Social Class, Race, and

Health

Overview of today’s lecture

To examine race and class disparity in health

To understand how health is affected by one’s

social class and race

To learn how health policies and social

policies are completely interwoven.

To learn that health care access has a much

smaller influence on population health than do

the underlying social determinants of health.

To learn theories on class and health

What’s the headline news today?

Federal government shutdown

What is the main cause of the shutdown?

Why?

Ideological divide

Health care as a commodity or human rights

Why do Republicans oppose to the law?

subsidies

Think about Spencer’s Social Darwinism

Photo of Spencer

Definition of Class

Quick review

Based on money or material possessions.

How is class defined by Mark and Weber?

K. Marx –

• the ownership of means of production

M. Weber –

• wealth, power, and prestige

Definition of Race

The inherited physical characteristics that distinguish one group from another.

Races are social classifications rather than biological categories.

Different societies have differing racial classifications.

Even for the same society, definition of race changes over time.

Definition of health

Health: A state of complete physical,

mental, and social well-being, and not

merely the absence of disease and

infirmity.

Relationship between race, class, and

health

Race ------------- Class

Class ---------- Health

Race---------- Health

Race Class Health

Terms for health inequalities

health inequalities refer to the unequal

distribution of environmental health

hazards and access to health services as

well as objective measures of health

outcome such as

illness/disease/mortality/life expectancy

“health variations“ (Britain)

“health disparities“ (USA)

Which term do you like to use?

Class disparity in access to health

care

• Among adults, 40% of those who have not

graduated from high school are uninsured,

compared with only 10% of college

graduates.

• More than 60% of the uninsured are in

low-income families.

• Persons who lack insurance receive less

medical care, including screening and

treatment, than those who are covered

and may receive poorer-quality care.

Class disparity in high blood lead

levels

• compared with high-income families, both

children and adults from poor families

show a sixfold increase in rates of high

blood lead levels, while middle-income

adults and children show a twofold

increase (Pamuk et al). • Lead is a highly toxic metal that was used for many years in

products found in and around our homes. An elevated blood lead

level in a child is defined as 10 or more micrograms of lead in a

deciliter (μg/dL) of blood.

Class and Race Variations

in Life Expectancy

Life expectancy –

the average number of years a person born in a given

year can expect to live

Social Class

• The upper class has a distinct advantage over the less

affluent in regard to life expectancy.

Race and Ethnicity

• In the U.S., whites have a longer life expectancy than

most racial and ethnic groups

African Americans have lowest life

expectancy

Life expectancy by Race, Sex, and

Age

Relative Risk of Premature Death by

Family Income

Low birthweight births by

race/ethnicity

http://diversitydata.sph.harvard.edu/Data/

Maps/Show.aspx?ind=197&ch=5&dtm=19

7&tf=36&sortby=Value&notes=True&rt=M

etroArea&rgn=ShowLargest100

Exposure to Neighborhood Poverty

by Race/Ethnicity and Income

http://diversitydata.sph.harvard.edu/Data/

Maps/Show.aspx?ind=141&ch=5&ch=49&

dtm=141&tf=7&sortby=Value&notes=True

&rt=MetroArea&rgn=ShowLargest100

Class and Health

Resources shape health before birth

and throughout Life

The consequences of living in a

positive setting or a negative one are

not transitory; they are cumulative.

Cumulative advantage hypothesis

The cumulative advantage hypothesis

states that health inequalities emerge

by early adulthood and subsequently

widen as economic and health

advantages of higher SES individuals

accumulate (House et al. 1994; Ross

and Wu, 1996; Lynch, 2003).

Resources Shape Health Before Birth

and Throughout Life

Even before children are born, the resources

their families can command are shaping their health.

Pregnant women from lowest levels of SES receive less prenatal care, experience higher levels of stress, and deliver more premature and low weight babies (less than 5.5 pounds).

The consequences of low birth weight

increased risk of infant death, slow cognitive development, hyperactivity, breathing problems, overweight, and heart disease.

Why the race and class health

disparity?

Remember C. Wright Mills?

Sociological Imagination

our ability to break ourselves free from

our particular circumstances and see

our social world in a new light.

Need to examine both micro (personal)

and macro (structural/institutional) factors

Why the race and class health

disparity? (continued)

Micro-level factors

education, occupation, income, health

insurance, stress, life style factors (diet,

exercise., etc., Sudano and Baker 2006)

Macro-level factors

Community differences, racial residential

segregation, historical and continuing racial

discrimination that structure and limit personal

resources (education, occupation, income,

health insurance)

The Macro Factors

Housing policy, education policy, labor market

policies, and zoning are critical to determining

the conditions that lead to patterns of disease

and mortality.

Policies that affect the health of the labor market

are important medicine we can apply.

Policies intended to increase the income (and

income security) of the poor will have great

positive impact on health outcomes.

The Macro Factors (continued)

In many cities urban renewal dismantled long-

standing social structures and organization,

paving the way for a range of social and health

problems.

Health policies and social policies are

completely interwoven.

Class and health (empirical studies)

Low SES individuals perform risky manual labor than

high SES individuals, and their health deteriorates faster

as a consequence (Marmot et al. 1997b; Schrijvers et al.

1998; Borg and Kristensen, 2000).

Education is found to have a causal effect on health and

mortality (Lleras-Muney, 2005; Oreopoulos, 2006; Smith,

2007; Silles, 2009).

Lynch et al. (1997) suggest that accumulated exposure

to economic hardship causes bad health.

Two thirds of the variation in health deterioration can be

explained by working environment and life style factors

alone (Borg and Kristensen, 2000).

Low Socioeconomic Status

Greater exposure to physical, chemical,

biological, and psychsocial hazards

Develop higher rates of psychological

distress and mental health problems

• Increased stress due to inadequate

financial resources

• Harmful behaviors such as smoking and

alcohol consumption

• Poorer eating habits and lack of exercise

Residential environments and health

Neighborhood differences not “naturally”

determined, result from specific policies

Physical AND social environments

Utah vs. Nevada study

environments can affect health related

processes (behaviors, stress)

Changes in neighborhood environments

likely to have multiple health and non

health benefits

Living in a disadvantaged community

Exposure to greater industrial pollution, lead, carbon dioxide, industrial waste, etc.

lack of access to amenities, which in turn may affect access to healthful foods, to opportunities for physical activity, and to medical and other services.

insecurity, fear of crime, suffering from the effects of a low position in the socioeconomic hierarchy, and lack of social support.

Living in a disadvantaged community

(continued)

Environmental racism

Poor minorities are still at far greater risk for environmental exposure than are whites in general, or middle-class adults and children of any race and ethnicity.

Short video

http://unnaturalcauses.org/video_clips_det

ail.php?res_id=409

Study by Diez Roux et al.

individual socioeconomic characteristics, particularly

income, are negatively related to the incidence of heart disease.

The researchers divided neighborhoods into groups on the basis of household income and other socioeconomic characteristics, separately for blacks and whites.

Among whites, as among blacks, the worse off the neighborhood, the higher the incidence of heart disease.

By bringing together two levels of analysis - communities and individual residents - they show that socioeconomic characteristics of communities, in addition to individual characteristics such as income, education, and occupation, are related to the incidence of heart disease.

Source: New England Journal of Medicine, v.345, n.2 12jul01

Class and Prevalence of Health Problems in Children

The Relationship Between Class and Health

How class affect health

Children who experience disease or disability tend to miss school, and ultimately complete fewer years of schooling.

This then limits the kind of occupations they qualify for, forcing them to poorly paid jobs.

Poorly paid jobs tend to be jobs with little control and stressful physical working conditions, both of which contribute to the onset of health problems.

The onset of health problems during the working life of an adult impacts the ability to continue working or to advance occupationally.

This impacts the economic security people experience in retirement.

The impact of family circumstances and

childhood on adulthood health

The impact of family circumstances and childhood may not show up until adulthood, after the body’s regulatory system has been overburdened for a long time, and the cumulative damage manifests itself as disease.

Disease may emerge only after years of cumulative risk.

High blood pressure, excessive weight gain – which may go on for awhile without producing alarming symptoms – can evolve into heart disease, diabetes, cancer, and other conditions that cut life expectancy.

The Long Term Impact of the

Environment/Community (Part I)

Toxins and pollutants, including lead, dirty air and noise -- >affect health directly and indirectly in the form of poor cognitive development, resulting in school performance problems.

Less access to playgrounds, parks, and other safe places to exercise.

Libraries are scarcer, and so opportunities to read are less plentiful.

Unstable housing that translates into disruptions in social support and lack of continuity in school attendance.

The Long Term Impact of the

Environment/Community (Part II)

Greater consumption of fast food; less access to healthy food. Poor eating habits set the stage for childhood

and adult obesity.

Violence in school and on the street exposes children to conflict and anxiety.

crime decreases the feasibility of routine exercise

Inadequate and delayed health care increases the chance that injuries and illnesses

will develop into permanent disabilities.

Policies that Affect the Class

Inequality

income and wealth distribution

educational attainment

occupational mobility

Theoretical models on class and

heath (Bartley and Blane, 2008)

Behavioral model

dietary choices, consumption of drugs, alcohol

and tobacco, exercises, immunization, and

antenatal services.

Materialist model

exposed to harm such as air-pollution and

damp housing and lack of access to health care

resources

Theoretical models on class and

heath (Bartley and Blane, 2008)

Psycho-social model

Stress and social integration

Study shows that good relationships with family and

friends, and who participate in the community, have

longer life expectancies than those who are relatively

isolated

Life-course model –

health disadvantage accumulates over time

Disadvantages are likely to accumulate

through childhood and adulthood

Conflict theory on class and heath

Dominant group make sure they will have

health care coverage, while simultaneously

ensuring that subordinate groups stay

subordinate through lack of access.

Education

Provide access to high quality early

childhood education for all children

Reform school financing to equalize

access to quality education in K through

12

Reduce financial barriers that prevent

qualified students from attending college

Training

Equalize access to opportunities for new

or enhanced job skills training on the job,

in community colleges, and in other

venues

Income

Provide adequate income to every household

through minimum wage increase

Offer income supports to families for newborns

Provide earned income tax credits to reduce the

burden on those with less income

Secure pension plans and increase saving

incentives

Policies that Blunt Adverse

Consequences

Environment

Provide affordable housing

Tighten zoning to restrict noise and

pollution

Enforce lead abatement ordinances

Increase traffic safety

Reduce violence and crime

Work

Limit exposure to physical hazards, chemicals, and psychosocial strains in workplaces

Increase opportunities for control over work demands

Reduce disruptive shift changes and extended work hours

Provide working parents with sufficient leave time to attend to children when they are sick

Minimize work-family conflict

Cigarettes and Alcohol

Ban smoking in public areas, subsidize treatment programs for smoking cessation and drug and alcohol abuse

Increase excise taxes on cigarettes, alcohol and junk food and use proceeds to support public health programs

Control advertising of tobacco and alcohol products

Limit the concentration and operating hours of stores selling alcohol

Recreation

Increase access to recreational facilities

through construction support and policies

to open up schools and other institutions

evenings or weekends

Nutrition

Ban sale of soft drinks and junk foods in

schools

Modify school lunch programs to improve

nutrition

Provide incentives (e.g., tax breaks or low

cost business loans) for green markets

and grocery stores that sell fresh produce

Long-term strategy for reducing health

expenditures

to address the underlying determinants of

disease

health care access has a much smaller

influence on population health than do the

underlying social determinants of health.

Discussion

Housing policy, education policy, labor

regulations, and zoning are critical to

determining the conditions that lead to

patterns of disease and mortality

Health policies and social policies are

completely interwoven.

Race and Health

More than 100 studies -- most published

since 2000 -- document the effects of

racial discrimination on physical health.

Black women who pointed to racism as a

source of stress in their lives developed

more plaque in their arteries -- an early

sign of heart disease -- than black women

who didn't.

racism harms health through….

actually experienced attacks,

perceived discrimination,

the concentration of ethnic minority groups

in lower social classes and in

unemployment (Saffron Karlsen, MSc, and

James Y. Nazroo, 2002)

Racial disparities in health

spring from pervasive social and

institutional forces.

higher rates of death and disease in

American blacks are linked to "social

determinants"

residential segregation, environmental waste,

joblessness, unsafe housing, targeted

marketing of alcohol and cigarettes, and other

inequities.

How Racism Affect Health

It acts as a chronic stressor (similar to job strain or marital conflict) leads to higher blood pressure, elevated heart

rate, increases in the stress hormone, suppressed immunity.

Chronic stress is also known to encourage unhealthy behaviors such as smoking and eating too much, that

themselves raise the risk of disease.

How Racism Affect Health

(continued)

racism-health link have tied experiences of

discrimination to poorer self-reported

health, smoking, low-birth-weight

deliveries, depressive symptoms, and

especially to cardiovascular effects.

A Mid-1980s experiment

African-American volunteers were hooked

up to blood-pressure monitors

Then they were exposed to a racially

provocative tape or TV

the volunteers' blood pressures rose, their

heart rates jumped, and they took longer

than normal to recover from both

reactions.

Long-term strategy for reducing health

expenditures

to address the underlying determinants of

disease

health care access has a much smaller

influence on population health than do the

underlying social determinants of health.

Demographic changes

Some facts

Life expectancy in China, Sri Lanka, and Kerala (a sizable state in southern India) exceeds 70 years, despite their having gross national products in 1994 of less than $1,000 per capita.

Harlem’s median family income in 1990 was $24,174, yet only 37 percent of black male would survive from the age of 15 years to 65 ( compared with 77 percent for white men ).

Poor people in the United States are rich by world standards, but they have worse health than the average in some poor countries.