EXPOSING THE ROOTS OF HEALTH DISPARITIES
Harvard Public Health Review, January 1, 2007
[Rachel’s introduction: “What intrigues Williams are not just extreme forms of racism, but their subtler, more insidious, day-to-day manifestations. A huge body of research on health disparities has led him to conclude that stress resulting from institutionalized racism and discrimination, be it real or perceived, blatant or muted, is an ‘added pathogenic factor’ that contributes to well-above-average levels of hypertension, respiratory illness, anxiety, depression, and other ills in minority populations.”]
By Richard Saltus
In his latest bid to unearth the dark, tangled roots of disparities in health between blacks and whites, Harvard School of Public Health (HSPH) newcomer David R. Williams has gone to South Africa….
Insidious racism
Williams looks at social policies and historical patterns of discrimination through a sociologist’s lens. By sifting and sorting data in fresh ways, he has cast new light on the causes of blacks’ poorer health and rates of survival, observe his new colleagues at HSPH. In August, Williams joined the faculty as the Florence Sprague Norman and Laura Smart Norman Professor of Public Health in the Department of Society, Human Development, and Health.
What intrigues Williams are not just extreme forms of racism, but their subtler, more insidious, day-to-day manifestations. A huge body of research on health disparities has led him to conclude that stress resulting from institutionalized racism and discrimination, be it real or perceived, blatant or muted, is an “added pathogenic factor” that contributes to well-above-average levels of hypertension, respiratory illness, anxiety, depression, and other ills in minority populations. Socioeconomic status is just part of the problem. While lower-income people generally tend to be less healthy, Williams says, “blacks do more poorly than whites at every level of socioeconomic status.”
The roots of health disparities run so deep that they’re invisible to most of society, he has found. “A lot of what I struggle with is understanding the larger social, political, and economic context in which health is embedded and the broader forces, many of them hidden, that shape mobility and access to health care,” Williams says. “I have argued, for example, that residential segregation, resulting from historical racist policies, is a fundamental cause of excess levels of ill health in the African-American population.”
Segregation by neighborhood is so high at every income bracket in the United States that, in many cities, it comes close to levels once legally mandated by apartheid in South Africa, Williams says. Sixty- six percent of blacks would have to move in order to distribute blacks and whites evenly.
Truth in numbers
Over the past decade, Williams has been among the top 10 most-cited researchers in the social sciences. His more than 100 papers have yielded insights such as these:
Blacks die at twice the rate of whites in the age groups 1-4 and 25-54–a grim fact often missed in comparisons of overall mortality rates, which yield a 30 percent mortality disadvantage for blacks.
In Pitt County, North Carolina, the odds of having hypertension were seven times higher for black men who as children and adults had low socioeconomic status (SES) than for black men whose SES was high.
In Mississippi, home to the highest heart disease death rates in America, the healthiest black women die from heart disease at a greater rate than the sickest white women.
Read all of it here.
