How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary (2012) / Chapter Skim
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2 What Progress in Reducing Health Disparities Has Been Made?: A Historical Perspective
2 What Progress in Reducing Health Disparities Has Been Made?: A Historical Perspective
Pages 7-30
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. He also noted that members of racial and ethnic minorities have access to a lower quality of health care services than majority group members.
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Because the country has an African American president and because many people of color are leading major corporations, some believe that U.S. society is now color-blind (e.g., Cho, 2009)
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In fact, earlier in the decade, Smedley said, private-sector leadership was critical in bringing attention to health inequities. For example, both the Robert Wood Johnson Foundation's Commission to Build a Healthier America and the Kellogg Foundation's ongoing focus on health inequities
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An additional link can be drawn between residential segregation and 1 Jim Crow laws were enacted in southern states and localities after the Civil War in order to institutionally segregate African Americans and whites (Woodward, 1955)
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However, Smedley noted that the decline was more rapid for poor 70 60 50 40 30 20 10 0 1960 1970 1980 1990 2000 Total Poor Families Poor African American Families Poor White Families Poor Hispanic Families FIGURE 2-1 Percentage of poor families living in high-poverty neighborhoods (poverty rate of 30 percent or more)
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. A more specific look at poor families shows that poor African American families were almost six times as likely as poor white families to live in a high-poverty neighborhood in 1960.
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WHERE DO HEALTH DISPARITIES STAND TODAY? David Williams has an academic and research background in public health as well as in the social, cultural, and historical issues associated with the health of African Americans.
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+ Education FIGURE 2-3 Rates of mortality from heart disease among African Americans (Af Am) and whites (W)
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However, it was not until 1990 that the life expectancy for African Americans reached 69.1 years, four decades later. In other words, it took African Americans 40 years to catch up to the life expectancy of white Americans in 1950.
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Even since 1999, the data show elevated rates of mortality for African Americans and American Indians at all ages compared with those for whites. Moreover, mortality rates for African Americans are trending downward, while mortality rates for whites are trending upward.
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It should be noted, however, that as indicated by Figure 2-6, neonatal mortality rates are highest for African Americans across all three age groups, with Puerto Rican women the second highest across all age groups when compared to white and Mexican women. Migration Patterns of migration should be considered when health disparities are examined, Williams said, because migration has powerful influences on health.
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Socioeconomic Disadvantage and Geographic Marginalization For those populations that have lived in the United States for multiple generations (American Indians and African Americans) , the data show a pattern that points to the roles of geographic isolation, residential segregation, and socioeconomic disadvantage in the creation and maintenance of health disparities.
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and infant mortality illustrate this linkage. Figure 2-9 shows that even white mothers who are high school dropouts have lower infant mortality rates than college-educated 2+ races, 2.6% Hispanic 23.9% White 46.1% Asian, 3.6% NH/PI, 0.17% African American 23.1% AI/AN, 1.6% FIGURE 2-8 Racial/ethnic composition of people in poverty in the United States.
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Compared with whites, African Americans with the same level of education earn less income. Compared with whites with the same income level, African Americans have less purchasing power because of the higher costs of goods and services in the places where African Americans live.
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Williams speculated that this increase is largely due to the positive health effects arising from civil rights policies. For example, the civil rights movement narrowed the economic gap between whites and African Americans by offering access to more and better jobs.
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W.E.B. DuBois wrote about African American health in the publication Philadelphia Negro, noting that "the most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race.
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In 1963, for example, President John F Kennedy noted that African Americans had a life expectancy that was 7 years shorter than that for whites.
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, Woolf and colleagues compared the number of lives saved by medical advances that resulted in a reduction of the number of deaths attributable to excess mortality among African Americans (176,663 deaths averted) with the number of lives saved when mortality rates between whites and African Americans are equalized (886,202 deaths averted)
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(As of December 2009, the Robert Wood Johnson Foundation's Commission came to a close; however, information may still be found at the following link: http://www.commissiononhealth.org/Education.aspx.) Along with race/ethnicity and education level, income is a third recurring theme affecting health inequities.
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In short, Woolf concluded, it is time to begin thinking more broadly about Policies to promote economic Policies to promote child development and reduce poverty and youth development and education, Policies to promote infancy through college healthier homes, neighborhoods, Economic & Social schools, and Opportunities and Resources workplaces Living & Working Conditions in Homes and Communities Medical Personal Care Behavior HEALTH FIGURE 2-13 Importance of social factors. SOURCE: Robert Wood Johnson Foundation, Commission to Build a Healthier Figure 2-13, color America (2009)
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Although these issues have been discussed for years, even most African Americans are unaware of the disparities in rates of infant mortality and life expectancy between African Americans and whites. Thus, the issue of first raising awareness is critical.
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Woolf responded that evidence of some positive trends can be seen; for example, educational attainment rates are increasing for all population groups in the United States. Positive trends from the health care sector are reductions in mortality rates and some increases in access to preventive services and other clinical services for disadvantaged populations.
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Racial/Ethic Minority Groups -- African Americans, American Indians and Alaska Na tives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, GA: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, U.S.
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2007. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: Results from the National Sur vey of American Life.
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