Health Disparities and Inequalities, Part II

Now, let's discuss some of the well researched, non-medical factors that shape health for different groups in the United States. With regard to neighborhood conditions, many, but not all studies have found that neighborhood features are associated with health even after considering a resident's individual level characteristics. For example, one may not know when they move into a neighborhood that that neighborhood places residents at risk for the adverse effects of air pollution, such as asthma. One may not know that the water flowing into homes is contaminated by a nearby plant or business. Or that not enough grocery stores exist in that area to provide healthy food options to all residents. These are all conditions, along with services such as transportation, trash removal and street lights, that shape a neighborhood resident's opportunity to be healthy in their home and surrounding environment. Similarly, the conditions of a workplace, where many working adults spend the majority of their waking hours, has the power to expose individuals to health risks. Certainly individuals engaged in more physical jobs face the potential for workplace injuries. In addition to those who stand for long hours, or sit behind a desk all day. There's a growing body of research on the dangers of being too sedentary for our health. Other types of work may expose individuals to constant mental health stressors. Certainly social workers are one profession who must engage in self care and be aware of their risk for burnout. The size, type, and support provided by one's workplace could also determine whether someone has employer sponsored health insurance. The ability to leave work to get medical care for themselves or their family members. And the ability to save for life after their working years. All of these work related factors influence both physical and mental health outcomes. Educational attainment or the number of formal years of education that one has, is one of the most powerful predictors of health and well-being. There are multiple pathways through which education can determine one's health risks or outcomes. First, increased education affords individuals the knowledge by itself, as well as the literacy to find and understand information about living healthfully. Research consistently demonstrates that individuals with higher education are more likely to engage in health promoting behaviors. Both because they have the additional knowledge of how to do so and the increased education is linked with increased income. That allows individuals to buy healthier foods, live in safer neighborhoods and access higher quality health care. In this way, educational attainment also impacts health through access to higher income. More stable working conditions and associated resources that contribute to improved physical and mental health. Further, higher educational attainment often increases ones access to social status. Or networks of other individuals with resources and knowledge that can be shared and leveraged for better health outcomes. In the United States and many other societies, race or ethnic group is often an important social factor that influences health. Primarily because of racism. Racism refers not only to overt, intentionally discriminatory actions and attitudes, but also to deep-seeded societal structures. That even without the intent to discriminate, systematically constrain some individual's opportunities and resources on the basis of their race or ethnic group. The effects of racism on health, are a prime example of the concept of embodiment. Derived from the field of social epidemiology, embodiment is the literal, biological internalization, of the material and social conditions experienced from conception to death. No aspect of our biology can be understood. Absence knowledge of contextual and historical influences on the individual life course. There are several theories of how racism operates to disadvantage health in certain racial and ethnic groups. The following theories are conceptualized in reference to the racial discrimination and subsequent health outcomes that African Americans experience. But these theories have since been applied to a range of racial ethnic groups and their experiences, as well. First, you may have heard of the story, or even the myth, of John Henry. John Henry was mythologized as The Steel Driving Man, or a rail worker of great strength, who died of mental and physical exhaustion. Moments after competing against a machine in a nail driving contest around 1870 in West Virginia. John Henryism was developed as a theory to explain how prolonged high effort coping or sustained cognitive and emotional engagement with psychosocial and environmental stressors. Physiologically harms African Americans and individuals with low socioeconomic status. When individuals are trying to free themselves from entrenched systems of social and economic oppression they are repeatedly exposed to psychosocial stressors. Actively working at trying to eliminate these stressors increases the heart rate and blood pressure. And over time, this develops into heart disease and hypertension, among other stress related diseases. Allostatic load is a concept that refers to the physiological burden imposed by stress. It's the cumulative wear and tear on the body systems due to repeated adaptation to stressors. Similarly, weathering is the result of high allostatic load. Weathering refers to the early health deterioration by African Americans at all income levels. As a consequence of the cumulative impact of repeated experiences, with social and economic adversity, and political marginalization. When persistent, high-effort coping, like John Henryism, results in acute and chronic stress, these processes severely damage the body, and speed aging, morbidity, and mortality. Bio markers are substances in the body used to measure the underlying social disparities in health. Common bio markers include cortisol, sympathetic nerve activity, blood pressure reactivity, cytosine production, and waist to hip ratios. Allostatic load scores are used as an empirical measurement for weathering. Research indicates that African American women bear a larger burden of allostatic load than African American men, white men, and white women. Due to the compounded experience of gender and racial discrimination. Discrimination and bias experienced by individuals from racial-ethnic groups not only occurs in the domains of employment, housing, education, and other sectors of society leading to increased internalized stress in subsequent health disparities. Discrimination also occurs in health and medical context. Unfortunately, a number of studies have established that African-American patients, in particular, experience poor quality medical visit communication than their white counterparts. More recently, a study of the American Journal of Public Health, was quoted as saying doctors tend to dominate conversations with African-American patients. Pay less attention to their personal and psychosocial needs and make patients feel less involved in making decisions about their health. That same study reported that two-thirds of doctors harbored unconscious racial biases towards patients. And that racial bias favoring whites was associated with greater clinician domination of the medical dialogue for African American patients. And less positive patient emotional tone in the visits of their African American patients. In addition, African American patients expressed less confidence in their clinicians. Perceived less respect from their doctors, liked their doctors less, and were less inclined to recommend their doctor to their friends. The majority of mental health and medical clinicians in the United States are not African American. And so in order to obtain health care African American patients must navigate a constant environment where implicit bias may be operating on how they are being spoken to or treated. Even patients with higher incomes, higher education, and more prestigious jobs, experience discrimination in healthcare that may lead to sub-optimal care. Unfortunately, other groups such as LGBTQ patients, overweight and obese patients, disabled patients, homeless patients and the elderly also struggle with implicit bias affecting their health care experiences to varying degrees. Now, watch the three clips on disparities in pre-term birth and infant mortality from the documentary Unnatural Causes. For a brief activity, discuss why African American women at every socio-economic level have higher rates of per-term birth and infant mortality. Than white women who haven't finished highschool or black women who immigrated here from other countries.