Racial disparities in health—making the connections

While African Americans continue to experience encouraging progress in all walks of life, certain gaps remain; this includes our health. African Americans, whether male or female, are more likely to suffer and die from diseases (both treatable and not) than most other racial-ethnic groups. These persistent gaps in health are referred to as racial health disparities. While some disparities exist because of limited access to doctors, diet, exercise, and other behavior, other disparities are the result of the cumulative effects of social disadvantage. Social disadvantages also accumulate over time because of societal factors like socio-economics (income, education, and occupational status) and social environment (housing, safety, the quality of one’s neighborhood, access to transportation, and stress). Understanding the impact of social disadvantage on health is important if we are to commit to the improved health of all African Americans.

Socio Economics

The Census Bureau reports that black households earn $.63 for every $1.00 earned in white households. This is relevant because access to salaried jobs with good health benefits is in part dependent upon educational achievement. Therefore, lower levels of education plus economic instability can result in negative health outcomes. Those earning less than $15,000 per year are nearly four times more likely to report having had a heart attack and more than six times more likely to report having had a stroke than are those earning more than $50,000 per year. Most African Americans who are unemployed experience this sporadically. They move in and out of the job force and work at jobs with no health care. Approximately 20% of African Americans lack health insurance and 25% of us do not have a doctor. What complicates these facts is that those without health insurance are more likely to live with an untreated chronic illness, and will be less likely to receive regularly scheduled screenings for cancer and other diseases. Individuals living in low-income households are more likely to sacrifice their own health to ensure a roof over their heads, and food on the table for their children and loved ones. In addition, income affects the quality of one’s diet. Dollar menus at fast food restaurants are quick and easily accessible solutions for families with limited income for food. Research in major cities has documented how limited access to affordable fresh produce, dairy, and other items results in the increased consumption of high sodium, high fat and high sugar processed foods; all of these are linked to hypertension, diabetes, heart and kidney disease.

Our Environment

As a nation, we still live, literally, with the legacy of economic and racial-ethnic segregation. African Americans have historically lived in neighborhoods with more health risks. Consequently, our health is affected by the quality of building material used in our homes, our proximity to fumes from vehicles, access to parks and playgrounds with functional athletic facilities, the availability of supermarkets as opposed to convenience stores, and whether we live near primary care providers. In a perfect world, all people would be able to live in a healthy, safe neighborhood. However, the reality is that people’s choice of neighborhood is directly affected by affordability. Our access to safe, health-preserving neighborhoods is dependent on our personal wealth, credit, income, and available bank funding.

Even though middle and high income African Americans have the resources to live in healthy neighborhoods and to seek proper health care, they still experience health disparities. These disparities highlight what many of us know—stress matters. Economics removes some of life’s challenges, but others still remain. Many of us experience the long term effects of stress related to work and family life but also the subtle impact of discrimination; the compounding of all of these stresses on African American women is commonly called weathering. In small doses, this is manageable. But imagine living in a subtle “fight or flight” mode over time. Eventually this stress minimizes the body’s ability to fight off a range of illnesses and can result in increased hypertension and heart disease.

A New Plan for Change

Despite all of these troubling facts, there are solutions. It is important to remember that while health disparities are persistent, they are not permanent. Health challenges due to behavior can be addressed by committing to making changes in our personal lives. Faith-based initiatives have successfully provided our communities needed health care, programs in nutrition, access to fresh produce, exercise and stress reduction classes. Through faith-based initiatives, non-profit health organizations, hospitals and government agencies partner with religious organizations and craft strategies intended to encourage feasible healthy lifestyles for African Americans. Religious leaders are trusted figures who have regular access to substantial numbers of African American men and women. Leaders receive information that they can use within their communities; these projects have been especially effective for African American women. Reducing the societal causes of health disparities will require a different scale of response that involves community groups and governmental agencies. In 2000, Congress established the National Center on Minority Health and Health Disparities (NCMHD) to lead, coordinate, support and assess the NIH effort to eliminate health disparities. One outcome of the legislation was a Strategic Plan and Budget for Eliminating Health Disparities, which includes prioritizing a national research agenda on and funding for research on health disparities. The Department of Health and Human Services has launched the National Partnership for Action to Reduce Health Disparities. Their goal is to work with community organizations, schools and health care professionals “to mobilize and connect individuals and organizations from across the country to create a Nation free of health disparities, with quality health outcomes for all.” State and city departments of health are committed to exploring health disparities and recommending improvements by promoting health equity. They recognize that it is important to measure the social, economic and environmental conditions that affect physical well-being; investigate the underlying conditions that impact health; address racial, economic and gender health disparities; and that being healthy is possible with job security, safe working conditions, and improved housing. Sustainable improvements in our health may be difficult, but it is possible through concerted collective action. Healthy living within all African American communities requires engaging within these communities, targeting social inequalities, generating creative public policy and research plus legislative action.

Renée T. White, PhD is Professor of Sociology and Black Studies and Academic Coordinator for Diversity and Global Citizenship at Fairfield University in Connecticut. She does research and has served as a consultant on reproductive health policy, urban inequalities and health disparities and is an advocate for health equity end economic justice. Professor White earned her MA and PhD in sociology from Yale University. Her most recent book is HIV/AIDS: Global Frontiers in Prevention/Intervention (Routledge Press)