UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
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Race / Racism

Background: More than 100 studies now link racism to worse health. Many people of color experience a wide range of serious health issues at higher rates than do whites, including breast cancer, heart disease, stroke, diabetes, hypertension, respiratory illness and pain-related problems. On average, African Americans, Native Americans, Pacific Islanders and some Asian American groups live shorter lives and have poorer health outcomes than whites. But why?

According to the Centers for Disease Control, African American men die on average 5.1 years sooner than white men (69.6 vs. 75.7 years), while African American women die 4.3 years sooner than white women (76.5 vs. 80.8 years). Vietnamese American and Korean American women suffer some of the highest rates of cervical cancer in the nation; Vietnamese American men die from liver cancer at a rate seven times that of non-Hispanic white men.

Class certainly plays a role. Because of historical discrimination and structural racism, people of color are likely to be less wealthy, to have less education and to live in segregated communities with underfunded schools, insufficient services, poor transportation and housing, and higher levels of exposure to toxic and environmental hazards. A wide body of evidence has shown that wealth predicts health: the higher you are on the class pyramid, the better your health. Every step down corresponds to slightly worse health, from top to bottom. Inequitable distribution of resources helps explain why.

Yet socioeconomic status doesn't account for the whole picture. In many instances, African Americans and other groups fare worse than whites at the same income levels. In fact, infant mortality rates among babies born to college-educated African American women are higher than those of white Americans who haven't finished high school. Recent Latino immigrants, though typically poorer, are healthier than the average American; yet the longer they're here, the more their relative health status declines even as their socioeconomic situation improves. Racism has proven to be a factor affecting health "upstream" and independent of class.

Could there be a genetic reason? Researchers funded by the National Institutes of Health, for example, have spent 40 years and several millions of dollars studying Native Americans in southern Arizona, trying to discover a biological reason for their high rates of Type 2 diabetes. Yet their findings remain inconclusive. Hypotheses like the "salt retention gene" explanation for high rates of hypertension among African Americans have also long been debunked scientifically, although they continue to hold currency in the popular press and public imagination.

In fact, studies comparing birth outcomes among white and Black American women showed that more low birth-weight babies are born to African Americans, but birth outcomes among white Americans and African-born immigrants to America were comparable. Moreover, the daughters of the African immigrants gave birth to low birth-weight babies at the same rate as African Americans.

One risk factor researchers are investigating is how the lived experience of racism can increase chronic stress levels and thus worse health among people of color. According to their thinking, addressing unequal birth outcomes, for example, requires more than just better prenatal care; it also requires that we change the social conditions that produce negative experiences over a lifetime. African Americans have among the worst hypertension rates not because of their genes but because of difficulties they face in their lives.

As sociologist Troy Duster explains, the impact of race on disease is not biological in origin but in effect. Anxiety, anger, or frustration from racist experiences trigger the body's stress response, which over time, creates wear and tear on the body's organs and systems. Dr. Camara Jones, a leading expert on racism and health at the Centers for Disease Control, puts it this way: "It's like gunning the engine of a car, without ever letting up. Just wearing it out, wearing it out without rest. And I think that the stresses of everyday racism are doing that." Dr. Jones and others are studying three kinds of racism - institutional, interpersonal and internalized - and how each contributes to health.

Whether it takes the form of overt discrimination or structural disadvantage, racism continues to influence how people are treated, what resources and jobs are available, where we are likely to live, how we perceive the world and our place in it, what environmental exposures we face, and what chances we have to reach our full potential. Important policies to address racism and its impact on health include more equitable school funding, better enforcement of anti-discrimination laws, housing mobility programs, better transportation, affirmative action, tax policy and land use, as well as economic revitalization, business investment and wealth accumulation in communities of color.

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Image Thumbnail Multiple risk exposure as a potential explanatory mechanism for the socioeconomic statusĖhealth gradient E-mail to a friend
Gary W. Evans and Pilyoung Kim

One potential underlying explanation for socioeconomic status (SES) gradients in health is exposure to multiple risk factors. Income and class tend to sort
individuals into different settings that are often accompanied by systematic differences in environmental quality. Housing and neighborhood quality, pollutants and toxins, crowding and congestion, and noise exposure all vary with SES. Persons lower in SES also experience more adverse interpersonal relationships with family members, friends, supervisors, and communitymembers. Furthermore, exposure to thesemultiple risk factors is associated with worse health outcomes. Thus, the convergence of exposure tomultiple physical and psychosocial risk factors accompanying disadvantage may account for a portion of SES gradients in health in both childhood and adulthood.

Image Thumbnail Nancy Krieger Interview (mp3) E-mail to a friend
PODCAST, Web-exclusive content from UNNATURAL CAUSES

In this audio podcast, excerpted from an interview conducted for UNNATURAL CAUSES, Nancy Krieger of the Harvard School of Public Health talks about the political economy of health, how racial and place-based inequities impact health, and how public health and social justice are inextricably intertwined.

ENHANCED PODCAST (m4a)

Image Thumbnail Nancy Krieger Interview (pdf) E-mail to a friend
EDITED INTERVIEW TRANSCRIPT, Web-exclusive content from UNNATURAL CAUSES

In this original interview conducted for UNNATURAL CAUSES, Professor Nancy Krieger of the Harvard School of Public Health discusses the social gradient, the political economy of health, and the role of public health in struggles for social justice.

Image Thumbnail National Alliance for Hispanic Health E-mail to a friend
WEB SITE

An action, advocacy, and research forum for Hispanic health and well being, NAHH informs and mobilizes consumers, supports health and human service providers in the delivery of quality care, improves the scientific basis for accurate decision-making by promoting better and more inclusive research, promotes appropriate use of technology, insures accountability and advocates on behalf of Hispanics, and promotes philanthropy. Their website contains a resource section with reports, fact sheets, news and helplines related to Latino/ Hispanic health issues.

Image Thumbnail Nearly 700 Medicines in the Pipeline Offer Hope for Closing the Health Gap for African Americans (pdf) E-mail to a friend
REPORT from the Pharmaceutical Research and Manufacturers of America, 2007

This publication from the Pharmaceutical Research and Manufacturers of America lists 691 medicines in development specifically for the African American population

Image Thumbnail Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places E-mail to a friend
SCHOLARLY ARTICLE by Kimberly Morland, et al. American Journal of Preventative Medicine

This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. It finds that, compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are three times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods. Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods.

Image Thumbnail New, Homes, New Neighborhoods, New Schools: A Progress Report on the Baltimore Housing Mobility Program E-mail to a friend
Poverty and Race Research Action Council

This report describes and evaluates the ambitious voucher program that has enabled 1500 families living in highly segregated and disadvantaged Baltimore inner city neighborhoods to move to integrated, suburban "opportunity" neighborhoods.  The initiative originated as a partial settlement of the public housing desegregation case, Thompson v. HUD and was launched in 2003.

Image Thumbnail Opportunity Agenda E-mail to a friend
WEB SITE

The Opportunity Agenda works across social justice issues to build public support for greater opportunity in America. With a growing community of partners that spans diverse issues and constituencies—human rights, racial equality, immigration, health care, labor rights, education, criminal justice, and others—they work to move hearts and minds as well as public policy and political discourse. Over time, their activities hope to achieve: (1) measurably better media coverage that shifts the public debate; (2) visibly improved public support for social justice values and policies; and (3) greater capacity within social justice organizations and movements to communicate our shared values and vision for America.

Image Thumbnail Oprah's unhealthy mistake E-mail to a friend
EDITORIAL by Osagie K. Obasogie, Los Angeles Times, May 2007

Like a game of whack-a-mole, the "slavery hypothesis" of hypertension keeps popping up in the media, popular culture and even medical texts no matter how many times it is slammed down. It has come to symbolize the incessant way in which unfounded biological theories of racial difference continue to thrive despite significant evidence to the contrary.

Image Thumbnail Overcoming Obstacles to Health E-mail to a friend
REPORT from the Robert Wood Johnson Foundation, 2013

This report by Paula Braveman and Susan Egerter for the Robert Wood Johnson Foundation Commission for a Healthier America, summarizes in clear language the current research on why Americans have worse health and shorter lives than people of other rich nations.  The report analyzes the latest data and contains many useful charts.

 

Image Thumbnail Overview of Racial/Ethnic Disparities in Health (pdf) E-mail to a friend
PRESENTATION TRANSCRIPT, David Williams, 2004

A transcript of Williams's lecture at "Racial/Ethnic & Socioeconomic Disparities in Health: Implications for Action." He presents a clear overview of the association between race and ethnic status and how it combines with socioeconomic status to affect health.

Image Thumbnail Patterns and Causes of Disparities in Health (pdf) E-mail to a friend
ARTICLE by David Williams, Chapter in Policy Challenges in Modern Health Care

This chapter provides an overview of social disparities in health in the United States. It begins by outlining the complex social forces that combine to produce variations in health. It then considers the patterns of racial/ethnic differences in health and shows how these must be understood in the context of the heterogeneity of those groups, and the even larger disparities by socioeconomic status (SES) and gender. The chapter concludes by focusing on the opportunities and challenges for reducing social disparities in health in the United States.

People in Poor Neighborhoods Breathe More Hazardous Particles E-mail to a friend
Scientific American

Tiny particles of air pollution contain more hazardous ingredients in non-white and low-income communities than in affluent white ones, a new study shows.

Image Thumbnail Place Matters for Health in the San Joaquin Valley E-mail to a friend
REPORT from Joint Center for Political and Economic Studies & San Joaquin Valley Place Matters Team, 2012

This study examines the relationships between place, race and ethnicity, and health in the San Joaquin Valley of California and attempts to address two specific questions raised by the San Joaquin Valley Place Matters Team: What is the relationship between social factors and premature mortality? What is the relationship between social factors and exposure to environmental hazards?

Image Thumbnail Place Matters: Exploring Our Neighborhoods E-mail to a friend
LESSON PLAN developed by California Newsreel, 2009

Students investigate their own neighborhoods and gain practice in research and analysis while drawing connections between health and a neighborhood's physical, social, service, and economic environments.

Image Thumbnail PolicyLink E-mail to a friend
WEB SITE

PolicyLink is a national research and action institute advancing economic and social equity by "Lifting Up What Works." By developing and implementing multifaceted strategies, PolicyLink seeks to ensure that everyone—including low-income communities of color—can contribute to and benefit from local and regional growth and development. 

Image Thumbnail Poverty & Race Research Action Council E-mail to a friend
WEB SITE

PRRAC is a civil rights policy organization convened by major civil rights and anti-poverty groups in 1989. PRRAC's primary mission is to help connect social scientists with advocates working on race and poverty issues, and to promote a research-based advocacy strategy on issues of structural racial inequality.

Poverty As A Childhood Disease E-mail to a friend
Blog post by Dr. Perri Klass at the New York Times "Well" blog

"Think for a moment of poverty as a disease, thwarting growth and development, robbing children of the healthy, happy futures they might otherwise expect. In the exam room, we try to mitigate the pain and suffering that are its pernicious symptoms. But our patients’ well-being depends on more, on public health measures and prevention that lift the darkness so all children can grow toward the light."

Image Thumbnail Presentation - The Unsolved Mystery of Racial Disparities in Birth Outcomes (pdf) E-mail to a friend
PRESENTATION SLIDES from Paula Braveman, MD, MPH, Professor of Family & Community Medicine and Director of the Center on Social Disparities in Health, University of California, San Francisco

Dr. Braveman made this presentation, fully titled "The Unsolved Mystery of Racial Disparities in Birth Outcomes: Is Racism-Related Stress a Missing Part of the Puzzle?" at the NIH Summit on Health Disparities in December 2008. It provides an excellent summary of the logic and evidence that points to structural racism as a key factor in explaining the Black / white gap in infant mortality and low birth weight. Includes considerations of neighborhood, employment, social factors, the life-course model, and the "immigrant paradox."

Image Thumbnail Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (pdf) E-mail to a friend
WORKBOOK - Centers for Disease Control and Prevention, 2008

This workbook is for community-based organizations seeking to affect the social determinants of health through community-based participatory approaches and nontraditional partnerships. Along with an introduction to the concepts of health equity, the workbook presents case studies of communities working at both small and large scales. The authors then provide guidelines for developing your own initiative, from creating partnerships to identifying your approach to assessing and maintaining your progress.

Image Thumbnail Public Health Puzzle: Social Determinants of Health (pdf) E-mail to a friend
NEWSLETTER, Chronic Disease Notes & Reports, Centers for Disease Control and Prevention

This issue of cdnr is the first part of a 2-part series on eliminating health disparities. It includes articles on disparities in maternal and child health, eliminating disparities in oral health, and health disparities among Native Hawaiians and other Pacific Islanders.

Image Thumbnail RACE - The Power of an Illusion E-mail to a friend

The PBS companion website for a three-part series about race in society, science, and history, from the same producers as UNNATURAL CAUSES. Includes interactivites, an "Ask the Experts" feature, background readings, and additional resources.

To buy the film, visit the California Newsreel site.

Image Thumbnail RACE - The Power of an Illusion E-mail to a friend
DOCUMENTARY SERIES produced by California Newsreel, 2003

What is this thing we call 'race'? Where did the idea come from? What are the patterns of human variation? And if race isn't biological, what is it? How do our social institutions 'make' race? Used widely in classrooms and community spaces, This acclaimed three-part series compels viewers to scrutinize some of their most fundamental beliefs.

Also see the extensive companion Web site, with games, interactivities, and additional information.

This film is part of the Structural Racism sub-category of California Newsreel's African American Perspectives Collection.

Image Thumbnail Race and Socioeconomic Factors Affect Opportunities for Better Health (pdf) E-mail to a friend
REPORT by the RWJF Commission to Build a Healthier America, April 2009

This issue brief provides evidence and explanations for striking differences health status by both race and socioeconomic status.

Image Thumbnail Race in the Epidemiologic Literature: An Examination of the American Journal of Epidemiology, 1921-1990 E-mail to a friend
SCHOLARLY ARTICLE by Jones, LaVeist, and Lillie-Blanton, American Journal of Epidemiology, 1991

This study examines the past and current uses of "race" in US epidemiologic research. It finds that the proportion of U.S. original research papers containing a reference to "race" rose steadily from 1975. However, rather than increasing inclusion of "nonwhite" groups in studies, consideration of "race" seems to have simply increased explicit exclusion of "nonwhites."  Abstract only.

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