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 What Is Race? E-mail to a friend
INTERACTIVITY from RACE: The Power of an Illusion, 2003

We all know that people look different. Anyone can tell a Czech from a Chinese. But are these differences racial? What does race mean? Find the answers to these and other questions by exploring different interactivities within this site.

There's less - and more - to race than meets the eye.

Image Thumbnail When the Bough Breaks - Transcript (pdf) E-mail to a friend
UNNATURAL CAUSES, Episode 2

African American infant mortality rates remain twice as high as for white Americans.  Black mothers with graduate degrees have as many low birth-weight babies as white women who haven’t finished high school. How does the chronic stress of racism over the life course become embedded in our bodies and increase risks?

Image Thumbnail When the Bough Breaks - Transcript with Citations (pdf) E-mail to a friend
UNNATURAL CAUSES, Episode 2, Copyright Vital Pictures 2008
Image Thumbnail Where Race Lives E-mail to a friend
INTERACTIVITY from RACE: The Power of an Illusion, 2003

Where you live in the U.S. isn't just a matter of preference. It's also about providing for the future. Does everyone have the same access to home ownership, good schools, and resources?

Explore how government policies and past discrimination have made generating wealth easier for some Americans than for others.

Image Thumbnail Why Our Greatest Health Concern Isn't Diet or Exercise - It's Neighborhood E-mail to a friend
OP-ED by Larry Adelman on AlterNet.org, February 19, 2009

Series Creator and Executive Producer Larry Adelman expands upon economist Robert Evan's analogy of health care as a repair shop to illustrate the crucial role that "road conditions" play in determining our health status.

Download as PDF.

Image Thumbnail Why Place & Race Matter: Impacting health through a Focus on Race and Place E-mail to a friend
PolicyLink

This report builds on PolicyLink's earlier work to look more intentionally and explicitly at race and ethnicity and what they mean in the context of building healthy communities. "Why Place and Race Matter" dives deeply into these issues and profiles dynamic groups and initiatives throughout California and beyond. Although approaches vary, each illuminates the interplay among people, place, and race. We hope these strategies and profiles will facilitate the exchange of ideas, encourage partnerships across disciplines and sectors, and stimulate action to build healthy communities.

Image Thumbnail Youth Empowerment Strategies (YES!) Anti-Violence Program in Richmond, California E-mail to a friend
WEB-EXCLUSIVE VIDEO, Unnatural Causes

Learn more about YES! - the after-school youth anti-violence program featured in "Place Matters."

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