Racial Health Inequities Research Articles

Racial inequalities and perinatal health in the southeast region of Brazil

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (< or = 4 years, 27.2 and 38.0%) and lower family income (< or = 1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.

Reifying Human Difference: The Debate on Genetics, Race, and Health

The causes of racial and ethnic inequalities in health and the most appropriate categories to use to address health inequality have been the subject of heated debate in recent years. At the same time, genetic explanations for racial disparities have figured prominently in the scientific and popular press since the announcement of the sequencing of the human genome. To understand how such explanations assumed prominence, this essay analyzes the circulation of ideas about race and genetics and the rhetorical strategies used by authors of key texts to shape the debate. The authority of genetic accounts for racial and ethnic difference in disease, the author argues, is rooted in a broad cultural faith in the promise of genetics to solve problems of human disease and the inner truth of human beings that is intertwined with historical meanings attached to race. Such accounts are problematic for a variety of reasons. Importantly, they produce, reify, and naturalize notions of racial difference, provide a scientific rationale for racially targeted medical care, and distract attention from research that probes the complex ways in which political, economic, social, and biological factors, especially those of inequality and racism, cause health disparities.

National Data for Monitoring and Evaluating Racial and Ethnic Health Inequities: Where Do We Go From Here?

The elimination of racial and ethnic health inequities has become a central focus of health education and the national health agenda. The documentation of an increasing gap in life expectancy and other health outcomes suggests the need for more effective strategies to eliminate health inequities, which can be informed by better monitoring and evaluation data. Although the sophistication and volume of health data available have increased dramatically in recent years, this article examines the quality of the current data collected to achieve the goal of eliminating racial and ethnic health inequities. This article explores several key aspects of data to inform addressing inequities including terminology, the role of data, and explanations of the problem. The authors conclude with recommendations for refining data collection to facilitate the elimination of racial and ethnic health inequities and suggest how the Society for Public Health Education can become a more central figure in our national efforts.

“Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States

We considered whether US Blacks experience early health deterioration, as measured across biological indicators of repeated exposure and adaptation to stressors. Using National Health and Nutrition Examination Survey data, we examined allostatic load scores for adults aged 18-64 years. We estimated probability of a high score by age, race, gender, and poverty status and Blacks' odds of having a high score relative to Whites' odds. Blacks had higher scores than did Whites and had a greater probability of a high score at all ages, particularly at 35-64 years. Racial differences were not explained by poverty. Poor and nonpoor Black women had the highest and second highest probability of high allostatic load scores, respectively, and the highest excess scores compared with their male or White counterparts. We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.

Aspectos epidemiológicos das desigualdades raciais em saúde no Brasil

In Brazil, data on education, the labor market, and the law enforcement and court systems have already documented that racial discrimination is a structural factor underlying economic and social disadvantages experienced by racial/ethnic minorities. However, racial inequalities in health have received little investigation. According to health indicators presented in this paper, race is a strong predictor of variability in mortality. Early mortality is more frequent among indigenous and black Brazilians; mortality rates from stroke and especially maternal mortality rates are exceedingly higher among black women; violence occurs predominantly among young black men. Lifetime socioeconomic differences across successive generations have been identified as the main cause of racial inequality in health. It is also suggested that racial discrimination and its impact on health are at the origin of these inequalities. Instruments to directly or indirectly measure the impact of racial discrimination on health are discussed. The article suggests that investigation of the impact of both social class and race on health is the most productive approach, both for research as well as for policies to address health inequalities.

Researching Health Inequities among African Americans: The Imperative to Understand Social Class

Racial and ethnic inequities in health abound in many disease categories. African-American communities suffer from an increased burden of illness, with higher incidence and mortality rates and more severe morbidity in cerebrovascular disease, heart disease, several cancers, diabetes, and many other ailments. Healthy People 2010, the federal government's health plan, calls for eliminating health disparities by race, ethnicity, gender, education, income, disability, geographic location, or sexual orientation. Research aimed at increasing our understanding of these health disparities and designing and evaluating interventions to improve African-American health is hampered by a liberal, classless approach. The authors argue for a theoretical framework in this research that recognizes that class exploitation sets the stage for and interacts with racial discrimination to determine racial inequities in health.

Skin pigmentation, self-perceived color, and arterial blood pressure in Puerto Rico

Darker skin color has been associated with higher average blood pressure in several African-derived populations in the Americas. This pattern has been interpreted as evidence of genetic, physiologic, or sociocultural mechanisms, but existing evidence does not provide an adequate means of evaluating these alternatives. This paper introduces a measurement strategy to isolate the cultural and biological dimensions of skin color, and it develops a specific hypothesis regarding the cultural significance of skin color in Puerto Rico and its relationship to arterial blood pressure. Data come from a face-to-face survey in southeastern Puerto Rico (N = 100). There is no association between blood pressure and skin pigmentation, as measured by reflectance spectrophotometry. However, the discrepancy between self-perceived color and skin pigmentation, a measure we call "color incongruity," is associated with systolic blood pressure (SBP) through an interaction with socioeconomic status (SES) (P = 0.009). For low-SES respondents, darker self-ratings of color relative to skin pigmentation are associated with higher mean SBP. For high-SES respondents, however, darker self-ratings of color relative to pigmentation are associated with lower mean SBP. We interpret this pattern as evidence that the relationship between skin color and blood pressure is mediated by sociocultural processes, and we highlight the need for testable hypotheses and appropriate measurement operations in research on racial inequalities in health.

Are racial disparities in health conditional on socioeconomic status?

Racial health inequality is related to socioeconomic status (SES), but debate ensues on the nature of the relationship. Using the US National Health and Nutrition Examination Survey I and the subsequent follow-up interviews, this research examines health disparities between white and black adults and whether the SES/health gradient differs across the two groups in the USA. Two competing mechanisms for the conditional or interactive relationship between race and SES on health are examined during a 20-year period for black and white Americans. Results show that black adults began the study with more serious illnesses and poorer self-rated health than white adults and that the disparity continued over the 20 years. Significant interactions were found between race and education as well as race and employment status on health outcomes. The interaction effect of race and education showed that the racial disparity in self-rated health was largest at the higher levels of SES, providing some evidence for the “diminishing returns” hypothesis; as education levels increased, black adults did not have the same improvement in self-rated health as white adults. Overall, the findings provide evidence for the continuing significance of both race and SES in determining health status over time.

To have and have not: Health and health care disparities in chronic kidney disease

A 50-year-old African American man came to the emergency room complaining of substernal chest discomfort over the past 2 months, as well as anorexia, general malaise, and decreased urinary frequency over the past 2 weeks. The patient stated that his chest pain lasted 2 to 3 minutes; did not radiate to the neck, jaw, or shoulder; was precipitated by lifting heavy objects; and did not occur at rest. He admitted to mild shortness of breath when walking up the stairs at home. He noted that for 2 weeks, he had been feeling exhausted and had had poor appetite, weight loss, and less frequent urination than usual. The patient had last seen a physician 4 years ago at an urgent care facility for a pilonidal cyst abscess. Five years prior to that, he had been told by a primary care physician that he had hypertension. He was treated with an unknown medication and, after a follow-up visit, was told that his blood pressure was normal. He has no other known history of cardiovascular or renal disease. He takes no medications. He lost his job as a cook and the health insurance that the job provided; he now says that he is unable to continue seeing the physician. He completed high school, is married, and works as a taxi driver as well as at a local farmers market on weekends. His father had hypertension and died suddenly at age 55. His mother is 71 and has diabetes. He has one older brother who

Brazilian and international nursing have a key role for combating racial exclusion and health inequities

Afro-descendant an indigenous populations have systematically over 500 years lagged behind the white population includding health issues.This secular process of exploitation lead to inequity and exclusion. It is necessary a clear understanding of the racism as a subtle social ideology of discrimination for designing and implement effective programs and policies that promote development with justice or in other words affirmative actions.Even the World Bank recognize that nurses can provide the majority of the care in clinical and health public services. But although our mission is based on humanistic principles, we have to point out the human rights to advocate for ethnic groups that are underserved or not have access to health.The reports of WHO and PAHO note the necessity of including the ONU´s report of Durbam´s Conference against Racism (August 2001) in the agenda of each health instituition. Particularly inLatin Americaand Caribe, we nurses must plan our actions with the main objectives of reduce and eliminate health disparities related mainly to racial an gender discrimination considering the cultural and ethnic aspects of our populations to provide culturally sensitive care.At the last number of the OBJN, I claimed to all nurses to show to the world wide what we have done, what we are doing, and our potencial skills to improve health and care for the population (CRUZ, 2002). Now, the OBJN claim to all nurses worldwide to contribute to the overall WHO/PAHO efforts and to do as much as possible to reduce an eliminate health disparities related to racial and gender discrimination.

Brazilian and International Nursing Have a Key Role for Combating Racial Exclusion and Health Inequities

Brazilian and International Nursing Have a Key Role for Combating Racial Exclusion and Health Inequities

Racial ideology and explanations for health inequalities among middle-class whites.

Middle-class whites' explanations for racial inequalities in health can have a profound impact on the type of questions addressed in epidemiology and public health research. These explanations also constitute a subset of white racial ideology (i.e., racism) that in itself powerfully affects the health of non-whites. This study begins to examine the nature of attributions for racial inequalities in health among university students who by definition are likely to be involved in the research, policy, and service professions (the upper middle class). Investigation of the degree to which middle-class whites attribute racial inequalities in cardiovascular health (between themselves and African Americans, American Indians, or Asian Americans) to biological, social, or lifestyle factors reveals that whites tend to attribute their own health to lifestyle choice and to biology rather than to social factors. These results suggest that contemporary middle-class whites' "self-serving" explanations for racial inequalities in health are comprised of two beliefs: implicit biologism (race is an attribute of organisms rather than a social relation) and liberal belief in self-determination, choice, and individual responsibility--some of the core lay beliefs of the worldview that sustains neoliberal capitalism. Contemporary white middle-class explanations for racial inequalities in health appear to include assumptions that justify class inequality. Liberal approaches to racism in public health are bound to miss a key component of racial ideology that is currently used to justify racial and class inequalities.

Tackling ethnic and racial oral health inequalities in older people which way forward?

Tackling ethnic and racial oral health inequalities in older people which way forward?

Intelligence, genes, and success: scientists respond to the bell curve

Part 1 Overview: re-examining The Bell Curve a synopsis of The Bell Curve. Part 2 The genetics-intelligence link: of genes and IQ the malleability of intelligence is not constrained by heritabiligy racial and ethnic inequalities in health - environmental, psychosocial, and physiological pathways. Part 3 Intelligence and the measurement of IQ: theoretical and technical issues in identifying a factor of general intelligence the concept and utility of intelligence is there a cognitive elite in America?. Part 4 Intelligence and success: reanalyses of data from the NLSY cognitive ability, wages, and meritocracy the hidden gender restriction - the need for proper controls when testing for racial discrimination does staying in school make you smarter? The effect of education on IQ in The Bell Curve.

Racial and Gender Inequalities in Health and Health Care

P aradoxically, anthropology's disciplinary genealogy can be traced to an earlier of and the races of man (Tylor 1946[1881]); yet, as Barbee rightfully emphasizes by quoting Barrett, [t]he social anthropology of racism ... has been a dismal failure (Barbee p. 323). Culture's victory over biology in battles against scientific racism eventually deconstructed the notion of race as a biological reality. Unfortunately, the no-race posture that became the new convention (Littlefield et al. 1982) resulted in, as Jackson would phrase it, the virtual in mainstream anthropological discourse of the social differences and inequalities that have come to be constituted in historically specific racial orders. Regardless of its untenable status as a biological entity, race, especially in the ways it has been constructed and reconstructed since the era of European colonial expansion and conquest, is a social phenomenon, a marker of hierarchical social location (Glick Schiller and Fouron 1990) rationalized in terms of the natural history of human (or subhuman) biology or, in view of the implications of some contemporary discourses, in terms of some persistent cultural pathology and untranscendable social and cultural distance. The whiting-out of socially constructed race and of the structures, practices, and ideologies of power disparity that produce and reproduce it signals a grave intellectual inadequacy that, as I will argue below, has not been redressed by the discipline's concern with and commitment to the study of ethnicity. This special issue, along with a recent current of other publications (e.g., Critique of Anthropology 1992; Frankenberg 1993; Menchaca 1993; Smedley 1993; Wade 1993), is a welcome response to the need for critical anthropological interrogations, analyses, and theorizing on the problematics of race and racism. The interrelated focus on gender is especially apropos in light of the fact that one of the most visible recent directives for anthropological inquiry

Racial inequalities in health: a challenge to the British National Health Service.

The existence of racial inequalities in health in the United Kingdom is examined using both indirect and direct data. The evidence strongly supports the view that the health experience of black and other ethnic minority groups is worse than that of the indigenous white population. Ways of improving this situation are outlined; they indicate the need for a coordinated Health service response incorporating planning, training, and equal opportunities in both service provision and employment practices.