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

  • Conclusion

Click on images to explore differences

  • How is health impacted by race and, consequently, class?

    Today, 40 years after the Civil Rights Movement, racial discimination persists in the form of differential access to jobs, good schools, and opportunities as well as negative stereotypes and unfair treatment.

    According to Dr. Camara Jones of the CDC, there's an eternity of difference in the experiences of people who are confronted daily by racism and people who never think about race, and those differences translate into inequities in health.

    Click on each image above to explore how race and class impact health.

    NOTE: the questions in this activity are taken from a popular diversity exercise based upon the work of Peggy McIntosh. Click here to learn more about the diversity exercise.

  • Are you ever followed when you enter a store?

    More than 100 studies now link racial discimination to worse physical health.

    Reality: For many people of color, discrimination continues to be a frequent, even daily occurrence. Whether it's overtly unfair treatment - e.g., being denied a job, promotion, housing, or a loan, being confronted with negative stereotypes, being pulled over for "driving while black or brown" - or more subtle experiences such as poor service or people acting fearful around you, these experiences have an effect on health.

    Health Implications: Exposure to discrimination, real or even perceived, puts the body "on alert." Cortisol and other stress hormones flood the body, increasing heart rate, blood sugar, blood pressure and disrupting other physiological processes. Over time, the accumulation of these "micro-insults" to bodily systems can increase the risk of every chronic disease as well as immune problems and even early death.

  • Did you grow up in a house that was owned by your parents?

    Between 1934 and 1962, the federal government underwrote 120 billion dollars in new housing. Less than 2% went to non-whites.

    Reality: For most Americans, the majority of their wealth comes from owning a home. Past discrimination in housing policies, lending, and real estate practices means that today, people of color are less likely to own a home, or if they do, it's probably worth significantly less than one owned by a white family. Even today, people of color are still more likely to be denied loans, to pay higher interest rates, or to face foreclosure because of questionable sub-prime mortgage practices.

    Health Implications: Home ownership translates into better health in several ways: (1) people whoare wealthier generally live longer and don't get sick as often; (2) wealthier neighborhoods have betterschools and services, a cleaner environment, better job opportunities, and access to health-promotingresources such as supermarkets and parks; and (3) financial security means less stress about makingends meet, money for college, retirement and the next generation, and having a buffer against hardtimes. In fact, psychologist Sheldon Cohen found that growing up in a house owned by one's parentshas a significant impact on immune response in adulthood. Remarkably, every additional year of homeownership corresponded to a stronger immune system as adults.

  • Are your parents educated professionals (doctors, lawyers, etc.)?

    College graduates can expect to live 5 years longer than people who haven't finished high school. Women who haven't finished high school are 1.5 times as likely to give birth to a pre-mature or low birthweight baby compared to those with college degrees.

    Reality: Research has long shown that higher parental education and occupational status are associated with higher academic performance and achievement among children. This, of course, contributes to higher socioeconomic status (and better health) for those children in adulthood. Children with more educated parents benefit from access to better services and schools, greater financial resources, higher expectations, and social networks and connections that provide opportunities to learn and get ahead themselves.

    Health Implications: In addition to wealth, health follows an education gradient – people who are more highly educated have, on average, better health; people with less education are less healthy. Parents' educational and socioeconomic status affects the health of their children even into adulthood. Educational status both reflects and shapes access to resources and opportunities that can promote or threaten health.

  • Can you express your opinion without feeling like you are representing your race?

    Public schools today are more racially segregated than when the landmark case Brown vs. the Board of Education was decided in 1954. In California, 90% of students in overcrowded schools are children of color, two thirds of them Latino.

    Reality: Although many whites feel that racial discrimination is a thing of the past, people of color continue to experience both subtle and overt forms of discrimination. Today, schools and neighborhoods remain deeply segregated and people of color are underrepresented in higher education as well as certain types of jobs and communities. Negotiating a predominantly white environment can be stressful and people of color may not have access to support networks and resources to help them cope.

    Health Implications: Everyday discrimination contributes to chronic stress, which manifests in both physical and mental health problems. Some studies have shown that subtle discrimination actually has a greater impact on mental health than obvious bigotry. Young adults are especially vulnerable to perceptions that society devalues their racial group – they may act out and turn to negative behaviors to cope with stressful racial experiences. Moreover, people who feel socially excluded and who lack support networks and meaningful opportunities to participate are more likely to experience a range of diseases, including cardiovascular problems, stroke, diabetes, even cancer.

  • Do your parents have a foreign accent?

    By the year 2050, one if four Americans will be Latino.

    Reality: At each step down the socioeconomic ladder, African Americans, Native Americans and Pacific Islanders seem to have worse health than their white counterparts. Interestingly, that's not the case for many new immigrants of color. Recent Latino immigrants, for example, are poorer than the average American, but have better health. However, the longer they live here, the more their health advantage erodes. Latinos who have been here five years or more are about one and a half times as likely to be obese or have high blood pressure as new arrivals.

    Health Implications: Researchers debate the reasons for immigrants' extraordinary health. For one thing, healthier people are more likely to immigrate in the first place. But researchers also suspect that new immigrants bring with them a sense of hopefulness, strong family and cultural ties, and aspects of immigrant communities - such as traditional diet, social support and cohesion, and prohibitions on negative behaviors - which are health protective. Unfortunately, within a generation, the health advantage has largely disappeared. Children of African and Latino immigrants, for example, tend to have the less desirable health outcomes similar to their American-born counterparts.

  • Did you grow up in a safe neighborhood with good access to parks and supermarkets?

    White neighborhoods have 4 times as many supermarkets as Black or Latino neighborhoods. In Black neighborhoods, 80% of billboards advertise tobacco or alcohol.

    Reality: Dozens of empirical studies over the last 40 years have determined that low-income communities and communities of color are more likely to be exposed to environmental hazards. Black and Latino neighborhoods also have fewer parks and green space and fewer places to walk, jog, exercise or play. In many areas, students of color also remain highly concentrated in majority-minority schools with less funding, larger class sizes, and more non-credentialed teachers. Not surprisingly, high school dropout rates in these communities have reached alarming levels.

    Health Implications: Despite people's best intentions, it's difficult to make good choices about food and exercise without healthy options. Poor and minority communities are doubly disadvantaged: they not only lack access to full-service supermarkets and clean parks, they are dominated by liquor stores, fast food outlets, and advertising for alcohol and tobacco products. Add to that the stress of coping with substandard housing conditions, underfunded schools, neighborhood violence, environmental hazards, higher levels of air and noise pollution and you have a recipe for chronic stress. For children, living in these conditions is toxic to their brain development, and contributes to higher rates of asthma, obesity and injury.

  • Is your primary ethnic identity American?

    Until 1952, non-white immigrants to the U.S. were not allowed to become naturalized citizens.

    Reality: For many people of color, the notion of American identity is complicated because historically, they have been treated as second-class citizens and, in some cases, even denied the right to become Americans. Today, discrimination and exclusion persist in different forms. Because society continues to use a racial lens, many people of color identify more with a racialized or “hyphenated” American identity than with a broad one.

    Health Implications: The ability to participate fully in society is a critical factor in health. Unfair treatment, exclusion, feeling devalued – all of these are associated with poorer physical and mental health. Interestingly, for people of color, a strong ethnic identity mitigates some of the stress of negative racial experiences. A similar parallel is evident in new immigrant communities, where hopefulness and strong cultural ties help shield people from the health effects of negative experiences and social conditions.

  • Do you think about your race often, all the time, or very seldomly?

    A nationwide study of health among Asian Americans found that everyday discrimination was associated with chronic cardiovascular, respiratory, pain-related conditions and other health concerns.

    Reality: How often one thinks about race is not a reflection of personal attitudes but how often one feels “under a lens” or experiences discrimination. Such experiences cut across class lines – in fact, some studies suggest that highly educated people of color may face more stress and alienation if their work environment, schools and neighborhoods are predominantly white and if support mechanisms are not available.

    Health Implications: More than 100 studies now link racial discrimination to physical health. In one study, Black women who reported they had been victims of racial discrimination were 31% more likely to develop breast cancer. Other studies have tied experiences of racism to higher levels of arterial plaque and higher blood pressure levels. Exposures to chronic stress can also lead to negative coping behaviors that threaten health, such as smoking, overeating, substance abuse and violence.

  • How is health impacted by race and, consequently, class?

    The effects of racial discrimination are not just psychological or temporary. Instead, they reflect patterns of advantage and opportunity in society and they accumulate over a lifetime – what expert Jack Shonkoff calls the “pile up” of risk or disadvantage.

    The good news is that these social patterns are not natural or inevitable. We have the power to reform the structures and attitudes which produce and reproduce inequities. As Opportunity Agenda’s Brian Smedley has written, the solutions have been with us all along: evidence suggests that if we work towards social justice, everyone’s health - not just the health of those on the bottom - will improve as a result.

    That’s a struggle worth fighting and one that we can win.

    Visit our Health Equity database to find resources related to this activity.