Race and health in the United States
Encyclopedia
Research on race and health in the United States shows many health disparities between the different racial/ethnic groups. The possible causes, such as genetics, socioeconomic factors, and racism, continue to be debated.
or African American
, White
(European American
), Asian
, native Hawaiian or other Pacific Islander
, and American Indian or Alaska native. However, this definition is inconsistently applied across the range of studies that address race as a medical factor, making assessment of the utility of racial categorization in medicine more difficult.
in the United States was 47 years. By century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although longevity
in the U.S. population has increased substantially, race disparities in longevity have been persistent. African American
life expectancy at birth is persistently five to seven years lower than European Americans.
The vast majority of studies focus on the black-white contrast, but a rapidly growing literature describes variations in health status among America's increasingly diverse racial populations. Where people live, combined with race and income
, play a huge role in whether they may die young. A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education. A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. Still, sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years) The differences were reduced when the data were controlled for education.
, HIV/AIDS, and infant mortality
than whites. U.S. ethnic groups can exhibit substantial average differences in disease incidence, disease severity, disease progression, and response to treatment.
. Both had dramatic and positive effects on black health status and outcome, but were discontinued. Although African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980.
Demographic changes can have broad impacts on the health of ethnic groups. Cities in the United States have undergone major social transitions during the 1970s 1980s and 1990s. Notable factors in these shifts have been sustained rates of black poverty and intensified racial segregation, often as a result of redlining
. Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature. Race has played a decisive role in shaping systems of medical care in the United States. The divided health system persists, in spite of federal efforts to end segregation, health care remains, at best widely segregated both exacerbating and distorting racial disparities. Furthermore, the risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting to some that environmental factors and not genetics are the causes of most of the differences.
(SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. Hope Landrine and Elizabeth A. Klonoff found that racist discrimination is rampant in the lives of African Americans and is strongly related to psychiatric symptoms. A study on racist events in the lives of African American women found that lifetime racism was positively related to lifetime history of both physical disease and frequency of recent common colds. These relationships were largely unaccounted for by other variables. Demographic variables such as income and education were not related to experiences of racism. The results suggest that racism can be detrimental to African American's well being. The physiological stress caused by racism has been documented in studies by Claude Steele
, Joshua Aronson, and Steven Spencer on what they term "stereotype threat
." Kennedy et al. found that both measures of collective disrespect were strongly correlated with black mortality (r = 0.53 to 0.56), as well as with white mortality (r = 0.48 to 0.54). A 1 percent increase in the prevalence of those who believed that blacks lacked innate ability was associated with an increase in age-adjusted black mortality rate of 359.8 per 100,000 (95% confidence interval: 187.5 to 532.1 deaths per 100,000). These data suggest that racism, measured as an ecologic characteristic, is associated with higher mortality in both blacks and whites.
Princeton Survey Research Associates found that in 1999 most whites were unaware that race and ethnicity may affect the quality and ease of access to health care.
, with 61 percent of uninsured black adults reporting medical bill or debt problems, vs. 56 percent of whites and 35 percent of Hispanics. Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured. However, a survey conducted in 2009 examining whether patient race influences physician's prescribing found that racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race. Medications were recommended at comparable rates for hypercholesterolemia, hypertension and diabetes between Caucasians and African Americans.
In other cases inequalities in health care reflect a systemic bias
in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of racism in science
and medicine shows that people and institutions behave according to the ethos of their times and warns of dangers to avoid in the future.
Nancy Krieger contended that much modern research supported the assumptions needed to justify racism. Racism underlies unexplained inequities in health care, including treatment for heart disease, renal failure, bladder cancer, and pneumonia. Raj Bhopal writes that these inequalities have been documented in numerous studies. The consistent and repeated findings that black Americans receive less health care than white Americans—particularly where this involves expensive new technology—is an indictment of American health care.
The infant mortality rate for African Americans is approximately twice the rate for European Americans, but, in a study that looked at members of these two groups who belonged to the military and received care through the same medical system, their infant mortality rates were essentially equivalent. Recent immigrants to the United States from Mexico have better indicators on some measures of health than do Mexican Americans who are more assimilated into American culture. Diabetes and obesity are more common among Native Americans living on U.S. reservations than among those living outside reservations.
A report from Wisconsin’s Department of Health and Family Services showed that while black women are more likely to die from breast cancer
, white women are more likely to be diagnosed with breast cancer. Even after diagnosis, black women are less likely to get treatment compared to white women. University of Wisconsin African-American studies Professor Michael Thornton said the report’s results show racism
still exists today. "There’s a lot of research that suggests that who gets taken seriously in hospitals and doctors’ offices is related to race and gender," Thornton said. "It’s related to the fact that many black women are less likely to be taken seriously compared to the white women when they go in for certain illnesses."
Krieger writes that given growing appreciation of how race is a social, not biological, construct, some epidemiologists are proposing that studies omit data on "race" and instead collect better socioeconomic data. Krieger writes that this suggestion ignores a growing body of evidence on how noneconomic as well as economic aspects of racial discrimination are embodied and harm health across the lifecourse. Gilbert C. Gee's study A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status found that individual (self-perceived) and institutional (segregation and redlining
) racial discrimination is associated with poor health status among members of an ethnic group.
Although the relationship racism and health is unclear and findings have been inconsistent, three likely mechanisms for cardiovascular damage have been identified:
. Likewise beliefs such as "The government is trying to limit the Black population by encouraging the use of condoms" have also been studied as possible explanations for the different attitudes of whites and blacks towards efforts to prevent the spread of HIV
/AIDS
.
Infamous examples of real racism in the past, such as the Tuskegee Syphilis Study
(1932–1972), have injured the level of trust in the Black community towards public health efforts. The Tuskegee study deliberately left Black men diagnosed with syphilis untreated for 40 years. It was the longest nontherapeutic experiment on human beings in medical history. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The false belief that AIDS is a form of genocide
is rooted in recent experiences of real racism. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. Researchers in public health hope that open and honest conversations about racism in the past can help rebuild trust and improve the health of people in these communities.
industries
such as toxic waste
disposal; and the exclusion of people of color or lack thereof from public and private boards, commissions, and regulatory bodies results in greater exposure to pollution. RD Bullard writes that a growing body of evidence reveals that people of color and low-income persons have borne greater environmental and health risks than the society at large in their neighbourhoods, workplaces and playgrounds.
Policies related to redlining
and urban decay
can also acts as a form of environmental racism
, and in turn have an impact on public health. Urban minority communities may face environmental racism in the form of parks that are smaller, less accessible and of poorer quality than those in more affluent or white areas in some cities. This may have an indirect impact on health since young people have fewer places to play and adults have fewer opportunities for exercise.
Robert Wallace writes that the pattern of the AIDS
outbreak during the 80s was affected by the outcomes of a program of 'planned shrinkage
' directed in African-American and Hispanic communities, and implemented through systematic denial of municipal services, particularly fire extinguishment resources, essential for maintaining urban levels of population density and ensuring community stability. Institutionalized racism affects general health care as well as the quality of AIDS health intervention and services in minority communities. The overrepresentation of minorities in various disease categories, including AIDS, is partially related to environmental racism. The national response to the AIDS epidemic in minority communities was slow during the 80s and 90s showing an insensitivity to ethnic diversity in prevention efforts and AIDS health services.
would aid in explaining race differences in infant mortality rates across cities. Analyzing 176 large and midsized cities, LaVeist found support for the hypothesis. Since LaVeist's studies, segregation has received increased attention as a determinant of race disparities in mortality. Studies have shown that mortality rates for male and female African Americans are lower in areas with lower levels of residential segregation
. Mortality for male and female European Americans was not associated in either direction with residential segregation.
In a study by Sharon A. Jackson, Roger T. Anderson, Norman J. Johnson and Paul D. Sorlie the researchers found that, after adjustment for family income, mortality
risk increased with increasing minority residential segregation among Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. In most age/race/gender groups, the highest and lowest mortality risks occurred in the highest and lowest categories of residential segregation, respectively. These results suggest that minority residential segregation may influence mortality risk and underscore the traditional emphasis on the social underpinnings of disease and death. Rates of heart disease among African Americans are associated with the segregation patterns in the neighborhoods where they live (Fang et al. 1998). Stephanie A. Bond Huie writes that neighborhoods affect health and mortality outcomes primarily in an indirect fashion through environmental factors such as smoking, diet, exercise, stress, and access to health insurance and medical providers. Moreover, segregation strongly influences premature mortality in the US.
men in swaths of South Dakota, who die around 58.
The risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting that socioeconomic inequities are the root causes of most of the differences.
Overview
In biomedical research conducted in the U.S., the 2000 US census definition of race is often applied. This grouping recognizes five races: blackBlack
Black is the color of objects that do not emit or reflect light in any part of the visible spectrum; they absorb all such frequencies of light...
or African American
African American
African Americans are citizens or residents of the United States who have at least partial ancestry from any of the native populations of Sub-Saharan Africa and are the direct descendants of enslaved Africans within the boundaries of the present United States...
, White
White people
White people is a term which usually refers to human beings characterized, at least in part, by the light pigmentation of their skin...
(European American
European American
A European American is a citizen or resident of the United States who has origins in any of the original peoples of Europe...
), Asian
Asian people
Asian people or Asiatic people is a term with multiple meanings that refers to people who descend from a portion of Asia's population.- Central Asia :...
, native Hawaiian or other Pacific Islander
Pacific Islander
Pacific Islander , is a geographic term to describe the indigenous inhabitants of any of the three major sub-regions of Oceania: Polynesia, Melanesia and Micronesia.According to the Encyclopædia Britannica, these three regions, together with their islands consist of:Polynesia:...
, and American Indian or Alaska native. However, this definition is inconsistently applied across the range of studies that address race as a medical factor, making assessment of the utility of racial categorization in medicine more difficult.
Life expectancy
The twentieth century witnessed a great expansion of the upper bounds of the human life span. At the beginning of the century, average life expectancyLife expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
in the United States was 47 years. By century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although longevity
Longevity
The word "longevity" is sometimes used as a synonym for "life expectancy" in demography or known as "long life", especially when it concerns someone or something lasting longer than expected ....
in the U.S. population has increased substantially, race disparities in longevity have been persistent. African American
African American
African Americans are citizens or residents of the United States who have at least partial ancestry from any of the native populations of Sub-Saharan Africa and are the direct descendants of enslaved Africans within the boundaries of the present United States...
life expectancy at birth is persistently five to seven years lower than European Americans.
The vast majority of studies focus on the black-white contrast, but a rapidly growing literature describes variations in health status among America's increasingly diverse racial populations. Where people live, combined with race and income
Income
Income is the consumption and savings opportunity gained by an entity within a specified time frame, which is generally expressed in monetary terms. However, for households and individuals, "income is the sum of all the wages, salaries, profits, interests payments, rents and other forms of earnings...
, play a huge role in whether they may die young. A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education. A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. Still, sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years) The differences were reduced when the data were controlled for education.
Specific diseases
Health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to European Americans, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Minorities also have higher rates of cardiovascular diseaseCardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
, HIV/AIDS, and infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
than whites. U.S. ethnic groups can exhibit substantial average differences in disease incidence, disease severity, disease progression, and response to treatment.
- African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death. The cancer incidence rate among African Americans is 10% higher than among European Americans.
- U.S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos.
- Adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.
- Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U.S. population.
- European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics.
History
Disparities in health and life span among blacks and whites in the US have existed since the period of slavery. David R. Williams and Chiquita Collins write that, although racial taxonomies are socially constructed and arbitrary, race is still one of the major bases of division in American life. Throughout US history racial disparities in health have been pervasive. Clayton and Byrd write that there have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865–1872) was linked to Freedmen's Bureau legislation and the second (1965–1975) was a part of the Black Civil Rights MovementAfrican-American Civil Rights Movement (1955-1968)
The African-American Civil Rights Movement refers to the movements in the United States aimed at outlawing racial discrimination against African Americans and restoring voting rights to them. This article covers the phase of the movement between 1955 and 1968, particularly in the South...
. Both had dramatic and positive effects on black health status and outcome, but were discontinued. Although African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980.
Demographic changes can have broad impacts on the health of ethnic groups. Cities in the United States have undergone major social transitions during the 1970s 1980s and 1990s. Notable factors in these shifts have been sustained rates of black poverty and intensified racial segregation, often as a result of redlining
Redlining
Redlining is the practice of denying, or increasing the cost of services such as banking, insurance, access to jobs, access to health care, or even supermarkets to residents in certain, often racially determined, areas. The term "redlining" was coined in the late 1960s by John McKnight, a...
. Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature. Race has played a decisive role in shaping systems of medical care in the United States. The divided health system persists, in spite of federal efforts to end segregation, health care remains, at best widely segregated both exacerbating and distorting racial disparities. Furthermore, the risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting to some that environmental factors and not genetics are the causes of most of the differences.
Racism
Racial differences in health often persist even at "equivalent" socioeconomics levels. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health. Using The Schedule of Racist EventsPsychometrics of racism
Psychometrics of racism is an emerging field that aims to measure the incidence and impacts of racism on the psychological well-being of people of all races...
(SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. Hope Landrine and Elizabeth A. Klonoff found that racist discrimination is rampant in the lives of African Americans and is strongly related to psychiatric symptoms. A study on racist events in the lives of African American women found that lifetime racism was positively related to lifetime history of both physical disease and frequency of recent common colds. These relationships were largely unaccounted for by other variables. Demographic variables such as income and education were not related to experiences of racism. The results suggest that racism can be detrimental to African American's well being. The physiological stress caused by racism has been documented in studies by Claude Steele
Claude Steele
Claude Mason Steele is an American social psychologist and currently the I. James Quillen Dean for the School of Education at Stanford University, as well as Professor Emeritus in the Department of Psychology at Stanford...
, Joshua Aronson, and Steven Spencer on what they term "stereotype threat
Stereotype threat
Stereotype threat is the experience of anxiety or concern in a situation where a person has the potential to confirm a negative stereotype about their social group. First described by social psychologist Claude Steele and his colleagues, stereotype threat has been shown to reduce the performance of...
." Kennedy et al. found that both measures of collective disrespect were strongly correlated with black mortality (r = 0.53 to 0.56), as well as with white mortality (r = 0.48 to 0.54). A 1 percent increase in the prevalence of those who believed that blacks lacked innate ability was associated with an increase in age-adjusted black mortality rate of 359.8 per 100,000 (95% confidence interval: 187.5 to 532.1 deaths per 100,000). These data suggest that racism, measured as an ecologic characteristic, is associated with higher mortality in both blacks and whites.
Princeton Survey Research Associates found that in 1999 most whites were unaware that race and ethnicity may affect the quality and ease of access to health care.
Inequalities in health care
There is a great deal of research into inequalities in health care. In some cases these inequalities are a result of income and a lack of health insurance a barrier to receiving services. Almost two-thirds (62 percent) of Hispanic adults aged 19 to 64 (15 million people) were uninsured at some point during the past year, a rate more than triple that of working-age white adults (20 percent). One-third of working-age black adults (more than 6 million people) were also uninsured or experienced a gap in coverage during the year. Blacks had the most problems with medical debtMedical debt
Medical debt refers to debt incurred by individuals due to health care costs and related expenses.Medical debt is different from other forms of debt, because it is usually incurred accidentally or faultlessly...
, with 61 percent of uninsured black adults reporting medical bill or debt problems, vs. 56 percent of whites and 35 percent of Hispanics. Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured. However, a survey conducted in 2009 examining whether patient race influences physician's prescribing found that racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race. Medications were recommended at comparable rates for hypercholesterolemia, hypertension and diabetes between Caucasians and African Americans.
In other cases inequalities in health care reflect a systemic bias
Systemic bias
Systemic bias is the inherent tendency of a process to favor particular outcomes. The term is a neologism that generally refers to human systems; the analogous problem in non-human systems is often called systematic bias, and leads to systematic error in measurements or estimates.-Bias in...
in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of racism in science
Scientific racism
Scientific racism is the use of scientific techniques and hypotheses to sanction the belief in racial superiority or racism.This is not the same as using scientific findings and the scientific method to investigate differences among the humans and argue that there are races...
and medicine shows that people and institutions behave according to the ethos of their times and warns of dangers to avoid in the future.
Nancy Krieger contended that much modern research supported the assumptions needed to justify racism. Racism underlies unexplained inequities in health care, including treatment for heart disease, renal failure, bladder cancer, and pneumonia. Raj Bhopal writes that these inequalities have been documented in numerous studies. The consistent and repeated findings that black Americans receive less health care than white Americans—particularly where this involves expensive new technology—is an indictment of American health care.
The infant mortality rate for African Americans is approximately twice the rate for European Americans, but, in a study that looked at members of these two groups who belonged to the military and received care through the same medical system, their infant mortality rates were essentially equivalent. Recent immigrants to the United States from Mexico have better indicators on some measures of health than do Mexican Americans who are more assimilated into American culture. Diabetes and obesity are more common among Native Americans living on U.S. reservations than among those living outside reservations.
A report from Wisconsin’s Department of Health and Family Services showed that while black women are more likely to die from breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, white women are more likely to be diagnosed with breast cancer. Even after diagnosis, black women are less likely to get treatment compared to white women. University of Wisconsin African-American studies Professor Michael Thornton said the report’s results show racism
Racism
Racism is the belief that inherent different traits in human racial groups justify discrimination. In the modern English language, the term "racism" is used predominantly as a pejorative epithet. It is applied especially to the practice or advocacy of racial discrimination of a pernicious nature...
still exists today. "There’s a lot of research that suggests that who gets taken seriously in hospitals and doctors’ offices is related to race and gender," Thornton said. "It’s related to the fact that many black women are less likely to be taken seriously compared to the white women when they go in for certain illnesses."
Krieger writes that given growing appreciation of how race is a social, not biological, construct, some epidemiologists are proposing that studies omit data on "race" and instead collect better socioeconomic data. Krieger writes that this suggestion ignores a growing body of evidence on how noneconomic as well as economic aspects of racial discrimination are embodied and harm health across the lifecourse. Gilbert C. Gee's study A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status found that individual (self-perceived) and institutional (segregation and redlining
Redlining
Redlining is the practice of denying, or increasing the cost of services such as banking, insurance, access to jobs, access to health care, or even supermarkets to residents in certain, often racially determined, areas. The term "redlining" was coined in the late 1960s by John McKnight, a...
) racial discrimination is associated with poor health status among members of an ethnic group.
Cardiovascular disease
Research has explored the impact of encounters with racism or discrimination on physiological activity. Most of the research has focused on traits that cause exaggerated responses, such as neuroticism, strong racial identification, or hostility. Several studies suggest that higher blood pressure levels are associated with a tendency not to downplay racist and discriminatory incidents, or that directly addressing or challenging unfair situations reduces blood pressure. Personal experiences of racist behaviors cause physiological arousal and increase stress and blood pressure.Although the relationship racism and health is unclear and findings have been inconsistent, three likely mechanisms for cardiovascular damage have been identified:
- Institutional racismInstitutional racismInstitutional racism describes any kind of system of inequality based on race. It can occur in institutions such as public government bodies, private business corporations , and universities . The term was coined by Black Power activist Stokely Carmichael in the late 1960s...
leads to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions. - Personal experiences of racism acts as a stressorStressorStressor is a chemical or biological agent, environmental condition, an external stimulus or an event that causes stress to an organism. An event that triggers the stress response may include for example:...
and can induce psychophysiological reactions that negatively affect cardiovascular health. - Negative self-evaluations and accepting negative cultural stereotypes as true (internalized racism) can harm cardiovascular health.
Fear of racism
While actual racism continues to have adverse impacts on health, fear of racism, due to historical precedents, can also cause some minority populations to avoid seeking medical help. For example, a 2003 study showed that a large percentage of respondents perceived discrimination targeted at African American women in the area of reproductive healthReproductive health
Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
. Likewise beliefs such as "The government is trying to limit the Black population by encouraging the use of condoms" have also been studied as possible explanations for the different attitudes of whites and blacks towards efforts to prevent the spread of HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
.
Infamous examples of real racism in the past, such as the Tuskegee Syphilis Study
Tuskegee Syphilis Study
The Tuskegee syphilis experiment was an infamous clinical study conducted between 1932 and 1972 in Tuskegee, Alabama by the U.S. Public Health Service to study the natural progression of untreated syphilis in poor, rural black men who thought they were receiving free health care from the U.S...
(1932–1972), have injured the level of trust in the Black community towards public health efforts. The Tuskegee study deliberately left Black men diagnosed with syphilis untreated for 40 years. It was the longest nontherapeutic experiment on human beings in medical history. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The false belief that AIDS is a form of genocide
Genocide
Genocide is defined as "the deliberate and systematic destruction, in whole or in part, of an ethnic, racial, religious, or national group", though what constitutes enough of a "part" to qualify as genocide has been subject to much debate by legal scholars...
is rooted in recent experiences of real racism. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. Researchers in public health hope that open and honest conversations about racism in the past can help rebuild trust and improve the health of people in these communities.
Environmental racism
Environmental racism is a form of racial discrimination where race-based differential enforcement of environmental rules and regulations; the intentional or unintentional targeting of minority communities for the siting of pollutingPollution
Pollution is the introduction of contaminants into a natural environment that causes instability, disorder, harm or discomfort to the ecosystem i.e. physical systems or living organisms. Pollution can take the form of chemical substances or energy, such as noise, heat or light...
industries
Industry
Industry refers to the production of an economic good or service within an economy.-Industrial sectors:There are four key industrial economic sectors: the primary sector, largely raw material extraction industries such as mining and farming; the secondary sector, involving refining, construction,...
such as toxic waste
Toxic waste
Toxic waste is waste material that can cause death or injury to living creatures. It spreads quite easily and can contaminate lakes and rivers. The term is often used interchangeably with “hazardous waste”, or discarded material that can pose a long-term risk to health or environment.Toxic waste...
disposal; and the exclusion of people of color or lack thereof from public and private boards, commissions, and regulatory bodies results in greater exposure to pollution. RD Bullard writes that a growing body of evidence reveals that people of color and low-income persons have borne greater environmental and health risks than the society at large in their neighbourhoods, workplaces and playgrounds.
Policies related to redlining
Redlining
Redlining is the practice of denying, or increasing the cost of services such as banking, insurance, access to jobs, access to health care, or even supermarkets to residents in certain, often racially determined, areas. The term "redlining" was coined in the late 1960s by John McKnight, a...
and urban decay
Urban decay
Urban decay is the process whereby a previously functioning city, or part of a city, falls into disrepair and decrepitude...
can also acts as a form of environmental racism
Environmental racism
Environmental racism is a sociological term referring to policies and regulations that disproportionately burden minority communities with negative environmental impacts....
, and in turn have an impact on public health. Urban minority communities may face environmental racism in the form of parks that are smaller, less accessible and of poorer quality than those in more affluent or white areas in some cities. This may have an indirect impact on health since young people have fewer places to play and adults have fewer opportunities for exercise.
Robert Wallace writes that the pattern of the AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
outbreak during the 80s was affected by the outcomes of a program of 'planned shrinkage
Planned shrinkage
Planned shrinkage is a public policy, practiced most notably in the 1970s in New York City, of withdrawing essential city services from neighborhoods suffering from urban decay, crime, and poverty so that neighborhoods may be claimed by outside interests for new development...
' directed in African-American and Hispanic communities, and implemented through systematic denial of municipal services, particularly fire extinguishment resources, essential for maintaining urban levels of population density and ensuring community stability. Institutionalized racism affects general health care as well as the quality of AIDS health intervention and services in minority communities. The overrepresentation of minorities in various disease categories, including AIDS, is partially related to environmental racism. The national response to the AIDS epidemic in minority communities was slow during the 80s and 90s showing an insensitivity to ethnic diversity in prevention efforts and AIDS health services.
Segregation
Some researchers suggest that racial segregation may lead to disparities in health and mortality. Thomas LaVeis (1989; 1993) tested the hypothesis that segregationRacial segregation in the United States
Racial segregation in the United States, as a general term, included the racial segregation or hypersegregation of facilities, services, and opportunities such as housing, medical care, education, employment, and transportation along racial lines...
would aid in explaining race differences in infant mortality rates across cities. Analyzing 176 large and midsized cities, LaVeist found support for the hypothesis. Since LaVeist's studies, segregation has received increased attention as a determinant of race disparities in mortality. Studies have shown that mortality rates for male and female African Americans are lower in areas with lower levels of residential segregation
Residential Segregation
Residential segregation is the physical separation of cultural groups based on residence and housing, or a form of segregation that "sorts population groups into various neighborhood contexts and shapes the living environment at the neighborhood level."...
. Mortality for male and female European Americans was not associated in either direction with residential segregation.
In a study by Sharon A. Jackson, Roger T. Anderson, Norman J. Johnson and Paul D. Sorlie the researchers found that, after adjustment for family income, mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
risk increased with increasing minority residential segregation among Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. In most age/race/gender groups, the highest and lowest mortality risks occurred in the highest and lowest categories of residential segregation, respectively. These results suggest that minority residential segregation may influence mortality risk and underscore the traditional emphasis on the social underpinnings of disease and death. Rates of heart disease among African Americans are associated with the segregation patterns in the neighborhoods where they live (Fang et al. 1998). Stephanie A. Bond Huie writes that neighborhoods affect health and mortality outcomes primarily in an indirect fashion through environmental factors such as smoking, diet, exercise, stress, and access to health insurance and medical providers. Moreover, segregation strongly influences premature mortality in the US.
Socioeconomic factors
A study by Christopher Murray contends the differences are so stark it is "as if there are eight separate Americas instead of one." Leading the nation in longevity are Asian-American women who live in Bergen County, N.J., and typically reach their 91st birthdays, concluded Murray’s county-by-county analysis. On the opposite extreme are American IndianIndigenous peoples of the Americas
The indigenous peoples of the Americas are the pre-Columbian inhabitants of North and South America, their descendants and other ethnic groups who are identified with those peoples. Indigenous peoples are known in Canada as Aboriginal peoples, and in the United States as Native Americans...
men in swaths of South Dakota, who die around 58.
- Asian-Americans, average per capita income of $21,566, have a life expectancy of 84.9 years.
- Northland low-income rural Whites, $17,758, 79 years.
- Middle America (mostly White), $24,640, 77.9 years.
- Low-income Whites in Appalachia, Mississippi Valley, $16,390, 75 years.
- Western American Indians, $10,029, 72.7 years.
- Black Middle America, $15,412, 72.9 years.
- SouthernSouthern United StatesThe Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive area in the southeastern and south-central United States...
low-income rural Blacks, $10,463, 71.2 years. - High-risk urban Blacks, $14,800, 71.1 years.
The risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting that socioeconomic inequities are the root causes of most of the differences.