Place, Not Race: Disparities Dissipate In Southwest Baltimore When Blacks And Whites Live Under Similar Conditions
TL;DR: Focusing on a racially integrated, low-income neighborhood of Southwest Baltimore, Maryland, it is found that nationally reported disparities in hypertension, diabetes, obesity among women, and use of health services either vanished or substantially narrowed and that when social factors are equalized, racial disparities are minimized.
Abstract: Much of the current health disparities literature fails to account for the fact that the nation is largely segregated, leaving racial groups exposed to different health risks and with variable access to health services based on where they live. We sought to determine if racial health disparities typically reported in national studies remain the same when black and white Americans live in integrated settings. Focusing on a racially integrated, low-income neighborhood of Southwest Baltimore, Maryland, we found that nationally reported disparities in hypertension, diabetes, obesity among women, and use of health services either vanished or substantially narrowed. The sole exception was smoking: We found that white residents were more likely than black residents to smoke, underscoring the higher rates of ill health in whites in the Baltimore sample than seen in national data. As a result, we concluded that racial differences in social environments explain a meaningful portion of disparities typically found in national data. We further concluded that when social factors are equalized, racial disparities are minimized. Policies aimed solely at health behavior change, biological differences among racial groups, or increased access to health care are limited in their ability to close racial disparities in health. Such policies must address the differing resources of neighborhoods and must aim to improve the underlying conditions of health for all.
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TL;DR: To address race disparities in diabetes, policymakers should address problems created by concentrated poverty, and housing and development policies in urban areas should avoid creating high-poverty neighborhoods.
Abstract: Objectives We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalenceMethods We used data from the 1999–2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial composition and poverty concentration on the odds of having diabetesResults We found a race–poverty–place gradient for diabetes prevalence for Blacks and poor Whites The odds of having diabetes were higher for Blacks than for Whites Individual poverty increased the odds of having diabetes for both Whites and Blacks Living in a poor neighborhood increased the odds of having diabetes for Blacks and poor WhitesConclusions To address race disparities in diabetes, policymakers should address problems created by concentrated poverty (eg, lack of access to reasonably priced fruits and vegetables, recreational facilities, and health care services; high crime rates; and greater exposures to
289 citations
TL;DR: This article reviews the research literature on diminished gain and discusses possible causes for it, such as the societal barriers created by structural racism, and policy solutions that may reduce Blacks’ diminished gain.
Abstract: There are persistent and pervasive disparities in the health of Black people compared to non-Hispanic Whites in the United States. There are many reasons for this gap; this article explores the role of “Blacks’ diminished gain” as a mechanism behind racial health disparities. Diminished gain is a phenomenon wherein the health effects of certain socioeconomic resources and psychological assets are systematically smaller for Blacks compared to Whites. These patterns are robust, with similar findings across different resources, assets, outcomes, settings, cohorts, and age groups. However, the role of diminished gain as a main contributing mechanism to racial health disparities has been historically overlooked. This article reviews the research literature on diminished gain and discusses possible causes for it, such as the societal barriers created by structural racism. Policy solutions that may reduce Blacks’ diminished gain are discussed.
278 citations
TL;DR: It is concluded that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health.
Abstract: Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic ...
182 citations
Cites background from "Place, Not Race: Disparities Dissip..."
...…indicates that whites and blacks living in the same integrated, lowincome neighborhood have either nonexistent or much smaller differences in prevalence of hypertension, diabetes, obesity, and other health behaviors compared to national estimates of racial differences (LaVeist et al. 2011)....
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..., neighborhood characteristics) (LaVeist et al. 2011) and the psychological stress of social disadvantage (Lantz et al....
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...However, we acknowledge that it is rarely the case that whites find themselves in contexts identical to those in which blacks find themselves, even when living in poverty (LaVeist et al. 2011)....
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...…settings, the prevalence of these health conditions among whites is much more similar to the average for blacks (i.e., whites in these settings have higher prevalence of hypertension, obesity, and diabetes than national averages, as expected based on fundamental cause theory) (LaVeist et al. 2011)....
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...Email: bmezuk@vcu.edu The source of this missing variance is thought to be attributable to the contextual physical and social environment (e.g., neighborhood characteristics) (LaVeist et al. 2011) and the psychological stress of social disadvantage (Lantz et al. 2005)....
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TL;DR: The AAP recommends more research, both in the United States and internationally, on measures of race, ethnicity, and SES and how these complex constructs affect health care and health outcomes throughout the life course.
Abstract: An extensive literature documents the existence of pervasive and persistent child health, development, and health care disparities by race, ethnicity, and socioeconomic status (SES). Disparities experienced during childhood can result in a wide variety of health and health care outcomes, including adult morbidity and mortality, indicating that it is crucial to examine the influence of disparities across the life course. Studies often collect data on the race, ethnicity, and SES of research participants to be used as covariates or explanatory factors. In the past, these variables have often been assumed to exert their effects through individual or genetically determined biologic mechanisms. However, it is now widely accepted that these variables have important social dimensions that influence health. SES, a multidimensional construct, interacts with and confounds analyses of race and ethnicity. Because SES, race, and ethnicity are often difficult to measure accurately, leading to the potential for misattribution of causality, thoughtful consideration should be given to appropriate measurement, analysis, and interpretation of such factors. Scientists who study child and adolescent health and development should understand the multiple measures used to assess race, ethnicity, and SES, including their validity and shortcomings and potential confounding of race and ethnicity with SES. The American Academy of Pediatrics (AAP) recommends that research on eliminating health and health care disparities related to race, ethnicity, and SES be a priority. Data on race, ethnicity, and SES should be collected in research on child health to improve their definitions and increase understanding of how these factors and their complex interrelationships affect child health. Furthermore, the AAP believes that researchers should consider both biological and social mechanisms of action of race, ethnicity, and SES as they relate to the aims and hypothesis of the specific area of investigation. It is important to measure these variables, but it is not sufficient to use these variables alone as explanatory for differences in disease, morbidity, and outcomes without attention to the social and biologic influences they have on health throughout the life course. The AAP recommends more research, both in the United States and internationally, on measures of race, ethnicity, and SES and how these complex constructs affect health care and health outcomes throughout the life course.
156 citations
TL;DR: It is found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children and interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health.
Abstract: Methods We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child’s school) using partially adjusted models. Results There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child’s school were the most substantial mediators of racial and ethnic disparities. Conclusions We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child’s school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.)
150 citations
References
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01 Jan 1988
TL;DR: An ecological model for health promotion is proposed which focuses on both individual and social environmental factors as targets for health promotions and addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy factors which support and maintain unhealthy behaviors.
Abstract: During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
6,234 citations
TL;DR: It is concluded that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity.
Abstract: ▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...
2,696 citations
TL;DR: In this paper, 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, and conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.
Abstract: 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.
2,027 citations
Journal Article•
TL;DR: Evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status by determining access to education and employment opportunities and that effective efforts to eliminate racial disparities in health must seriously confront segregation is reviewed.
2,027 citations
TL;DR: The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings.
Abstract: Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings Directions for future research on the creation and maintenance of health promotive environments also are examined
1,851 citations