Origins of Health Disparities in Racial and Ethnic Minorities in the United States

Origins of Health Disparities in Racial and Ethnic Minorities in the United States

Hannah Eaton
Fall 2013
Health Policy and Health Systems
December 11, 2013

Health disparities are a huge cause for concern in the United States. The term health disparities is generally referred to as health or health care differences between racial/ethnic groups and includes differences in morbidity, mortality, and access to health care (LaVeist & Issac, 12). When comparing the health outcomes between non-Hispanic whites and minorities, the differences in inequality are substantial. For various and numerous health conditions, non-Hispanic blacks suffer disproportionately from disease, injury, death, and disability compared to non-Hispanic whites (1). In 2006, the overall mortality rate for blacks was 28 percent higher than whites. (LaVeist, 21). Similarly, Hispanics/Latinos also experience disproportionate health outcomes when compared to non-Hispanic whites (2). Among nonelderly adults, 16 percent of black Americans and 17 percent of Hispanics report that they are in only fair or poor health, while only 10 percent of white Americans report the same (AHRQ). Additionally, according to data from the National Center for Health Statistics, 2002, black Americans have death rates that are substantially higher than white Americans for both men and women. Black males have a death rate that is 35 percent higher than white men while the death rate for black women is 29 percent higher than white women. In this paper I investigate the most likely causes as to why these disparities in health and health care exist between white Americans and racial/ethnic minorities, particularly African Americans.
After thoroughly conducting research, one of the main causes that attributes to inequality in health and health care among racial and ethnic minorities is socioeconomic status. Socioeconomic status is generally defined through a combination of income, education, and occupation statuses (APA). To further explain, when an individual’s level of education increases, their occupational status also tends to increase, along with their income. Richard Shewder reported on his research about health among the U.S. public in a New York Times article in 1997 and concluded that “lower middle-class Americans are more mortal, morbid, symptomatic and disabled than up-middle-class Americans. With each little step down on the educational, occupational and income ladders comes an increased risk of headaches, varicose veins, hypertension, sleepless nights, emotional distress, heart disease, schizophrenia and an early visit to the grave.” This actuality is often referred to as “the status syndrome”. Furthermore, data strongly suggests that the relationship between SES and health is not a threshold actuality. Rather, it follows a continuous model, which alludes that whatever association there is between socioeconomic status and health exists at all levels (Barr, 53).
There are two main factors that contribute to “the status syndrome”. The first is the perception of relatively less privilege. In Donald A. Barr’s “Health Disparities in the United States”, he describes this phenomenon, “when one perceives the structure of the social system in which he or she lives as controlling, to a large extent, the outcomes of one’s life, that person is likely to place less emphasis on reducing individual behaviors that are known to adversely affect long-term health outcomes.” To further justify, a study conducted by the U.S. Department of Health and Services concludes that poor people have a smoking rate that is two times the smoking rate of high-income people for both males and females (Barr, 62).
A number of researches have also suggested that health status is in accordance with the level of inequality within that society. One hypothesis that explains this phenomenon states that societies that allow large income disparities are societies that tend to invest insufficient resources in human capital, health care, and other factors that promote health (Kawachi, Kennedy, Lochner, Prothrow-Stitch). It is also theorized that the increasing inequality has led to a succession in social capital. Social capital refers to characteristics of social relationships that promote cumulative action for mutual benefit (Barr, 89). A study conducted in 1997 compared responses from a survey, which questioned individuals’ level of trust in their own community, to health data gathered from that community. There was a marked association between perceptions of trust within a community and death rates from heart disease, cancer, and infant mortality (Barr 89-90). Additionally, social trust and group member ship are tightly linked with socioeconomic features, such as educational acquirement, according to analyses that controlled for poverty levels (Kawachi, Kennedy, Lochner, Prothrow-Stitch).
A second factor contributing to the “status syndrome” is material deprivation (Barr). With an increased socioeconomic status comes an increase in access to resources. An abundant number of studies have concluded that low-income communities are more likely to be exposed to environmental hazards, crowded and substandard housing, and lack quality school systems (Williams, 8).
Several studies have suggested that a possible contributor to the continuous relationship between socioeconomic status and health is the increased level of stress and chronic stress experienced by those living in disadvantaged homes and communities. (Barr, 73). Dr. Bruce S. McEwin, director of the neuroendocrinology laboratory at the Rockefeller University, has studied the subject for over thirty years. His research suggests that the interaction between environmental demands and the body’s capacity to manage possible external threats results in problems associated with stress. When the body’s stress load becomes severe or persists for too long without proper time to wane, the immune system can cripple. Other outcomes include straining of the heart, damage to memory cells, and the deposition of fat in the wrong areas (Vaccination News). Stress has also been strongly associated with increased heart rate and elevated levels of blood pressure, which is firmly linked to increased rates of heart attacks, stroke, kidney disease, and other illnesses (Barr, 78).
As discussed above, one’s socioeconomic status is a strong indicator of their overall health outcome of racial/ethnic minorities. However, when controlling socioeconomic status, African Americans have lower levels of life expectancy at every level of income (Williams, 176). Therefore, race itself must play a role in health disparities among racial/ethnic minorities.
Biological variation certainly exists among the human race, but the differences in genetics between different races are tiny compared to the amount of genetic variation within racial groups (Williams, 176). One substantial contributor to health disparities of racial/ethnic minorities is racism.
The historical and political discrimination and racism against minorities in the U.S. is a subject that all Americans have learned about or grown up with. For my investigation, the term racism represents LaVeist and Issac’s definition, “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation.” Racial/ethnic discrimination that persists places a disproportionate hardship of illness and premature death by those who experience it (LaVeist, Issac, 36). Perceived discrimination of racism can have psychological, physical, and behavioral affects on health. Discussed above, chronic stress has been discovered to increase risk for coronary artery disease, stroke, cognitive impairment, substance abuse, anxiety, depression and mood disorders (Smedley). So exposures to persistent discrimination generates a burden of stress to racial/ethnic minorities in addition to those who already obtain and experience lower health outcomes that are related to their lower socioeconomic status.
One effect of racism on racial/ethnic minorities is the restriction of socioeconomic advancement. Residential segregation creates and reinforces this inequality. Beliefs about black inferiority in the early 20th century led to policies that were instrumental in creating physical separation between blacks and whites. Several social institutions participated to enforce this separation. Banks were discriminatory in their lending practices, federal housing policies were created, and the real estate industry, as well as neighborhood organizations, participated in discrimination practices to ensure that blacks were confined to the most disadvantageous residential areas (Williams, 178). One result of residential segregation is the concentration of poverty, which in turn results in the concentration of poverty in school systems. In contrast to poor whites, many do not live in areas of concentrated poverty, and therefore have access to more desirable educational opportunities (Williams, 179). When looking at data from the U.S. Census Bureau, whites are less likely than blacks to never graduate from high school and to graduate from high school but not continue on to higher education. Additionally, substantially more white Americans finish college, obtain a master’s degree, and/or obtain a doctorate or professional degree compared to black Americans. Furthermore, white American men earn incomes that are higher than black American men at all levels of educational status (Barr, 48-49). This explains a possible cause for the higher death rate in black Americans considering Shewder’s conclusion based of the health of the U.S. public.
Each of these developments burdens racial minority groups, particularly blacks, in terms of their health. With little access to quality education, blacks have a higher chance of gaining an education worth less than that of whites. Their below-average education results in occupying an occupation with a lower income of whites, therefore resulting in a lower socioeconomic status. As discussed above, socioeconomic status is a clear indicator of health. With blacks having an increased chance of maintaining a low socioeconomic status, their outcome of health is bound to be disproportionately lower than that of whites.
One other result of residential segregation on the health of racial/ethnic minorities is the low quality conditions that minorities live in. Those living in segregation tend to have less access to health services, live in environments of neglect and deterioration, and tend to be exposed to environmental toxins and poor-quality housing (Williams, 183).
One aspect that could decrease the level of inequality in health status of racial and ethnic minorities is by increasing housing options for minority communities. This can potentially lead to racial/ethnic minorities having increased opportunities to attend quality schools, live in communities with higher social capital and less environmental hazards.
The research that I studied and analyzed discussed valid arguments as to why health disparities for racial/ethnic minorities exist. Another way to reduce these health disparities would to be to increase the amount of public health education. Extending this education into minority communities, as well as affluent communities. Increasing the awareness of health disparities of racial/ethnic minorities in America can increase the potential for policies to be made to reduce these disparities.
To conclude, two important contributors to the inequality between health in racial and ethnic minorities and the health in white Americans are socioeconomic status and race. Socioeconomic status follows a continuous model in that as one increases their socioeconomic status, their health outcome also increases. As for race, residential segregation has multiple effects on health. Perceived discrimination also takes a toll on the body due to the amount of stress it can cause. Increasing awareness of these disparities and increasing opportunities for minorities to obtain quality living and education are potential options to reduce the inequality in health for racial/ethnic minorities in America.

Web page:
1. "Health Disparities Experienced by Black or African Americans." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 14 Jan. 2005. Web. 10 Dec. 2013
2. "Health Disparities Experienced by Hispanics." JSTOR. Centers for Disease Control & Prevention (CDC), 15 Oct. 2004. Web. 10 Dec. 2013.
3. "Healthcare 411." Addressing Racial and Ethnic Disparities in Health Care. N.p., n.d. Web. 10 Dec. 2013.
Journal articles:
4. Williams, David R. "Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination." Annals of the New York Academy of Sciences 896.1 SOCIOECONOMIC (1999): 173-88. Print.
5. Kawachi, I., B. P. Kennedy, K. Lochner, and D. Prothrow-Stith. "Social Capital, Income Inequality, and Mortality." American Journal of Public Health 87.9 (1997): 1491-498. Print.
Book:
6. Barr, Donald A. Health Disparities in the United States: Social Class, Race, Ethnicity, and Health. Baltimore: Johns Hopkins UP, 2008. Print.
7. LaVeist, Thomas Alexis., and Lydia A. Isaac. Race, Ethnicity, and Health: A Public Health Reader. San Francisco, CA: Jossey-Bass, 2013. Print.