Social scientists and progressive policymakers have long known that black and brown children are more likely to live in poorer neighborhoods and therefore be exposed to greater health risks than their white counterparts. This month, the Public Broadcasting Service and the specialist journal Health Affairs are separately taking much needed steps to publicize these links between childhood poverty, race, and health.
Over the course of April, PBS will be running a four-part documentary series, Unnatural Causes . . . Is Inequality Making Us Sick, which focuses on these class- and race-based health disparities. Similarly, the journal Health Affairs has dedicated its March/April issue to research on health inequities, and includes an article about the impact of unequal geographical opportunity on health and well-being in childhood and throughout one’s life course. This column will present a review of some of the key research in this critical health care arena and the clear policy implications.
What the Research Indicates
Research shows that residential segregation, both de facto and de jure, is the most detrimental to the health of racial and ethnic minorities. High levels of residential segregation result in a large percentage of minority children living in neighborhoods characterized by concentrated poverty. According to the Health Affairs article, on average, about 76 percent of black children and 69 percent of Latino children (poor and non-poor) in large metropolitan areas live in neighborhoods with poverty rates higher than those found in the neighborhoods of the worst-off white children.
Further, minority children are more likely than their white counterparts to experience the double jeopardy of poor families plus poor neighborhoods. While only 1.4 percent of white children experience such double jeopardy, 16.8 percent of black children and 20.5 percent of Latino fall into these circumstances.
The Health Affairs article describes how disadvantaged neighborhoods are associated with detrimental health outcomes such as lower life expectancies, negative health behaviors such as sedentary lifestyles, and developmental delays, as well as higher rates of teen parenthood and academic failure. These neighborhood factors compound the risks associated with being from a poor family. While white children may only be adversely affected by poor family characteristics, minority children have the added burden of poor neighborhoods—they are more likely to be exposed to greater environmental risk factors simply because of where they live.
These neighborhood risks include a number of elements that crimp or cripple educational and economic attainment, homeownership rates, environmental conditions, and the delivery of health care services. All of these factors weigh heavily on the health of children and determine the neighborhood opportunity level of a child.
Take, for example, the profoundly negative effect that residential segregation has on individual earning power and employment opportunity. So-called out-migration of whites and some middle-class blacks from urban areas (where the majority of African Americans reside) to the suburbs over the past few decades has been accompanied by the movement of high-pay, low-skill jobs to the suburbs. These two connected trends have reduced work opportunities for African Americans who remain in urban neighborhoods, thereby affecting their access to job-based health insurance and an income high enough to afford to purchase health insurance.
For its part, the PBS series Unnatural Causes brings stark attention to these inequalities in society that lead to detrimental health outcomes for people of color and the poor. The series consists of seven episodes, each focusing on various components of social inequities that lead to disparities. So far the series has covered the connection between income/wealth inequality and health; the effect of racism on infant mortality; the decline of Mexican immigrant’s health after living in the United States for five consecutive years; and rates of diabetes among American Indians.
Last night, the series covered how location plays a direct role in an individual’s health. The series will culminate next Thursday with episodes on the health of Marshall Islanders since nuclear testing post-World War II, and on the effects of unemployment on health. The complete series will also air sometime after the final episodes on PBS channels.
This research and documentary indicate that policymakers must begin to look at health holistically. They cannot simply focus on those who are currently sick, but rather they must also address the health risks of those most likely to become ill or die prematurely. The authors of the article in Health Affairs specificallyurge those concerned with health care policy to make these issues a part of their agenda.
This new health agenda would likely complement current anti-poverty initiatives such as the one created by the Center for American Progress in its report From Poverty to Prosperity: A National Strategy to Cut Poverty in Half. Many of the Center’s recommendations would alleviate health concerns by helping families to increase their incomes, move out of high-poverty neighborhoods, and purchase health care and foods that promote good health.
Cases in point: the CAP report proposes increases to the federal minimum wage, the improvement and expansion of the earned income tax credits and child tax credits, and increases in the availability of housing vouchers, which would allow families to move out of high-poverty neighborhoods. If implemented, these recommendations, alongside equitable federal, state, and local economic development strategies to help lower-income communities benefit from regional economic growth, would go a long way toward breaking the links between childhood poverty, race, and health.
Equally important, however, is for health care specialists and policymakers to pay more attention to known determinants of racial health disparities. Efforts to find race-based medicines and genetic connections to various diseases and certain racial groups are beginning to gain traction. Just recently, for example, the National Institutes of Health launched the Center for Genomics and Health Disparities to investigate the connection between genetics and disease rates and the medical responses among races.
This effort may lead to new solutions and should be combined with continued efforts to address the known social determinants that negatively affect the health of people of color, though policymakers must ensure that efforts to conflate genetic and social science do not succeed. And critical attention must be paid to the need to secure affordable, quality health care for all.
See related articles:
- The Economic Costs of Poverty: Subsequent Effects of Children Growing Up Poor
- From Poverty to Prosperity: A National Strategy to Cut Poverty in Half
- Geneticizing Disease: Implications for Racial Health Disparities
- Community Interventions: Prevention’s Role in Reducing Racial Health Disparities