Introduction

An accurate picture of demographics of any society is crucial to assess a variety of health and human needs and planning for the future. Demographic characteristics of a given population, community, or ethnic group provide meaningful indicators of need, risk, and type of service interventions required. For example, if a significant segment of a given population or community is composed of ethnic minorities, and it is known that special needs or risks are associated with that ethnic status, then the service needs for that group can be systematically estimated. Some minority groups are likely to require greater needs for children and youth services simply because minority demographic profiles generally indicate larger families and more children. Likewise, if a given ethnic group has higher rates of poverty, the mental health needs of that community may be greater.

Demographics not only provide indicators of risk and need but also influence the type of services required, such as prevention services, education services,

Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations Copyright © 2000 by Academic Press. All rights of reproduction in any form reserved.

psychosocial interventions, and other delivery components of mental health systems and services. For example, differential rates of infectious disease, drug abuse, gang involvement, school drop-out rates, criminal/illegal behaviors, developmental problems, specific genetic disorders, mental disorders, and the like require differential allocation of resources, interventions, and services. Issues of availability of services, accessibility of services, and acceptability of health and mental health services are all intricately tied to demographic characteristics. Social-demographic characteristics may also dictate the language in which the service should best be delivered. Social-demographic features such as socioeconomic status (SES) have profound influences on all forms of illnesses and social problems.

The changing population structure of American minorities has always been intriguing and dynamic, given the evolving diversity of the U.S. population. The continuous change in the size, composition, and age structure of the U.S. population necessitates the understanding of the dynamic aspects of demographic change. The understanding of the current demographic phenomena of American minorities cannot be completed without comprehending the dynamic interplay of fertility, mortality, and migration, traditionally known as the three factors of population growth. This chapter will examine basic demographic and population growth factors for each of four racial, ethnic minority groups in the United States: African Americans, American Indians, Asian Americans, and Hispanic Americans. Each of these four minority groups is composed of a number of subgroups having a common core of some feature of culture.

Although the focus of this chapter will be on the prior-mentioned minorities, it is important to keep in mind that racial and ethnic boundaries are not fixed. Providers of health and related services to minorities should keep this "fluidity of identity" concept in mind. Most sociologists and demographers agree that ethnic boundaries are fluid in American society. The notion of "ethnic options" implies that many individuals in American society, by virtue of a multiethnic ancestry, can choose among several identities (Waters, 1990). Historically, race has long been considered essentially fixed and immutable. Scholars have generally ignored racial mixing, but more recently racial boundaries are assuming ambiguity and fluidity (Root, 1992; Spickard, 1989). To the degree that racial boundaries are fluid, membership in a particular racial/ethnic category is the outcome of a social process of identification.

Another caveat with respect to demographics of minorities that needs to be kept in mind is the limitations of census data with respect to enumeration methods used by the U.S. Census and their disparate impact on racially and ethnically diverse populations in the United States. In the 1990 Census there was a large undercount of racial and ethnic groups. It is estimated that the census missed 4.4% of African Americans, 5% of Hispanics, 2.3% of Asian and Pacific Islanders, and 12% of American Indians living on reservations (Perine,

FIGURE 1 Ethnic composition of the U.S. population in the year 2000.

■ AMER INDIAN B ASIAN 01 HISPANIC

FIGURE 1 Ethnic composition of the U.S. population in the year 2000.

1999). Children under the age of 18 make up 26% of the U.S. population but comprise 52% of the undercount in Census 1990. Because racial and ethnic minorities generally have larger families and more children, they are disparately impacted by undercounting. The undercount in Census 1990 is reported to have been 50% worse than the undercount of Census 1980 (Perine, 1999).

The U.S. population is growing and changing dramatically. Figures 1 and 2 show, respectively, the current and projected racial/ethnic composition of the United States. The Four National Panels on Cultural Competence In Managed Care Mental Health Service, sponsored by the Western Interstate Commission for Higher Education (WICHE, October, 1997), remind us that changes in numbers really represent changes in social structure along with the impact of

50% ■ AMER INDIAN E3 ASIAN HE HISPANIC

FIGURE 2 Ethnic composition of the U.S. population in the year 2050.

50% ■ AMER INDIAN E3 ASIAN HE HISPANIC

FIGURE 2 Ethnic composition of the U.S. population in the year 2050.

those changes on society and individuals. The four major racial/ethnic groups identified and presented in this chapter (African Americans, Asian/Pacific Islanders, Latino/Hispanic, and American Indian and Alaska Natives) have also been identified as underserved/underrepresented mental health groups (WICHE, 1997).

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