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 Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease E-mail to a friend
BOOK edited by Richard Hofrichter

This public health reader draws on the growing body of recent literature to offer a comprehensive collection of articles written by a panel of expert contributors who represent a broad range of fields—sociology, epidemiology, public health, ecology, politics, organizing, and advocacy. Each article explores a particular aspect of health inequalities and demonstrates how the sources of health inequalities are rooted in injustices associated with racism, social class, and sex discrimination. This important book examines the political implications of various perspectives used to explain health inequities and explores alternative strategies for eliminating them. 

See especially: "The Politics of Health Inequities," by Richard Hofrichter, available free online.

Image Thumbnail Health Equity and Social Justice Resources E-mail to a friend

From the National Association of County and City Health Officials (NACCHO)

Image Thumbnail Health in Black and White, An Interview with David Williams E-mail to a friend
INTERVIEW by Madeline Drexler, The American Prospect, April 27, 2007

Medical care itself is hardly the major determinant of health -- social context matters. Sociologist David Williams, one of the world's leading scholars on racial disparities in health and now the Norman Professor of Public Health at Harvard, talks about racial and socioeconomic disparities in health.

Image Thumbnail Health Justice Report Card E-mail to a friend
DATA TOOL from the Praxis Project

This tool is designed to help community based organizations, public health advocates and practitioners to look at how their county is doing along a range of issues related to the health and well being of communities. For each indicator, there are links to tools and resources to support organizing, advocacy and policy development toward that end.

Image Thumbnail Health Leadership: Action Steps DVD E-mail to a friend
PRESENTATION available from Blue Cross and Blue Shield of Minnesota Foundation

The 2007 Blue Cross Foundation Leadership Award Program and Luncheon featured a keynote by Dr. Anthony Iton, director of the Alameda County (California) public health department, on how race, class, wealth, education, geography and employment affect health status.

Also includes presentations from Atum Azzahir, co-founder, president and executive director of the Powderhorn Phillips Cultural Wellness Center in Minneapolis, and remarks by Marsha Shotley, foundation president; the new Minnesota Health Commissioner, Dr. Sanne Magnan; and Blue Cross and Blue Shield of Minnesota President Colleen Reitan.

Image Thumbnail Health Policy Institute of the Joint Center for Political and Economic Studies E-mail to a friend

With the mission to ignite a Fair Health movement that gives people of color the inalienable right to equal opportunity for healthy lives, this pioneering program of the Joint Center for Political and Economic Studies undertakes research, publications, activities, and projects designed to accelerate progress beyond listing and analyzing a litany of health disparities. Rather, they are directed toward collective strategies that will produce real change—and real opportunities for health.

See also: HPI Place Matters

Image Thumbnail How racism hurts -- literally E-mail to a friend
NEWS ARTICLE by Madeline Drexler, Boston Globe, July 15, 2007

A newspaper article that describes contemporary research on the effects of racism on health.

Image Thumbnail How Racism Impacts Pregnancy Outcomes E-mail to a friend

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

Image Thumbnail How the diabetes-linked 'thrifty gene' triumphed with prejudice over proof E-mail to a friend
The Globe and Mail

Jennifer Poudrier, an associate professor of sociology at the University of Saskatchewan, is one of many scholars to argue that the "thrifty gene" theory allows society to curl up with the notion that biology shoulders most of the blame for the ill health of native people. She dismisses it as “a colonial lens put on aboriginal history,” promoting the myth that indigenous people all have the same genes that make their diabetes “a special problem” beyond the reach of public-health initiatives.

Image Thumbnail How U.S. Laws and Social Policies Influence Chronic Stress and Health Disparities E-mail to a friend
SCHOLARLY ARTICLE, Holly Avey, Politics of Race, Culture, and Health Symposium, Ithaca College, Nov. 14, 2002

A clear, thorough overview explaining the stress process (exposures and vulnerabilities to stressors), physiological response to stressors (how stress "gets into the body"), and why people of color and lower socioeconomic status tend to be more negatively affected by stress. Concludes with policy implications.

Image Thumbnail How U.S. Laws and Social Policies Influence Chronic Stress and Health Disparities - A Response (pdf) E-mail to a friend
SCHOLARLY ARTICLE by Thomas C. Shevory, Ithaca College, 2002

A short response to Holly Avey's literature review that provides additional background and references regarding misconceptions of the character traits of "the poor" vs. "the affluent," chronic stressors, and the need for structural policy intervention.

Image Thumbnail Human Diversity E-mail to a friend
INTERACTIVITY from RACE: The Power of an Illusion, 2003

Our eyes tell us that people look different. But how different are we beneath the skin? Geneticists, anthropologists, and biologists are unlocking human variation and the evolution of our species. Let's see what they're finding out:

Test what you know about human diversity, and learn why race isn't biological.

Image Thumbnail Insights into Racial and Ethnic Group Differences in Birth Outcomes E-mail to a friend
A presentation by Dr. James W. Collins, Jr.

Dr. Collins' presentation surveys the level of infant mortality in the United States and identifies factors that contribute to the US' high rate of infant mortality.  Among these factors are cumulative, transgenerational factors: conditions, and environments experienced by one generation that relate to the pregnancy outcome of the next generation.  These include racism, chronic stress, and poverty.


Image Thumbnail Investigating How Racism Harms Health: New approaches and new findings (pdf) E-mail to a friend
ARTICLE by Nancy Krieger, CCHERS Winter Newsletter 2008, pps 3 and 5

Krieger looks at the history of and present trends in considering "race" in epidemiological research. Though theories regarding the influence of living conditions and social factors on the comparatively poorer health of African Americans go back even to the time of slavery in the U.S., the potential for biological explanations to justify first slavery, then second-class citizenship has contributed to the continuing dominance of bio-determinist (now genetic) explanations for "racial disparities" in mortality and health outcomes. New research is presenting strong evidence that social factors, including racism itself, have powerful effects on physical health.

Image Thumbnail Issue Brief: Racial and Ethnic Health Disparities (pdf) E-mail to a friend
ISSUE BRIEF by Kate Meyers, Kaiser Permanente Institute for Health Policy

This piece provides a roadmap for understanding the complex issue of disparities in health and health care. By breaking down the major themes from IHP's more comprehensive review and analysis of this topic published in March, this paper highlights the major factors that influence health disparities and the most promising arenas for policy action in a short format for quick reference. Together, these papers aim to support thinking, analysis, and discussion among groups from all different sectors that impact health.

These and other reports are also available at kpihp.org under the "Racial and Ethnic Health Disparities" issue area link.

Image Thumbnail john a. powell on Race and Privilege E-mail to a friend

How is race socially constructed? Why can't we get rid of the concept? How do whites benefit without having to do anything? What can we do about residential segregation and inequality?
john a. powell is director of the Institute for the Study of Race and Ethnicity in the Americas at Ohio State University and the Gregory H. Williams Chair in Civil Rights and Civil Liberties in the Moritz College of Law. He is a nationally recognized scholar on race, poverty, and regional equity. This interview was conducted for the documentary series RACE: The Power of an Illusion.

Image Thumbnail Joint Center for Political and Economic Studies E-mail to a friend

The Joint Center is the nation's only research and public policy institutions that focuses exclusively on issues of particular concern to African Americans and other people of color. Current research and analyses address critical issues in three key areas: political participation; economic advancement; and health policy.

Image Thumbnail Kim Anderson's Story E-mail to a friend
VIDEO EXCERPT, Unnatural Causes - Episode 2

When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. This excerpt from When the Bough Breaks explores racism's impact on pregnancy outcomes.

Image Thumbnail Kirwan Institute for the Study of Race and Ethnicity E-mail to a friend

The Institute aims to deepen understanding of the causes and consequences of and solutions to racial and ethnic hierarchy and disparity, with a focus on racially and ethnically marginalized populations. The successful pursuit of this goal has significantly enhanced the reputation of the University as a center of research and scholarship on issues related to race, ethnicity, democracy, and social justice. Its ultimate goal is to stimulate and facilitate transformative change, to bring about a society that is fair and just for all people. They approach these goals with the understanding that all communities of people are interconnected, and that by fostering positive relationships through research, scholarship and collaboration, we will deepen the possibility for change.

Image Thumbnail Living in Disadvantaged Neighborhoods is Bad for Your Health E-mail to a friend
VIDEO EXCERPT, Unnatural Causes - Episode 5

Why is your street address such a good predictor of your health? Increasingly, Southeast Asian immigrants like Gwai Boonkeut are moving into neglected urban neighborhoods where African Americans have long suffered, and now their health is being eroded too. What can be done to create a neighborhood that promotes rather than destroys health?

Image Thumbnail Louisville's Rubbertown Neighborhood Fights against Toxic Emissions E-mail to a friend

Eboni Cochran and her neighbors in Louisville have organized to demand that chemical companies in their area do a better job of monitoring and containing hazardous materials that seep into the soil and air. Across the country, polluting industries are concentrated in communities where the poor and people of color live.

Image Thumbnail Maternal Nutrition and Infant Mortality in the Context of Relationality E-mail to a friend
REPORT by Michael C. Lu and Jessica S. Lu, from the Health Policy Institute, 2007

This background paper explores the relationship between maternal nutrition and infant mortality. It provides an analysis of the relationship between maternal nutrition and leading causes of infant mortality, as well as maternal, infant, and child health; an overview of the nutritional status and behaviors of pregnant women in the U.S.; and a comprehensive review of the effectiveness of nutritional supplementation programs in pregnancy. The final chapters reframe the relationship between maternal nutrition and infant mortality within the context of relationality over the life course and offer related recommendations for research, policy, and practice.

Image Thumbnail Me, My Race, and I E-mail to a friend
INTERACTIVITY from RACE: The Power of an Illusion, 2003

Maybe it affects your every move. Maybe you never notice it.

Walk a mile in someone else’s shoes by watching and listening to four slideshows. You may be surprised to learn how great a role race plays in your own life.

Miles to Go before We Sleep: Racial Inequities in Health E-mail to a friend
ARTICLE by David R. Williams, Journal of Health and Social Behavior 53(3) 279-295

Large, pervasive, and persistent racial inequalities exist in the onset, courses, and outcomes of illness. A comprehensive understanding of the patterning of racial disparities indicates that racism in both its institutional and individual forms remains an important determinant. There is an urgent need to build the science base that would identify how to trigger the conditions that would facilitate needed societal change and to identify the optimal interventions that would confront and dismantle the societal conditions that create and sustain health inequalities.

Image Thumbnail Minority Health Resources Action Kit for Community Leaders E-mail to a friend
TOOLKIT by the Minority Health Initiatives Department at Families USA

The purpose of this Action Kit is to provide community leaders with the information, tools, and resources necessary to engage in health advocacy and improve the health and well-being of their communities. Sections of the toolkit place emphasis on the importance of public programs in reducing racial and ethnic health disparities.

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