Archive for health
Yesterday, a few of us at the Graduate Center hosted an interdisciplinary group of scholars to think critically about ‘whiteness and health.’ Across the day, with a kind of staccato arousal, I was struck by several ideas, including the following:
- “Actionable Decoys” seemed to emerge as so many of the talks sketched the landscape of global, economic, and health “concerns” that are actually instances of structural injustice and violence in which “whiteness” comes to be privileged, the standard, normative, or even healthy, and people of color or those in poverty hold risk, contamination, disease, TB, waste. That is the racist landscape which is built into material conditions and cultural constructions; the “actionable decoys” are the sites of intervention that policy makers and public health advocates address. That is, instead of dealing with the power struggles of the Occupation in the Middle East, or structural/historic injustice in New Orleans following Katrina or in the Rockaways following Sandy, we address (just for a moment) mental illness. Or, instead of attending to the wide and deep reach of structural racism under the skin and in the mind, we invest in MRI machines and psycho-physiological indicators to “document” how brains light up around racial anxiety. Or, the public health fetish with TB framed as a housing issue, that then enables the state to enter and destroy poor people’s housing (Samuel K. Roberts, Lisa O’Sullivan).
- My worry of course is that “science” enables and creates a scientific lubrication and justification for the narrow shape of the problem, enabling a violent intervention that situates the problem in the body/mind/housing of racialized (and poor) people as if there were no connection to widening inequality gaps and swelling privilege. Thus, “actionable decoys” are the closing of public housing, obesity campaigns, limits on college access for formerly incarcerated students at the precise same time and as a reaction to the now quite predictable action of a white-boy-with-a-gun who blows up a community. What I want to argue is that actionable decoys appear to be a form of ‘care’, responding to the ‘pain’ and ‘crisis’ in communities of color (particularly low income), while occluding issues of structure, privilege, history, whiteness-as-healthy, and ultimately generating a privatized market or opportunities for elites (a new pharmaceutical drug, new housing in gentrified neighborhoods, new schools in same neighborhoods).
- In the language of social science, whiteness gets reinscribed as the independent variable (IV) becomes the dependent variable (DV). The grants we get, the funding and socialization of students are all saturated in a fundamental sea of epistemological violence so that “race disparities” (or “gender disparities” or both) reveal AND occlude the structural conditions of oppression in which gender/race/class/sexuality/disability… emerge as axes of power/lines of analysis – but not the Independent Variable to be ‘fixed. Funding streams fetishize “race” as a predictor (IV) and damage as an outcome (DV), occluding structure, history and the circuits that link privilege and marginalization
- Several people raised the specter of whiteness becoming a market (Nadia Abu El-Haj, Alondra Nelson, Lisa Brundage, Barbara Katz Rothman). I was struck by the contrast to the hyper-criminalization of people of color. The result then is that if you support the market you can avoid criminalization – the methadone/bupe/oxycotin discussion (Helena Hansen, Julie Netherland) was superb on this point – but like enlisting in the military, those with green cards may become citizens. If you give your body to the market or the military – feed the system, you can avoid being criminalized; but if you won’t, or can’t, the cage awaits.
- There were so many evocative and powerful ‘couplets’ during the same afternoon, it prompted me to think about other kinds of twinings, and the slippage between them. Questions arise about: Who is the addict vs. who is dependent? What is obscured vs. what is privileged? Likewise, I started thinking about who is the ‘sex addict’ (which a predominantly white, and flourishing industry) and who is the ‘sexual predator’ (more often a person of color, incarcerated)? In the panel on addition (Helena Hansen, Julie Netherland), I was led to wonder about who gets to be medicalized (bupenorphine) and who gets to be criminalized (methadone). And yet, it is so hard to speak about white pathology because as Richard Dyer suggests, it falls apart in your hands, or it appears merely ‘human.’ As Rebecca Tiger’s presentation suggested, it is difficult to talk about the “desire to excuse”Lance Armstrong , without the contrast of Whitney Houston, because it appears to ‘natural’ and ‘we are all fallible’ when the case is White, and elite. In many ways, this extends the work of Sarah Carney who found that in press accounts of “failure to protect laws” (in which children die through accident while parents are distracted), that Black mothers are treated much more harshly than either white mothers or white fathers.
- A corollary, as raised by Akemi Nishidi in conversation with Zinobia Bennefield, is that the “vulnerable” group or one under structural attack is often quick to distance from their more vile category-twin. Thus, communities of color rightfully point to the over-enrollment of special education students who are Black. “We Are Not Crazy” is a rallying cry from communities that have been painted with the lamination of insanity, or even trauma without addressing the structural attack on madness, and the slippery construction of this swampy categorization, the real pain and the fantasy of the absence of pain in those of us not labeled (see Rachel Leibert’s work on this).
- The eery presence of the (white)absence of white responsibility (more precisely white elites) was with us throughout the afternoon. It is so difficult to hold White people or whiteness accountable, to speak the structural benefits of whiteness without doubling it as merit. What this means is that whiteness makes it so hard to critique Lance Armstrong, or the white man whose child tragically dies in the back of his car, but so easy to condemn Whitney Houston, or the black mother when the same happens. It’s as though “white responsibility” is an oxymoron and black blame is redundant. Whiteness as Teflon.
- Finally, I was struck by the ironies of anti-racist interventions being co-opted and exploited, toward racist (or racial?) ends. So, for example, the Human Genome Diversity Project, or even the ‘discovery’ of bupe as an alternative to methadone, or the Implicit Association Test which measures unconscious racism, or the early ‘care’ given to persons/housing/communities with TB or VD, all of these presumably (maybe not bupe) emerged out of concern for communities of color, concern about racism, but all of these have been inverted and turned back to racial and often racist purposes, at minimum reiniscribing the very racial “differences” and disparities they were presumably designed to combat.
~ Michelle Fine, Distinguished Professor, Graduate Center, CUNY
The archived video(s) of An Exploration of Whiteness and Health A Roundtable Discussion
is available beginning here (updated 12/16/12):
The examination of whiteness in the scholarly literature is well established (Fine et al., 1997; Frankenberg, 1993; Hughey, 2010; Twine and Gallagher, 2008). Whiteness, like other racial categories, is socially constructed and actively maintained through the social boundaries by, for example, defining who is white and is not white (Allen, 1994; Daniels, 1997; Roediger, 2007; Wray, 2006). The seeming invisibility of whiteness is one of its’ central mechanisms because it allows those within the category white to think of themselves as simply human, individual and without race, while Others are racialized (Dyer, 1998). We know that whiteness shapes housing (Low, 2009), education (Leonardo, 2009), politics (Feagin, 2012), law (Lopez, 2006), research methods (Zuberi and Bonilla-Silva, 2008) and indeed, frames much of our misapprehension of society (Feagin, 2010; Lipsitz, 1998). Still, we understand little of how whiteness and health are connected. Being socially assigned as white is associated with large and statistically significant advantages in health status (Jones et al., 2008). Anderson’s ground breaking book The Cultivation of Whiteness (2006) offers an exhaustive examination of the way whiteness was deployed as a scientific and medical category in Australia though to the second world war. Yet, there is relatively little beyond this that explores the myriad connections between whiteness and health (Daniels and Schulz, 2006; Daniels, 2012; Katz Rothman, 2001). References listed here.
The Whiteness & Health Roundtable is an afternoon conversation with scholars and activists doing work on this area.
The roundtable is sponsored by the Advanced Research Collaborative (ARC) and the Critical Social & Environmental Psychology program at the Graduate Center CUNY. The event is hosted by Michelle Fine (Distinguished Professor, Social Psychology, Women’s Studies and Urban Education), Jessie Daniels (Professor, Urban Public Health and Sociology) and Rachel Liebert, (PhD Student, Critical Social/Personality Psychology).
People who study the multiracial population are constantly confronted with the problem of small numbers to work with. A recent article I co-authored on the multiracial health (Bratter, Jenifer and Bridget K. Gorman. Forthcoming. “Does Multiracial Matter? A Study of Racial Disparities in Self Rated Health. Demography) required combining seven years of data from a health survey (over 1.7 million cases) to get 20,000 mixed-race folks for analysis. The 2000 Census, with its “check all that apply” race question, remains the database with the largest number of cases and the 2010 Census will be the first to count race the same way as the preceding installment. While this may sound like a mundane detail, this will allow us to gauge growth, decline, or stability of this population and whether this will affect the population bases of single-race communities. If the sheer anticipation doesn’t shake you to your core, perhaps you have forgotten the history of introducing this option into the Census.
Back in the 1990’s, deciding how to count the multiracial population was a hot political controversy, pitting two sides of a debate on race and identity against each other. According to Williams (Williams, Kimberley M. 2006. Mark one or More: Civil Rights in Multiracial America. Boston: Harvard University Press), multiracial organizations argued that the previous approach forced mixed-race children to choose one race and one side of themselves. Civil rights groups argued that this would weaken the population bases and the political power of monoracial groups, unnecessarily complicate the tracking of enforcement of civil rights legislation (which uses Census counts), and, unofficially provide an option for individuals who wished to abandon their race. Introducing “check all that apply”, not a single multiracial box, seemed like the perfect resolution. Multiracial people could be enumerated and be linked back to their component groups for tracking dynamics of monoracial communities.
Despite these hopes and fears, things remained pretty much the same. Although about 6.7 million persons (no small demographic potatoes) choose two or more races, it made the biggest difference for groups that had faced issues of mixed-heritage and identity for centuries – American Indians and Native Hawaiians. Meanwhile, there was little movement in the population base of the largest groups: Whites, Blacks, and to a lesser extent Asians. Also, approximately half of this group was under 18, which may mean that parents of multiracial children were declaring this as a race (Jones, Nicholas and Amy S. Smith. 2001. “Two or more Races Population : 2000.” [pdf] United States Census Bureau). As Reynolds Farley, declared in 2004, this was a “social movement that succeeded, but failed” to dramatically change our way of thinking about race (Farley, Reynolds. 2004. “Identifying with Multiple Races: A Social Movement that Succeeded but Failed?” Pp 123-128 in The Changing Terrain of Race and Ethnicity edited by Maria Krysan and Amanda Lewis. New York: Russell Sage Foundation). Maybe it’s just about timing, as many tell me. Including multiracial in any form is a recent development, the public has simply not gotten used to checking that box (or boxes). But alas, Farley’s estimates of inter-censual growth using the American Community Survey show a decline in the percentage of people selecting more than one race, from 2.4 to 1.9 percent (Farley, Reynolds. 2006. “The Multiple Race Population: Is it increasing or decreasing?” paper presented at the Annual Meeting of the American Sociological Association. Montreal, Canada).
This raises a bigger question – why haven’t things changed more? Aren’t we living in as multiracial society as we ever have? On one hand, multiculturalism seems to be everywhere, from mixed-race celebrities and high profile interracial couples, to growing racial/ethnic diversity. And ofcourse, there’s the rise of the nation’s first openly mixed-race U.S. President. But even Obama’s multiracial flag isn’t flown that high. He is universally touted as our first “Black” president, a racial identity he solidly embraces. And he’s not alone. Several studies using 2000 data show that selecting single races for biracial children is not uncommon. Since the U.S. Census ceased using enumerators, choosing a racial category goes far beyond simple ancestral accounting, which would place most everyone in the multiracial camp if they had the option. It reflects a sense of who we are and most importantly how we are treated.
Quantifying “treatment” is never an easy task, but any cursory look at social trends tells us that lives are lived very differently by race. The level of school segregation by race is nearly as high as it was in the 1960’s (Sikkink, David, and Michael O. Emerson. 2008. “School Choice and Racial Residential Segregation: The Role of Parent’s Education.” Ethnic and Racial Studies, 31:267-293), neighborhoods continue to be segregated by race (Wilkes, Irma and John Iceland, 2004.”Hypersegregatation in the 21st Century” Demography 41 (1): 23- 36), and while interracial marriage is increasing, its far lower than one would expect if race were not a factor (Qian, Zhenchao and Daniel Lichter. 2007. “Social Boundaries and Marital Assimilation: Interpreting Trends in Racial and Ethnic Intermarriage.” American Sociological Review 72:68-94). White per capita income continues to exceed Black per capita income by more than 12,000 dollars and Blacks can expect to die on average 5 years sooner than their White counterparts (Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14.[pdf] Hyattsville, MD: National Center for Health Statistics. 2009). Despite declines in reporting overtly racist attitudes, minorities continue to report confronting racial prejudice and growing number of studies report that having these experiences is significantly detrimental to their health (U.S. Census Bureau, 2008. “Table 688. Per Capita Money Income in Current and Constant (2007) Dollars by Race and Hispanic Origin” in Income, Poverty, and Health Insurance Coverage in the United States: 2007, Current Population Reports, P60-235. Author tabulation of difference between the per capita income (in 2007 dollars) for Blacks (alone or in combination), which was $18,107, and non-Hispanic Whites (alone), which was $31,051).
How can one sustain an identity “in-between” races when so much of our lives are patterned by racial divisions? From this vantage point, the paltry percentages and small sample sizes are yet one more testimony that we believe we are a multicultural society and but really aren’t. However, what gets overshadowed is that race does not cease to matter just because one selects more than one. Living “in-between” races does not qualify one for a pass on discrimination. Population projections forecasting a coming white minority do not include as “white” those who select white alongside other races. And why should they, when the official policy of the Office of Management and Budget is to include those of partial minority and majority races among the minority group for civil rights purposes (Williams, David R., Harold Neighbors, and Jackson 2003. “Race/Ethnic Discrimination and Health: Findings from Community Studies.” American Journal of Public Health 93: 200-208). Other indicators follow suit. According to our recent findings on multiracial health, those selecting more than one race do not have substantially better health that their component populations, and, in the case of White-American Indians, they report their health as significantly worse than their White counterparts (Goldstein, Joshua and Ann J. Morning. 2002. “Back in the Box:The Dilemma of Using Multiple-Race Data for Single-Race Laws.” Pp. 119-136 in The New Census Race Question: How the Census Counts Multiracial Individuals, edited by J. Perlmann and M. C. Waters. New York: Russell Sage). While some read these trends as examples of the unique challenges faced by the mixed-race population, this is simply a shade of the same old story: race still matters – no matter how many you choose.
So here’s my plea, if you believe you are mixed-race at all, mark those races. You’re not abandoning your tribe, nor are you escaping race. You are just recording all your complexity, and making some researchers very happy.
~ Jenifer L. Bratter is Assistant Professor, Department of Sociology, Rice University and Program Director for Race Scholars at Rice Institute of Urban Research (IUR).
Silvia Henriquez has an interesting article on today’s Huffington Post entitled “Policies to Curb Latina Teen Pregnancies Have the Reverse Effect.” In the piece, Henriquez argues that the policy efforts designed to curb Latina teen pregnancies are too narrow and shortsighted—they focus on birth control and marriage rather than on big picture issues like immigration, poverty, and inequality. What’s most important about Henriquez’s article is that she skillfully highlights the ways intersecting factors of race, gender, and class overlap to shape these high rates of teen pregnancy. Henriquez begins by offering some important context in which to situate the debate. She writes:
“Latina teens give birth at a rate more than twice that of white teens. Latinos have a much lower high school and college graduate rate compared to white teens.”
This background information gives insight into the environment facing pregnant Latina teens. Other sociological research has shown that when women give birth at young ages they are less likely to finish school, less likely to land well paying, stable jobs, and thus more likely to be poor. When the fathers are in comparable situations (like the lower high school and college graduation rates Henriquez describes), this only compounds young women’s likelihood of raising children in poverty. And given that institutional and employer-based racial discrimination still runs rampant, Latino/as are likely to face higher jobless and underemployment rates than whites, further exacerbating the chances of remaining poor. (Deirdre Royster’s book “Race and the Invisible Hand” is one such example of insidious racial discrimination in low skilled labor markets, though there are many others.) Henriquez continues on to say that:
“Myths — rather than realities — have too often guided the public discourse about Latinas and pregnancy. Latina teens don’t have sex more often than their white counterparts and most desire a college education. In addition, despite the demonization of immigrants in recent health care debates, most Latina teen moms are not immigrants.”
These are critical points that highlight the ways Latinas are cast in what Joe Feagin insightfully describes as the white racial frame. This frame (discussed elsewhere on this blog) encompasses stereotypes, sincere fictions, and ideologies about different racial groups. However, these stereotypes, images, and beliefs are shaped by gender as well as race. Thus, women of color often are cast as hypersexual, while men of color are likely to be depicted as criminals. As such, when Henriquez writes that Latina teens do not have sex more often than white teen girls, nor are they mostly immigrants, she counters white racial framing of Latinas as hypersexual, irresponsible, and a drain on national resources. (Similar imagery and framing was present in Ronald Reagan’s depictions of “welfare queens” in the 1980s.) Henriquez then identifies some of the factors that influence Latina teens’ high birth rates:
“Compared to white teens, Latina teens have higher pregnancy rates because they use birth control much less often and reject abortion much more often. Religion and family influence are very important factors, but for sexually active Latina teens these are not the only or even most relevant obstacles to birth control usage. For many Latinas, the top barriers to birth control usage are much more mundane: transportation, lack of health insurance or cash for health services, confusing and intimidating immigration regulation for households with a combination of citizens and non-citizens, and lack of guidance about available services. When teen pregnancy prevention programs and messages ignore these obstacles, Latinas become distanced from sex education efforts.”
Here is an incredibly important point that highlights Henriquez’s central thesis that bigger issues than simple individual choice are at play for Latina teen moms. The issues she cites—transportation, lack of health insurance—are directly linked to social class. If you’re a teenager in the suburbs with your own car, it’s relatively easy to head off to your local Planned Parenthood for condoms. If you have health insurance, you can visit your doctor, tell him or her you’re planning on becoming sexually active, and get safe, confidential counseling and birth control. Switch out the car, the suburbs, and the health insurance for an impoverished neighborhood, no access to a doctor, and no money to find one, and the picture gets much bleaker.
Note also that these aren’t just class issues. For Latinas, intersections of race and gender are also factors. Henriquez astutely points out that immigration regulation can add layers of bureaucratic confusion that can make it difficult for these teen girls to access social services. This is a point that highlights that race makes a difference, and that not all racial groups are interchangeable—these issues of immigration regulation are less likely to impact poor black teens, for instance. But they are more likely to impact teen Latinas who, by virtue of their sex, face greater potential consequences of sexual activity than do Latinos. Gender, race, and class all come together to shape this issue. Henriquez continues:
“Sex education programs often tell teens that delaying parenthood until they finish high school and college will bring them some version of the American dream: a good job, economic security, family stability. The troubling reality is that for Latinas this promise comes true for only a limited few. Recent research confirms that Latina teen mothers have roughly the same socioeconomic circumstances at age 30 as those Latina teens who delay childbirth. The unfortunate reality is that access to college and the opportunities that emerge as a result is starkly different for Latina teens and white teens.”
This reiterates Henriquez’s point that broader issues than personal choice are at play here. If Latina teen mothers are in the same socioeconomic place by age 30 as those who’ve chosen to delay childbearing, then this points to major issues in our educational and economic spheres. Most studies show that more education translates into increased economic rewards. Do Latinas have the same access as women of other racial groups to access higher education and its attendant rewards? Perhaps more importantly, do women of all racial groups have the same access as white men, who despite being a numerical minority of the population remain overrepresented in the highest paid, most prestigious positions?
I agree with Henriquez that these are the structural conditions that should be the subject of focus, rather than simplistic, “one-size-fits-all” policies that fail to take into consideration the ways that intersections of race, gender, class, and other factors shape groups’ experiences differently. Latino/as are the fastest growing segment of our population, and by the middle of this century, whites will cease to be a numerical majority as the population of other racial groups continues to grow. Given our rapidly changing national demographics, we would be wise to establish policies that eliminate institutional disadvantage for all groups of color.
I think that the national discussion about racism and health care reform gets so abstract sometimes that we forget that when we’re talking about health, we’re talking about people’s lives. And, as this short clip (about 4 minutes) demonstrates very powerfully, leading researchers contend that racism plays an important role in infant mortality among African American women, even when controlling for income and education. This clip, from Episode 2, “When the Bough Breaks,” in the video series “Unnatural Causes,” (2007), features UCLA obstetrician and gynecologist Dr. Michael Lu. Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery, one of the leading risk factors for early infant death:
And, in an interesting piece of research by one of the experts featured in the full episode, Dr. Camara Jones, concludes that: “being classified by others as White is associated with large and statistically significant advantages in health status, no matter how one self-identifies.” So, there’s a very real, somatic level at which racism both takes a toll on some and provides an advantage to others.
I think we should keep this in mind as the health care debate rages on. What kind of society do we want to create?
I’m gearing up for teaching this fall in an Urban Public Health program; part of what I like about the field is that it requires a very practical application of what can seem like abstractions in the field of sociology. So, to talk about racism and racial inequality in public health means to talk about how these affect people’s bodies, health and illness. Most eloquent on this subject recently is Marion Wright Edelman who has written about the impact of racial inequality on the health of children, she writes:
Right now, we live in a nation where children of color experience significant health disparities that begin before birth and follow them throughout their lives. Black infants are more than twice as likely as white infants to die before their first birthday and have higher infant mortality rates than children in 62 nations including Barbados, Malaysia and Thailand. One in every seven babies born to black mothers is born at low birthweight, a core risk factor for infant mortality and childhood developmental disorders. The rate of black infants born at low birthweight in the United States is worse than the rate of low birthweight in more than 100 nations including Algeria, Botswana and Panama.
Not surprisingly, black and Latino children also have higher incidences of childhood illnesses than white children. For example, one out of eight black children has asthma — one of the most common illnesses in children — compared to one in 12 white children. One out of every four black two-year-olds and one out of every five Latino two-year-olds is not fully immunized, although we know that every dollar spent vaccinating children against measles, mumps and rubella saves $16 in future costs. More than 30 percent of black children and about 40 percent of Latino children report not receiving dental care. Minority children are more likely to be living in poverty. However, racial disparities aren’t just about socio-economic status, although more than three-quarters of uninsured black children have a working parent, and more than half have a parent who works full-time throughout the year.
Edelman, a long-time defender of children’s rights, emphasizes “It doesn’t have to be this way,” and urges for reform on health care which would help address these persistent inequalities. Yet, even as much of the national public debate right now is focused on “health care reform” and that discussion has been derailed by racism.
Some anti-health care protesters, like the one in this photo (from here), cast their objections to health care reform in rather explicitly racist terms. As Maggie Mahar writes, the health care reform effort has reignited what she refers to as the “Culture Wars,” a familiar story in the American political landscape. When viewed in terms of Edelman’s point about the impact of racial inequality on children’s health, these kinds of battle lines seem even more cruel.
I want to suggest that we re-frame the current health care reform debate in terms of social justice. In my view, supporting universal health care for everyone in the U.S. is an important step toward re-dressing the persistent racial inequality that is endemic in our society.
A recent article in the American Journal of Public Health presents findings on experiences of everyday racism and HIV testing which are consistent with those from two other studies examining experiences of everyday racism’s relationship to preventive behaviors (condom use behaviors & mammography screening). The greater the level of everyday racism, the less likely people are to engage in health prevention behaviors. (Full citation for the article, which is behind a paywall: Ford CL, Daniel M, Earp JL, Kaufman JS, Golin CE, Miller WC. Perceived Everyday Racism, Residential Segregation and HIV Testing in an STD Clinic Sample. American Journal of Public Health Apr 2009 99;(Supp 1):S137-S143.)
The fact that racism takes a toll on the lives of people of color, and in particular on African Americans, is not especially new information. There’s a literature on this that’s been growing for some years. For example, Joe’s book with Karyn McKinney, The Many Costs of Racism, details the physical and psychological toll of racism on African American’s health.
What seems to be new here is that scholars in public health are increasingly documenting racism as an important underlying factor, if not a causal variable, in creating a number of specific health hazards and pathways to disease and mortality. In the past, public health – like many other fields – had attributed racial inequality to the vagueness of social determinants phrased in the passive voice. A research agenda that now explicitly includes racism is a step forward.
However, researchers are still overly cautious in their use of the term “perceived” as an ubiquitous qualifier to “everyday racism.” Calling the experiences of everyday racism “perceived” leaves open the possibility that these experiences were not, in fact, racism but instead, a misundertanding of the actual situation. If there is a “perception” of racism, then perhaps there is room for “misperception.”
Why does this matter? It leaves unsettled then what the root cause is: is it white racism that’s inflicting real harm on real people? Or, is it the “perceptions” of black folks and other people of color that need to be adjusted?
Make no mistake, this burgeoning field of studying the impact on health of racism is important. Yet, still largely missing here is a robust analysis of the cost of racism to whites. A colleague of mine, Amy J. Schultz and I wrote a book chapter on this “Whiteness and the Construction of Health Disparities,” (Jessie Daniels and Amy J. Schulz, pp. 89-127, in Gender, Race, Class, and Health, (Jossey-Bass, 2006), Leith Mullings and Amy J. Schulz, Eds.). Also missing here is what might be effective interventions, to use the public health language, to reduce the level of racism so that black and brown people might live longer, healthier lives.
Updated 6/26 to add: There’s an important piece on Racism’ Health Toll at Miller-McCune (from 6/15) that I should have referenced here. Highly recommended.
Racism is harmful to the mental and physical health of those who are the targets, yet little research has explored the impact of racism on those who perpetrate racism (photo credit: JessieNYC).
In terms of physical health and longevity, there is evidence that racism shortens peoples’ lives. A U.S. study found that discrimination increased mortality (rates of death) among African Americans compared to whites in a large sample (N=4154) of older adults. At the beginning of life, racism also takes a toll. Another study in the U.S. finds that black-white difference in infant mortality (deaths among those 0-1 years old) is due to racism, not race per se. (More about racism and infant mortality here.) And, if you take into account Native Americans’ health, the research clearly documents they suffer worse than average rates of depression, diabetes and cardiovascular disease (lots more on Native American health here).
In terms of mental health, racism costs people their sanity. One Dutch study of 4,074 people found that those who felt victimized by discrimination and forms of racism were twice as likely to develop psychotic episodes in the following three years. Being on the receiving end of racism creates intense and constant stress which boosts the risk of depression, anxiety and anger.
And, of course, because of the mind/body connection, factors like depression, stress (as Claire noted in her recent post) and anger can lead to or aggravate high blood pressure and heart disease. Even when people seek care to address these health issues, research consistently shows that racial and ethnic minorities receive inferior care compared to whites, even when everything else is equal (e.g., insurance, income, age, and severity of conditions).
“We know that black folks are at higher risk of hypertension, but in childhood, there are no differences between black and white blood pressure rates. By the time you get into the 25-44 year-old group, you start to see changes. We have evidence that in white folks, blood pressure is dropping at night, but not in black people. There’s a kind of stress, like you’re gunning your cardiovascular engine constantly if you’re black that results from dealing with people who are underestimating you, limiting your options. It results from little things like going to a store and if there are two people at the counter — one black and one white — the white person will be first approached. If you have stress from other sources, like a bad marriage, it’s not something you think about constantly. But the stresses associated with racism are chronic and unrelenting.”
Jones goes on to say that her research suggests that 50% of blacks think about their race at least once a day (and 22% said they think about it constantly), while in sharp whites rarely give any thought to their race in the course of a day.
And, it’s this part of the racism and health puzzle that’s little researched. While “whiteness studies” have been en vogue in the humanities and social studies for about 10 years, the academic trend has yet to have much of an impact on the study of health disparities. Few medical or public health researchers have taken up the investigation of what Joe has called the white mental health problem of persistent racism.
In a 2006 piece I co-authored with my colleague Amy Jo Schulz (Daniels, J., & Schulz, A.J. (2006). Constructing whiteness in health disparities research. In A. J. Schulz & L. Mullings, (Eds.), Gender, Race, Class, and Health (pp. 89-127), in which we examined the way that whiteness and white racial privilege are part and parcel of health disparities research. Here’s a brief excerpt that describes what typically happens in the “disparities” research:
“..the use of racial categories and comparisons with no consistent foundation for theorizing, understanding, or interpreting observed racial differences (or their absence) in health outcomes provides space for a wide range of potential explanations. Each of these “explanations” implicitly or explicitly constructs both race and Whiteness.
For example, within the literature on racial disparities in cardiovascular disease, comparisons of Black or Latino/a to White Americans show disparities not only in cardiovascular mortality rates (Cooper and others, 2000; Wong and others, 2002) but also in multiple risk factors, including high blood pressure (Cooper and Rotimi, 1997; National Heart Lung and Blood Institute, 2004; Crespo, Loria, and Burt 1996), obesity (James, 1999; Kumanyika, 2001), physical activity (Brownson and others, 2001; Crespo and others, 1996), and intake of micronutrients and macronutrients associated with cardiovascular risk (Li and others, 2000). In the absence of an explicitly social theory of race, analyses explaining racial disparities in cardiovascular disease in terms of biological, “lifestyle,” or “cultural” factors can reify racial differences and obscure connections to socially structured inequalities. In other words, explaining racial differences in health in terms of individual biology, genes, or behavior can locate health problems in the bodies of those most negatively affected by social inequalities. Such explanations fail to make explicit connections to histories of racism and the struggles against oppression by subordinated groups (Bonilla-Silva, 2003; Mullings, 2005). In the process, they also take out of the equation—and thus make invisible—the processes through which Whites maintain positions of relative advantage or privilege within racial hierarchies. In this sense, such explanations are consistent with the “colorblind” strategies of neoconservative and neoliberal Whiteness projects described above, in that they explain racial disparities in health in nonracial terms. “
Put another way, there are no actors in the world of health disparities research. There is only the passive voice of ‘structural inequality.’ Indeed, I witnessed this firsthand in on a meeting I sat in on recently about how to address infant mortality in New York City. When one of the people of color gathered around the table raised the issue of addressing racism as a root cause of infant mortality, one of the white people responded with a laugh, “well, I don’t think there’s much we can do to address racism.” This kind of flippant defeatism on the part of whites is surely part of the problem.
The fact is, racism continues to extract a toll from people of color in terms of physical and mental health. It brings death sooner to the elderly and diminishes the life chances of the newly born. As this inequality persists and there continues to be lots of agreement among liberals that this sort of inequality is wrong, there is scant little attention paid to the ways that we can dismantle racism and improve everyone’s health, rather than continuing the current system of inequality that systematically and disproportionately benefits the health of white people.
Two weeks ago, the results of an important study – “Childhood Poverty, Chronic Stress, and Adult Working Memory” – were published in the Proceedings of the National Academy of Sciences. The researchers, Gary W. Evans and Michelle A. Schamberg, examined the relationship between poverty and poor academic achievement, which they note has been studied extensively for many years ( photo credit: frerieke). What makes their research unique is that they measured the mediating effects that chronic stress, resulting from living in poverty during childhood, have on later achievement. They found that the chronic and intensive stressors caused by poverty leads to “working memory deficits” in young adulthood.
Because working memory is critical for language comprehension, reading, problem solving, and long-term retention of information learned, weakened working memory from poverty-induced stress may be central to explaining why young adults who lived in poverty as children have poorer educational outcomes than young adults who lived above the poverty line as children. The longer the child was poor, from birth to age 13, the weaker her or his working memory was as a young adult.
I read Evans and Schamberg’s study with great interest because of its important implications. Poor parents have long been exhorted to spend more time reading to their children and taking them to museums and other educational venues where admission may be free on certain days of the week, with the expectation that these activities, routinely provided by more affluent parents to their children, would improve poor children’s academic achievement.
However, while undoubtedly enriching, the Evans and Schamberg study indicates that these activities are not sufficient to compensate for the negative impact of the daily stressors inflicted by a life of economic deprivation.
Those stressors must be alleviated as well. As important as the findings are, though, the Evans and Schamberg study may not be generalizable to children of color. That’s because their sample was composed of 195 white male and female young adults. This surprises me given that, according to the U.S. Bureau of the Census, while 12.1% of white families live below the poverty line, 29.1% of black families and 24.3% of Hispanic families live in poverty. And the further impoverished a family is, the more likely they are to be black or Hispanic.
Certainly, poor black and Hispanic families experience the same kinds of stressors that poor white families experience: e.g., housing problems, the dangers posed by living in high-crime neighborhoods, stretching the limited income available to buy food and pay for other necessities. But poor families of color experience a stressor that poor white families do not experience: racism.
There is a substantial body of research that shows that racism is a chronic stressor throughout the life course for people of color, and that the stress caused by racism has serious negative effects on both psychological and physical health. For instance, Nancy Krieger and Stephen Sidney found that stress induced by racial discrimination has as much or more of an impact on blood pressure as smoking, lack of exercise, and a high-fat, high-sodium diet (“Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults,” American Journal of Public Health, 86(1996):1370-1378). Ruth Thompson-Miller and Joe Feagin found in their interviews with elderly blacks that memories of racist interactions with whites produced a number of negative physical and psychological reactions indicative of what they call “race-based traumatic stress,” the impact of which lasts a lifetime (“Continuing Injuries of Racism: Counseling in a Racist Context,” The Counseling Psychologist, 35(2007):106-115).
Importantly, Thompson-Miller and Feagin show that men and women of color experience race-based traumatic stress regardless of their social class. But when we consider the additional stressors of poverty and the fact that people of color are disproportionately represented among the poor, the need to examine racism as a stressor in research such as Evans and Schamberg’s seems essential.
Although they do not mention examining racial differences or the potential role of racism on working memory or other indicators of academic achievement in future studies, I hope Evans and Schamberg, as well as other scientists, will undertake this challenging but important research.
For an extensive review of research on the physical and especially psychological impacts of racism on people of color, see a special issue of The Counseling Psychologist. I’m grateful to Ruth Thompson-Miller at Texas A&M University for bringing this special issue to my attention.
In a report just released from the NIH, as many as 1 in 100 black men and women develop heart failure before the age of 50, which is 20 times the rate in whites in the same age group. In public health terms, these racial differences in health are referred to as “health disparities,” and the newly released report from the NIH raises questions about why there are such stark disparities across racial groups ( photo credit: derek*b).
According to the NIH, this sharp rise in heart failure is directly related to the increased levels of hypertension (aka, high blood pressure) for blacks. There’s a growing body of scientific literature which points to the experience of racism as a major factor in elevated blood pressure, one of the leading risk factors for early heart failure. David Williams was a pioneer in this field with his 2001 article, “Racism, discrimination and hypertension: evidence and needed research,” (Ethn Dis. 2001 Fall;11(4):800-16). That piece spawned a bunch of others, including an excellent piece by Wyatt and colleagues entitled, “Racism and cardiovascular disease in African Americans,” (Am J Med Sci. 2003 Jun;325(6):315-31), which posits that there are three levels of racism that affect the cardiovascular disease (CVD) of African Americans, namely:
First, institutional racism can lead to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions that can adversely affect cardiovascular health. Second, perceived/personally mediated racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. Third, in race-conscious societies, such as the United States, the negative self-evaluations of accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health.
And, in a recent cross-sectional study that included African American men (n = 393) and women (n = 717), researchers at the University of North Carolina Chapel Hill found that the likelihood of hypertension significantly increased with higher levels of perceived stress following racism from non-African-Americans.
While many people contend that racism is no longer a relevant or life-threatening issue, this kind of evidence persuades me that addressing racism is more crucial than ever.