Attachment--and loss.

Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health:

Racial residential segregation: A fundamental cause of racial disparities in health

Higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death. Other racial/ethnic minority populations also have elevated disease risk for some health conditions. This paper considers the complex ways in which race and socioeconomic status (SES) combine to affect health. SES accounts for much of the observed racial disparities in health. Nonetheless, racial differences often persist even at “equivalent” levels of SES. Racism is an added burden for nondominant populations. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health by restricting socioeconomic opportunities and mobility. 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.

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Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination

All Our Kin: Strategies for Survival in a Black Community. C. B. Stack. New York: Harper & Row. 1974. Carol Stack wrote one of the most powerful books of the last half century about African American families. The book's power derived from its focus on the stories and the lives of persons who were struggling to manage with limited resources and who had evolved seamless methods of survival and coping strategies. Stack was not content to view the problems of impoverished African American families from an outside perspective, as had been done in the past, but chose instead to present her work from the view of the participants. She presented a sensitive view of families that has not been duplicated to this day. Stack put specific emphasis on being accepted by the families before she began interviewing them. She and her son took a long time to be accepted by the families as they gradually became participants in the day-to-day lives of the "Flats." She was sensitive to the patterns of interactions among the networks of family and friends that would have been overlooked by almost any other researcher or method of observation. The book showed how a person from another racial and economic group was able, with skill, to become an intimate part of the experience and the lives of very poor families. Her anthropological approach stands in sharp contrast to the countless attempts of others to quickly go in and pull out slices of families' lives with a preexisting conceptual framework. The African American families of the Flats were presented as they were, not from a White academic theoretical perspective that was not based on reality. Stack made many observations that allowed one to see the intricate workings of the families that "outsiders" had not been documented before. Participants were allowed to make observations about their own families' patterns of interaction and to uncover truths of family functioning based on the reality of their lives. Important data on these second-generation urban dwellers are presented in such a calm manner that one could overlook their significance to the field. The impact of the economic pressures on the men and women in the African American community show how persons can have mainstream values but are prevented from achieving them because of the lack of employment and economic security within the community. In response to the reality, Stack found that African Americans have cooperated to produce an adaptive strategy of exchanging goods and trading resources, as well as offering child care or temporary fosterage. Kinship boundaries were more elastic than they were in more affluent families because these individuals immersed themselves in a domestic network of kinfolk and fictive kin, or those who became as kin. The participants in Stack's study moved around and had loyalties to more than one household grouping at a time, making their family networks unlike the "household" structures of most American families. These networks were diffused over several kin-based households that changed frequently. The usual method of arbitrarily specifying widely accepted definitions of the family as nuclear or matrilocal may block one from seeing the world as it exists in very poor communities. Stack's observations refuted the "culture of poverty" position that had seen African Americans as having no culture or totally negative qualities of family disorganization, personal disorganization, and fatalism. Unfortunately, too many current writings on African Americans still take these same positions. The views may be the result of ignorance, naivete, or complex levels of racism that insidiously make their way into present family literature. Stack continued to reflect on the poverty of the participants' situations. By doing so, she avoided another position that is all too common-assumption that all African American families are the same, regardless of their levels of poverty or affluence. …

All Our Kin: Strategies for Survival in a Black Community

THE STATE OF THE CHILD: 1985 is an update of an earlier report on children in Illinois published in 1980. Like its predecessor it presents trends in selected social indicators of childrens lives. It describes facts about who the children are where they live the composition of their families their economic situation their experience in care away from home their health the violence in their lives their expression of alienation from themselves and from society the nature of their attachment to school and to work and the character of the local environment in which they live and grow. Where possible it compares the situation of children today with their situation 5 years ago and identifies some of the key policy changes that have occurred during this period. The present report follows the convention established in the previous report of not advocating particular solutions to the problems documented by the indicators. Although the logic of Maltusian economics suggests that fewer child dependents ought to translate into improved societal provision for children and youth in their families schools neighborhoods and in the marketplace the paradox is that the collective condition of children and youth in our society has worsened. A larger proportion of children live in poverty their fathers are more likely to be absent their welfare support is more meager their family care is less secure and their participation in the labor force is more problematic. One of the explanation for this divergence from expections is that the reduction in the birth rate that underlies the numerical decrease in child dependents in Illinois is occurring more rapidly among older upper income and better educated couples. A second finding is that the care provided to children in families increasingly involves only 1 paretn mother. Changing family organization and increased child poverty provide the context for the finding that the care provided children in families is increasingly at risk of disruption by out-of-home replacement

Mark F. Testa

Papers

The state of the child: 1985.

Flexibility, Innovation, and Experimentation