Race and Age: Critical Intersections in Addressing Ageism and Health
Introduction to Race and Age in Health
Critical Intersection: The presentation by Andrea Miller, LMSW, for SW355: "Addressing Ageism and Health," focuses on the crucial intersection of race and age.
GVSU General Education: US Diversity Definition
The U.S. is characterized by increasing diversity, encompassing individuals from a multitude of backgrounds.
This diversity presents both opportunities and challenges, including the pervasive issue of systemic racism.
Power and privilege are identified as fundamental forces that shape relationships and institutions within this diverse landscape.
Profile of the Diverse Aging Population
Growing Diversity:
of older Americans identify as a racial or ethnic minority.
This translates to million out of million older adults ().
Older adults also demonstrate diversity across various dimensions, including gender, socioeconomic status (SES), caregiving roles, and geography.
Census data consistently indicates a continuous growth in racial and ethnic diversity over time within the older adult population.
US Population by Race & Ethnicity (2024 data):
White: of the total population.
Latino/Hispanic:
Black:
Asian:
Groups identifying as multiple races and Indigenous/Native groups are experiencing a proportional increase.
Trends: The share of the White population is declining, while the share of multiracial and Latino populations is rising significantly (e.g., White Americans constituted in ).
Driving Forces of Diversity Trends & Immigration:
Population changes are not solely driven by immigration.
Fertility rates, the aging of existing populations, and shifts in racial/ethnic identity also contribute significantly to racial diversification.
Projection: The U.S. is projected to become increasingly multiracial and Latino in the coming decades.
By 2050, projections are:
Non-Hispanic White:
Hispanic:
Black:
Asian:
Key Theories on Race, Age, and Disadvantage
Diminished Return Theory:
Core Concept: High socioeconomic status and income do not provide equal protection or benefits for minority older adults compared to their White counterparts.
Example: For African Americans, achieving higher income levels does not necessarily lead to better mental health outcomes.
Implication: Racial disparities in health and well-being persist even when individuals reach higher socioeconomic levels.
Double Jeopardy Theory:
Coined by: Dowd & Bengston ().
Argument: Argues that the combination of race and age results in a compounded disadvantage.
Explanation: This theory helps explain health disparities, where, for instance, Black older adults face cumulative negative effects stemming from lifelong discrimination.
Intersectionality:
Coined by: Kimberlé Crenshaw ().
Definition: Examines how various social and political identities (such as race, gender, age, class, sexual orientation, disability, etc.) combine to create unique experiences of discrimination and privilege.
Critique of Single-Axis Analysis: Argues that analyzing oppressions in isolation (e.g., focusing only on race or only on gender) cannot adequately explain the complex, multidimensional nature of oppression experienced by individuals with multiple marginalized identities.
Most Studied Intersection in Gerontology: Gendered ageism, which explores the combined impact of ageism and sexism, particularly on older women.
Specific Populations and Intersectional Challenges
Older LGBTQ+ Adults:
Profile: A diverse population within itself, facing unique disparities.
Disparities: Experience higher rates of cognitive impairment and poverty compared to heterosexual, cisgender older adults.
Social Networks: Often rely on friend-centered networks due to historical exclusion from traditional family structures and societal marginalization.
"Gay Ageism": A specific form of discrimination resulting from the intersection of ageism and LGBTQ+ status.
Policy & Advocacy: SAGE's (Advocacy & Services for LGBTQ+ Elders) advocacy efforts led to Administration for Community Living (ACL) updates, officially recognizing LGBTQ+ elders and older adults with HIV as groups with a 'most significant social need,' qualifying them for targeted support.
Research: The "Aging with Pride: IDEA study" is highlighted as the first federally funded dementia intervention specifically designed for LGBTQ+ older adults.
Older Black & Latinx LGBTQ+ Adults:
Experiences: Report significantly higher levels of perceived racism and homophobia compared to their White LGBTQ+ counterparts.
Discrimination: Face greater cumulative lifetime discrimination.
Support Deficiencies: Frequently lack robust emotional and social support networks.
Fear of Disclosure: Harbor a significant fear of disclosing their identities in healthcare and social service settings due to past negative experiences or anticipated discrimination.
Advocacy Organizations:
NCBA (National Caucus & Center on Black Aging): Dedicated to championing the rights and well-being of Black elders.
NHCOA (National Hispanic Council on Aging): Works to empower Latino elders and their caregivers.
Implications for Professionals (Healthcare & Social Work)
Core Responsibilities and Ethical Mandates:
Address Intersectionality: Professionals in healthcare and social work must consciously address intersectionality in their practice when working with aging populations.
Understand Lived Experiences: Gaining a deep understanding of the unique lived experiences of diverse older adults is crucial for effective and culturally competent care.
Advocate for Systemic Change: A commitment to advocating for systemic changes is necessary to reduce the pervasive effects of racism and ageism.
Commit to Equity, Dignity, and Social Justice: Professionals have an ethical responsibility to uphold equity, ensure dignity, and promote social justice in all aspects of their practice.
Ethical Foundation: The NASW (National Association of Social Workers) Code of Ethics explicitly calls for professionals to challenge injustice and to respect the inherent dignity and worth of all people, directly aligning with the principles discussed.
ntroduction to Race/Ethnicity as a Health Indicator
Race and ethnicity profoundly influence an individual's health across a multitude of domains, especially in later life.
This influence is not random but is systematically tied to inequities that shape health outcomes.
Key areas impacted include:
Longevity (life expectancy)
Physical conditions
Mental health
Functioning (daily activities)
Socioeconomic & environmental factors
Racial Differences in Life Expectancy
There are consistent and significant gaps in U.S. life expectancy when analyzed by race/ethnicity.
Black and Native populations consistently exhibit shorter life expectancies compared to other groups.
Latino paradox: A puzzling phenomenon where Latino populations often demonstrate a longer life expectancy despite facing socioeconomic disadvantages (Andrasfay & Goldman, 2021).
Nutrition and Malnutrition
Food insecurity is a critical issue that disproportionately affects:
Minority older adults
Low-income groups
Renters
Approximately of urban older adults are categorized as having a high nutrition risk.
Black elders represent the largest proportion of older adults at nutritional risk.
Hispanic elders show the most concerning nutrition profiles.
Consequences of Malnutrition: It is directly linked to increased morbidity (illness), mortality (death), and accelerated physical decline.
Racial Health Disparities
Health disparities are observed across various aspects of health:
Disease burden (prevalence and severity of illnesses)
Diagnosis patterns
Treatment approaches and effectiveness
Overall quality of life
Health behaviors
Access to healthcare services
These disparities are inherently systemic, meaning they are not random or due to individual choices alone, but rather embedded in societal structures and policies.
Health outcomes are shaped by the powerful intersection of age, race/ethnicity, and socioeconomic status (SES).
Link Between Race and Health
Older Black adults experience a more rapid rate of physiological dysregulation, which is a breakdown in the body's stress response systems.
Contributing factors to this accelerated dysregulation include:
Economic hardship
Inadequate access to preventive care
Structural barriers within society and healthcare
Challenges in managing chronic diseases
Chronic stress stemming from discrimination
Functioning Limitations
Black older adults face a significantly higher risk of limitations in:
Activities of Daily Living (ADLs): Basic self-care tasks like bathing, dressing, eating.
Instrumental Activities of Daily Living (IADLs): More complex tasks like managing finances, cooking, shopping, using transportation.
These disparities persist even when comparing individuals across different education and income groups (Chen et al., 2021; Tipirneni et al., 2021).
The presence of these limitations indicates a higher need for care earlier in later life among Black older adults.
Mental Health: Depression
There is a higher prevalence and severity of depression among older Black and Hispanic adults.
These groups are also less likely to receive adequate or appropriate treatment for depression.
Experiences of everyday discrimination and chronic stress are directly linked to an increased risk of depression in older adults (Barry et al., 2014; Vyas et al., 2020).
Dementia & Cognition
Dementia disproportionately affects non-White populations.
Risk factors such as untreated hypertension and other health disparities significantly increase the risk of developing dementia.
Persistent experiences of chronic discrimination and stress contribute to a higher risk of neurocognitive impairment (Chen & Zissimopoulos, 2018; Nkwata et al., 2021).
Racial Wealth and Homeownership Gap
Black and Hispanic households possess considerably less wealth and have lower rates of homeownership compared to White households.
Alarmingly, the homeownership gap is wider in the present day than it was during periods of explicit segregation (Ray et al., 2021).
Significant disparities also persist in retirement assets and overall financial security for minority populations (Federal Reserve, 2019; Smith, 2020).
Justice and Incarceration
Black adults are incarcerated at nearly the rate of White adults.
Latinx adults are more likely to be incarcerated than White adults.
The U.S. is facing an **
Race-Based Stress Over Time and Resilience (SW355: Addressing Ageism and Health)
This presentation by Andrea Miller, LMSW, explores race-based stress, its historical and systemic roots, and the concept of resilience in coping with its effects.
The "Pyramid" of Race-Based Stress
Visible "Tip of the Iceberg": Race-based stress is presented as the visible manifestation of systemic racism.
Underlying Components (The Submerged "Iceberg"):
Historical race-based trauma and stress: Refers to the profound, enduring mental and emotional injury inflicted by past racial injustices.
Collective and community trauma: Involves shared psychological and emotional harm experienced by entire groups or communities due to systemic racism.
Individual cumulative lifelong stress: Encompasses the ongoing, accumulating stress experienced by individuals over their lifespan due to racial prejudice and discrimination.
Historical Context of Race-Based Stressors
Native Americans:
Presence in North America for over years.
Forced relocation to reservations.
Traumatic experiences in boarding schools aimed at assimilation.
Enslaved Africans:
Period of enslavement from to .
Legacy of slavery and the Civil War.
The th Amendment abolished slavery but was followed by other forms of oppression.
Asian Immigrants:
Significant immigration period from to .
Enactment of the Chinese Exclusion Act, severely restricting Chinese immigration.
Post-Slavery to Civil Rights Era:
Jim Crow laws: Legally enforced racial segregation and discrimination.
Systemic segregation in housing, education, and public spaces.
Brown v. Board of Education: Landmark Supreme Court case challenging school segregation.
Civil Rights Act: Legislation aimed at ending discrimination based on race, color, religion, sex, or national origin.
Systemic Racism
Roots: Fundamentally rooted in colonialism and capitalism.
Nature: It is not merely a matter of individual bias but represents persistent, structured inequity embedded within institutions and society.
Impact: Creates collective and generational trauma, affecting the well-being of entire communities across generations.
Fueling Factor: Zero-sum thinking—the belief that one group's gain is another's loss—fuels white supremacy (McGhee, ).
Racism as a Cumulative Stressor
Definition: Racism is characterized as a chronic, unjust, and cumulative stressor.
Multi-level Impact: Affects health at individual, community, and generational levels.
Consequences: Leads directly to significant health inequities and profound human rights violations.
Racial Microaggressions
Definition (Sue et al., ): Subtle, everyday verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color.
Three Types of Microaggressions (Sue et al., ):
Microassaults: Explicit racial derogatory attacks or slurs, often conscious and intentional discriminatory acts.
Microinsults: Subtle communication or snubs that convey rudeness or insensitivity and demean a person's racial heritage or identity, often unconsciously. Example: "How did you get this job?" implying they might not have earned it.
Microinvalidations: Communications that subtly exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color. Example: "I don't see color," which dismisses the lived racial experiences of individuals.
Impact: Microaggressions collectively undermine identity, erode mental health, and contribute to chronic stress.
Cumulative Inequality Theory
Core Principle: Early disadvantages accumulate over time, leading to significant disparities in later life.
Significance of Exposure: The timing and duration of stress exposure are critical factors influencing long-term outcomes.
Consequence: Cumulative stress ultimately leads to functional limitations in later life.
Demographic Disparities: This theory shows stronger indirect effects for Black and Hispanic older adults, indicating they experience greater accumulated disadvantage.
Resilience: Individual
Definition: The ability to bounce back, maintain health, and effectively recover from stress or adversity.
Role: Acts as a crucial protective factor against the detrimental impacts of racism and trauma.
Measurement: Often measured using tools such as the Brief Resilience Scale (Smith et al., ), which assesses an individual's perceived ability to recover from stress.
Key Factors Contributing to Individual Resilience:
Self-efficacy: Belief in one's capacity to succeed in specific situations or accomplish a task.
Optimism: A general expectation that good things will happen.
Mastery: The belief that one has control over life circumstances.
Empowerment: The process of becoming stronger and more confident.
Social support: Access to networks of people who can provide emotional, practical, and informational aid.
Coping strategies: Effective methods used to deal with stressful situations.
Spirituality: Connection to something larger than oneself, providing meaning and purpose.
Resilience: Collective
Definition: Community resilience refers to the ability of a community to absorb strain and build collective capacity in the face of adversity.
Protective Processes in Collective Resilience:
Storytelling and creativity: Means of processing trauma, affirming identity, and transmitting cultural knowledge.
Solidarity and sense of community: Developing strong bonds and mutual support among community members.
Spirituality: Shared spiritual practices or beliefs that provide comfort, meaning, and collective strength.
Hope for change: A collective belief in the possibility of a better future and motivation to work towards it.
Becoming an Antiracism Practitioner
Self-Examination: Crucial to self-examine one's own values, beliefs, and behaviors in relation to race and equity.
Commitment to Action: Involves a dedication to practices that actively promote equity and human rights.
Definition of Anti-racism: Anti-racism is understood as proactive action against racism, going beyond mere absence of racist acts or beliefs.