is one central theme that runs throughout these three publications, it is that we must understand the meaning of diversity. Comparisons between ethnic/racial groups can only identify differences; they cannot explain them. As Stanford notes, each group will have different social, political and economic histories. A diverse older population will need many services from, and will be able to contribute many services to, our future society. To be responsive to these challenges and opportunities, our society and its institutions must become knowledgeable, remain flexible, exercise creativity and be prepared to make some hard choices (Bass et al. 1990). Aging and Health notes that ethnicity must be perceived separately from social class. The same argument is presented by Kart in Black Aged. Ethnicity has become a key word in gerontology. The sub-field of minority gerontology is gaining acceptance in academic and policy circles. All three books reinforce the need to continue that momentum with further studies. Minority gerontology, however, is still in an early stage. The literature is filled with comparisons. The time has come for minority gerontology to mature. Researchers in minority gerontology must go beyond comparisons of homogeneous ethnic groups and sort out the rich diversity within those groups and develop the appropriate theories, paradigms, and causal relationships that explain the effect of diversity on services, policy and research. However, if we do move to that higher level, then we have another dilemma: how to serve increasingly diverse ethnic groups in the United States and abroad. Do we have the dollars and resources to provide ethnics with specific programs, or do we select programs based on needs that all groups share (i.e., health care, housing, income)? Although these books represent an important step forward, they still do not tackle the issue of policies and programs at the national, state and local levels. In Black Aged, Skinner sidesteps politics by focusing on functional needs rather than demographic indicators. Is this realistic, or is it idealistic? Nonetheless, all three books serve a useful purpose by providing a place to begin looking at programs and policies. In the future, we will also be looking to other countries to see what has and hasn't worked. When the American Association of Retired Persons and the Pan American Health Organization joined forces to promote research and understanding of a political minority group - women - it brought minority gerontology to the international scene. Understanding diversity in aging and ethnicity must include rigorous and systematic research as well as understanding the diverse politics and policies at local, state, national, and international levels.
BOOK REVIEW ESSAY
103
REFERENCE CITED Bass, S.A., E.A. Kutza, and F.M. Torres-Gil 1990 Conclusion: Directions for Responsiveness. In Diversity in Aging: Challenges Facing Planners and Policy Makers in the 1990s. S.A. Bass, E.A. Kutza, and F.M. Torres-Gil, eds. Pp. 175-183. Glenview, Illinois: Scott, Foresman and Company.
Ethel Percy Andrus Gerontology Center University of Southern California Los Angeles, CA 90089--0191, U.S-4.
UNDERSTANDING DIVERSITY IN AGING AND ETHNIC1TY
Book Review Essay 1989 Mid-Life and Older Women in Latin America and the Caribbean Washington, D.C.: American Association of Retired Persons and Pan American Health Organization, X + 424 pp. $20.00. Zev Harel, E.A. McKinney and M. Williams, eds. 1990 Black Aged: Understanding Diversity and Service Needs. Newbury Park, CA: Sage Publications, 264 pp. $36.00 (hardback), $17.95 (paperback). Kyriakos S. Markides, ed. 1989 Aging and Health: Perspectives on Gender, Race, Ethnicity and Class. Newbury Park, CA: Sage Publications, 255 pp. $35.00 (hardback), $16.95 (paperback). Health, health status and health care are common topics of debate and study in this country today. How to deliver health services to a multi-ethnic community has not been explored as much, yet it is a growing problem. "Minority gerontology," a growing sub-field in gerontology, attempts to examine issues pertinent to older persons in ethnically, racially and linguistically diverse populations. As such, this sub-field has grown considerably in this country and abroad. The three works presented in this article are examples of in-depth investigations on issues of health, health status and health care, as well as the delivery of health services. Aging and Health: Perspectives on Gender, Race, Ethnicity and Class, an edited work, provides an excellent basis from which critical study of the roles of age, gender, class, race/ethnicity and health, including health status and health care, evolve. Black Aged: Understanding Diversity and Service Needs, another edited work, provides an in-depth case study of how one ethnic group has fared in the social services arena and provides an understanding of how a targeted service delivery system can miss minorities if that system does not understand the norms of the culture. Mid-Life and Older Women in Latin America and the Caribbean is a series of articles that provides regional perspectives on the health and psychosocial status of women and provides a review of formal and informal social systems, including the social status of women in specific countries. This essay is divided into two parts. Part I reviews the three noted works and concentrates primarily on the individual works. Part II is a discussion of the works and the broader arenas in which these works are situated.
Journal of Cross-Cultural Gerontology 7: 97-103, 1992. © ! 992 Kluwer Academic Publishers. Printed in the Netherlands.
98
BRIANLOUISLIPSHYAND FERNANDOM. TORRES-GIL PART I
Aging and Health: Perspectives on Gender, Race, Ethnicity and Class Aging and Health provides fundamental information on the interrelationships of health, aging, gender, class and, to a limited extent, ethnicity. The purpose of this book is not to provide answers. Rather, it is to organize and present available data that will "facilitate and stimulate research on aging and health that goes beyond the collection and analysis of relatively simple data based on selfreports (p. 8)." The conceptual overview, written by the editor, Kyriakos S. Markides, is perhaps the best chapter of the book. He summarizes the critical information and evidence brought forth by the other authors and provides a coherent overview of the factors affecting aging and health. He states that traditional risk factors in health are not as predictable in old age and that concentrations of health problems and demands on health care resources are increasing. Furthermore, sex, like age, is fundamentally a biological variable; yet it is also a social variable that needs to be better understood and investigated in terms of its relationship with health. In addition, significant class associations with diseases or illnesses are too numerous to mention; yet little attention has been given to class and socioeconomic status. Finally, Markides acknowledges that race/ethnicity must be understood independently of the effects of social class. This book succeeds in providing the fundamental information upon which we can better understand the interrelationship of health and aging. The need for understanding the effects of race/ethnicity is clearly identified, as are the health differences between ethnic groups. However, there is more to understanding the effects of ethnicity than looking at racial mortality, morbidity and "crossover" tables, which are used extensively in the book. Comparisons of ethnic groups do little to promote the study of ethnic groups. What is lacking in discussing race/ethnicity is an analysis of race/ethnicity independent of the effects of social class. The selection of three ethnicities and the in-depth descriptions of those ethnicities fall short of truly understanding race/ethnicity. The discussions of these groups do not separate the effects of social class from the effects of race/ethnicity nor do they attempt to do so. Nonetheless, the book does provide the most up-to-date overview of information available on aging, health, gender and class in a well-organized manuscript that will facilitate and stimulate further research on aging and health. This book is highly recommended for both researchers as a reference tool and instructors who wish to provide a firm foundation in aging and health to their students.
Black Aged: Understanding Diversity and Service Needs Black Aged is based on a conference at Cleveland State University. The book's chapters were derived from presentations made at that conference. The book is divided into two parts: "Understanding Diversity" and "Social
BOOKREVIEWESSAY
99
Forces and Understanding Service Need and Use." The book is structured in such a manner that it is necessary to understand the underlying information presented in Part I in order to understand the needs and usage pattem and problems described at length in Part II. In the chapter "Diverse Black Aged," E. Percil Stanford provides a basis for understanding the diversity of any ethnic group. "Collectively, Black older persons should be viewed from the perspective of their own history, without having to suffer the indignity of being compared with those older persons who have, for the most part, had entirely different social, political and economic experiences (p. 41)," he writes. In the chapter "Diversity Among Aged Black Males," Cary S. Kart acknowledges the contributions made by minority scholars in promoting double jeopardy as a concept. Yet he shows that this terminology is comparative in nature, and that these comparisons are not appropriate in understanding minority groups. He states, "Recognition of the diversity within the population should lead us away from the comparisons of double jeopardy and toward a sharper focus on minority aging itself. Efforts at teasing out how race interacts with age, cohort and period effects may provide a greater understanding of the minority aging experience (p. 112)." Kart and Stanford both state that comparisons between ethnic groups alone do not explain racial differences. Each culture is unique and must be treated as such. It is disappointing, then, that Part II does not follow the suggestions of these two authors. Part II is filled with comparisons of Blacks' use of federal programs, health care, family and caregiving responsibilities with that of Whites. In his chapter on the use of Title II (Social Security Act), Michael Williams states that, while 93% of all elderly derive some of their income from Title II, the needs of the Black elderly are not being met and that 50% of the Black elderly are still living in poverty. Williams calls for comprehensive changes to Title II, stating that, given the current projections of employment, Title II will continue to be inadequate in reducing the likelihood of poverty for the Black elderly, and our Supplemental Security Income program (SSI) assures elders little more than a "starvation diet." In another chapter, John H. Skinner states that targeting efforts of Older Americans Act have failed and that funding formulas are as responsible for that failure as the implementation procedures. Although specifically written about Black elderly, Skinner's chapter shows the ramifications for all minority groups and seems to expound upon Stanford and Kart's statements about understanding the minority aging experience. Skinner offers an understanding of why targeting minority groups has thus far failed and offers his own solutions to the problem. He argues for targeting efforts that focus primarily on functional status rather than on demographics. He states that no single demographic indicator nor any combination of indicators can adequately represent the needs for which they are intended. Furthermore, using demographic indicators as a basis for targeting is misleading and inappropriate, because targeting formulas utilize aggregate data
100
BRIAN LOUISLIPSHYAND FERNANDOM. TORRES-GIL
in which the net result is an erroneous estimate, and inappropriate emphasis is given to factors that do not truly represent need (p. 176). A model that he originally proposed in 1981 and expanded in 1985 focuses on the functional ability and functional needs of people. Targeting services known to have an impact on need status were matched with persons possessing specific needs patterns. This concept has been tested by Skinner using a secondary analysis of a 1977 study by the General Accounting Office. Although Skinner's analysis is limited because it was performed on a small scale in Cleveland, it has vast policy implications because of its reliance on functional assessments instead of demographic indicators. Two chapters in Part II of this book look at health care utilization and health status, both concluding that Blacks needs more, but have less access to, health care than Whites. A chapter on family caregiving cites a lack of information and referral as a key problem. It points out that the Black family structure is very diverse, and that the informal support network has been the central form of support in the culture. In their chapter, "Clinical Social Work Practice," Gerace and Noelker state that "practitioners need to understand Black culture so that misdiagnosis of client problems and inappropriate treatment do not result (p. 238)." This reinforces the first part of the book and brings into practice the suggestions of Stanford and Kart. It is only through an understanding of the diversity of the Black culture and its functional needs that the effective targeting discussed by Skinner can be achieved. This understanding would help in restructuring other governmental benefits, including access to health care, Social Security and SSI, by addressing diverse functional needs rather than political interests. It is this understanding of diversity that the book hopes to accomplish. The book, although limited by its constant comparisons of Black vs. White, contains a wealth of information. The concepts proposed by Stanford, Kart and Skinner are welcome contributions to the field of minority gerontology. It is these new approaches in understanding diversity that makes this book a must for all gerontologists. The situations exposed and solutions proposed in this book can work with other ethnic groups. It may be entitled Black Aged, but it is really about understanding the diversity and service needs of all minority ethnic groups. Mid-Life and Older Women in Latin America and the Caribbean Mid-life and Older Women in Latin America and the Caribbean is a pioneer publication. A joint effort between two large organizations, it is the culmination of a project to promote a better understanding of middle-aged and older women in Latin America and the Caribbean. Both the project and the book are divided into two parts. The first part is a background report that includes review of available statistical data and literature. The second part consists of papers presented at the first "Consulting Group Meeting on Mid-Life and Older
BOOKREVIEWESSAY
101
Women in Latin America and the Caribbean: Current Research and Policy Implications." Lee Sennott-Miller, author of the background report, suggests that women at mid-life and older play such a key role in the region that if their productive resources and caregiving roles were suddenly withdrawn, the effects on the region's economy would be devastating. Sennott-Miller provides an in-depth discussion of the region from a demographic perspective. Descriptions of that region's sub-regions, compared with other sub-regions such as the Andean Area, Southern Cone, Brazil, Central America, Mexico, Latin Caribbean and Caribbean, as well as the diversity of the entire region, is addressed throughout the report. The most intriguing aspect of the report is the justification for the study of older women. High fertility levels are expected to continue, while the infant mortality rate is slowing due to "child survival efforts." The result is a population explosion that will produce the largest increase in the absolute numbers of older persons over the next 50 years. Sennott-Miller cites Guatemala as an example where the number of persons over age 65 is expected to increase by 375%. She further states that it are these types of countries that are least prepared for the special needs of elderly. With elderly women outnumbering elderly men, the social, economic and health problems of the aging population will be largely the problems of women. The urgency to tackle the "population explosion" in Latin America and the Caribbean is the theme throughout the book. The first step is for the countries within the region to acknowledge the demographic realities and diversity of older persons. In her chapter on the aging female population and economic issues, Gloria L.N. Scott states, "In 1984, for the first time, Caribbean Ministers of Health considered the problems of the aged as a group with specific health care needs. Although women face the same health problems as men, they suffer from many additional health risks due to their lower socioeconomic status, their limited access to basic resources, the time and energy demands of a double workday that combines the household maintenance and economic production .... " A positive, albeit limited, beginning has occurred. Equal access to health services as a principle has been adopted by all the countries covered in the report, and most have assigned priority to vulnerable groups, including the elderly and women, although not necessarily elderly women. The major contributions of this book lie not just with acknowledging that aging and the plight of older women are crucial issues. It also points out that these populations face many of the circumstances that affect ethnic minorities in the United States. To that extent, we can learn from each other. While there are similarities in the regions, there is also great diversity. Unless there is a solid understanding of this diversity, problems in service delivery may develop. The Latin American and Caribbean countries have the opportunity to try new and bold measures in service delivery to vulnerable groups. But like the United States, the problems in service delivery may lie more in the highly politicized bureaucracies than anywhere else.
102
BRIAN LOUIS LIPSHY AND FERNANDOM. TORRES-GIL
This book provides a unique opportunity to gain insight and understanding of our own country by looking at another region of the world. The background essay is one of the most comprehensive pieces of literature on the region available and provides the reader with a solid foundation upon which the second part of the book is built. With vast amounts of information on a number of countries and an even greater number of cultures in an easy to read format, this book is a must for those interested in race/ethnicity and aging. PART II If there is one central theme that runs throughout these three publications, it is that we must understand the meaning of diversity. Comparisons between ethnic/racial groups can only identify differences; they cannot explain them. As Stanford notes, each group will have different social, political and economic histories. A diverse older population will need many services from, and will be able to contribute many services to, our future society. To be responsive to these challenges and opportunities, our society and its institutions must become knowledgeable, remain flexible, exercise creativity and be prepared to make some hard choices (Bass et al. 1990). Aging and Health notes that ethnicity must be perceived separately from social class. The same argument is presented by Kart in Black Aged. Ethnicity has become a key word in gerontology. The sub-field of minority gerontology is gaining acceptance in academic and policy circles. All three books reinforce the need to continue that momentum with further studies. Minority gerontology, however, is still in an early stage. The literature is filled with comparisons. The time has come for minority gerontology to mature. Researchers in minority gerontology must go beyond comparisons of homogeneous ethnic groups and sort out the rich diversity within those groups and develop the appropriate theories, paradigms, and causal relationships that explain the effect of diversity on services, policy and research. However, if we do move to that higher level, then we have another dilemma: how to serve increasingly diverse ethnic groups in the United States and abroad. Do we have the dollars and resources to provide ethnics with specific programs, or do we select programs based on needs that all groups share (i.e., health care, housing, income)? Although these books represent an important step forward, they still do not tackle the issue of policies and programs at the national, state and local levels. In Black Aged, Skinner sidesteps politics by focusing on functional needs rather than demographic indicators. Is this realistic, or is it idealistic? Nonetheless, all three books serve a useful purpose by providing a place to begin looking at programs and policies. In the future, we will also be looking to other countries to see what has and hasn't worked. When the American Association of Retired Persons and the Pan American Health Organization joined forces to promote research and understanding of a political minority group - women - it brought minority gerontology to the international scene. Understanding diversity in aging and ethnicity must include rigorous and systematic research as well as understanding the diverse politics and policies at local, state, national, and international levels.
BOOK REVIEW ESSAY
103
REFERENCE CITED Bass, S.A., E.A. Kutza, and F.M. Torres-Gil 1990 Conclusion: Directions for Responsiveness. In Diversity in Aging: Challenges Facing Planners and Policy Makers in the 1990s. S.A. Bass, E.A. Kutza, and F.M. Torres-Gil, eds. Pp. 175-183. Glenview, Illinois: Scott, Foresman and Company.
Ethel Percy Andrus Gerontology Center University of Southern California Los Angeles, CA 90089--0191, U.S-4.
