Is Racism a Fundamental Cause of Inequalities in Health?

Is Racism a Fundamental Cause of Inequalities in Health?

Authors and Affiliation

  • Jo C. Phelan, Department of Sociomedical Sciences, Columbia University

  • Bruce G. Link, Department of Epidemiology, Columbia University, New York State Psychiatric Institute, New York, New York 10032

  • Contacts: jcp13@columbia.edu, bgl1@columbia.edu

Abstract

  • Key concepts: Racism, race, health inequalities, fundamental causes.

  • Thesis Statement: SES (socioeconomic status) is a fundamental cause of health inequalities. Both systemic racism and SES contribute to racial disparities in health outcomes.

  • Conclusion: Racial inequalities in health are primarily due to racism, leading to SES differences which further exacerbate health inequalities. Racism has a direct impact on health independent of SES, influencing power, prestige, neighborhood context, and healthcare access.

Introduction

  • Emphasis on SES as a crucial cause of health disparities.

    • Key feature: Persistent health inequalities despite changes in diseases, health risks, and treatments.

  • Racial health disparities have similarly persisted; hence, racism is assessed as a potential fundamental cause of health inequalities.

  • Implication: Eradicating racial disparities in health requires addressing racism directly, not just intermediary risk factors.

SES as a Fundamental Cause of Health Inequalities

  • Foundation of Fundamental Cause Theory: Developed by Link & Phelan in 1995, explaining SES mortality associations persisting over centuries despite environmental changes.

  • Historical Context: Health inequalities linked to ongoing social inequalities, stemming from major public health shifts (e.g., diseases and health risks).

  • Key Features of Fundamental Causes:

    • Resources allowing risk reduction and health advantages across various diseases.

    • Flexibility in resource use leads to enduring disease associations, irrespective of changing disease landscapes.

  • Long-Term Impact: Health inequality cannot be solved simply by addressing risk factors; must resolve underlying resource inequalities.

Exploring Racism as a Fundamental Cause of Health Inequalities

  • Racial Health Disparities in the U.S.: Black Americans demonstrate worse health outcomes and shorter life expectancies compared to white Americans.

    • Example: 2010 data indicated life expectancy for black Americans was 75.1 years vs. 78.9 years for white Americans.

  • Historical data traces racial health disparities, highlighting persistent mortality inequalities even through social changes.

  • Main Hypothesis: Racism indirectly and directly affects health outcomes through its influence on SES and other racial-related resources.

  • Conceptual Model Illustration: Connections between systemic racism, racial differences in SES, and flexible resources vital for health outcomes.

Relationship Between Racism and SES

  • Contrasts between black and white Americans in various SES indicators:

    • Median household income: Black Americans earn approximately 60% of white household income.

    • Wealth: Black family wealth is less than 17% of white wealth.

    • Education: 31% of whites possess a bachelor’s degree vs. 21.2% of blacks.

  • Systemic Racism Concept:

    • Associated with historical advantages for whites and systemic structures preserving power dynamics across numerous social institutions (government, education, media, etc.).

  • Changing Mechanisms: Throughout history, mechanisms linking systemic racism to SES have shifted (e.g., from slavery to segregation laws, then to covert discrimination).

Flexible Resources Related to Racism and Health Inequalities

  • Definitions of Flexible Resources: Abstract and adaptable resources affecting health; racism creates inequalities in these resources across racial groups.

  • Resources of interest:

    • Prestige: Inherent value and recognition tied to social status, often perpetuated by stereotypes and implicit biases.

    • Power: Direct and indirect control exerted by racial group members; black power dynamics altered due to systemic racism.

    • Freedom: Capacity to control personal life circumstances and actions, constrained by institutional racism.

    • Beneficial Social Connections: Racial segregation limits access to advantageous networks and collective resources, impacting health outcomes.

Implications of Racism on Health Outcomes

  • Health Disparities: Multiple studies demonstrate that racial disparities exist across a variety of health metrics even when SES is controlled.

    • Evidence shows black Americans face heightened mortality risks for nearly all significant causes of death (8 out of 10 leading causes in 2000).

    • Residual health differences largely cannot be explained purely by differences in SES.

  • Mechanisms Linking Racism to Health Outcomes:

    • Stress from discrimination is emphasized as a critical health risk factor, affecting both physical and mental health through physiological stress responses and chronic pathways.

    • Neighborhood effects are significant, linking the context of living environments with chronic health issues.

Area-Specific Disparities

  • Neighborhoods with high black populations generally have fewer resources (e.g., grocery stores, medical facilities), inferior education, and increased exposure to harmful conditions.
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Conclusion

  • Racial disparities in health are largely attributable to systemic racism functioning as a fundamental cause of inequities in SES.

  • There is a strong need for policies targeting racism specifically, alongside initiatives to address SES inequalities, given that interventions focusing only on one aspect may not lead to lasting health equity.