March 9, 2005

Segregation is bad medicine, UM study suggests

ANN ARBOR, Mich.—Social factors—particularly residential segregation and neighborhood quality—contribute to racial disparities in the death rates of white and Black Americans, according to an analysis by researchers at the University of Michigan and Indiana University.

Large disparities persist for deaths due to homicide, heart disease and cancer, according to U-M researcher David R. Williams and IU researcher Pamela Braboy Jackson, who tracked changes in Black and white deaths from five conditions over a 50-year period. But the gap has narrowed for deaths from the flu-pneumonia and suicide.

The analysis appears in the March/April 2005 issue of Health Affairs. The research was supported by the John D. and Catherine T. MacArthur Foundation and the Robert Wood Johnson Foundation.

"We need to rethink what constitutes health policy in this country," said Williams, a sociologist at the U-M Institute for Social Research (ISR). "Given the broad social determinants of health and mortality, policies far removed from traditional health policy can have decisive consequences."

Among the major findings:

• For the two leading causes of death in the U.S.—heart disease and cancer—Blacks had death rates 30 percent higher than whites in 2000. In 1950, the two races had comparable death rates from heart disease and Blacks had lower death rates from cancer.

• The racial gap in homicide death rates narrowed between 1950 and 2000, but the homicide rate (the 15th leading cause of death in the U.S.) was still almost six times greater for Blacks than for whites.

• For flu and pneumonia, the seventh-leading cause of death, large racial differences in death rates existed in 1950, with Black mortality 70 higher than that of whites.   Over the last half-century, striking declines in death rates occurred for both races, with larger declines for Blacks than for whites. "The virtual elimination of a racial disparity in death rates from flu and pneumonia is a result of the ready availability of treatment facilitated by Medicare and Medicaid," noted Jackson. "Social variations in motivation, knowledge and resources played a small role in eliminating a large disparity in health."

• For suicide, the 11th leading cause of death, Black death rates have consistently been less than white death rates. "High levels of self-esteem and religious involvement in the Black community are potential contributors to the better suicide and mental health profile of Blacks," noted Williams.

Williams and Jackson maintain that racial differences in socioeconomic status, neighborhood residential conditions and medical care are important contributors to continuing racial differences in death rates from heart disease, cancer and homicide.

Education, income and health practices, including diet, physical activity, tobacco use and alcohol abuse, all play a role in racial differences in disease and mortality, they point out. But other factors also come into play.   For example, the homicide death rate for African-American men with at least some college education is 11 times that of similarly educated whites. "Strikingly, the homicide rate of black males in the highest education category exceeds that of white males in the lowest education group," the authors write.

Elevated levels of stress and a heightened vulnerability to stress among people who are disadvantaged may be another link between race, socioeconomic status and health, the authors note. But the stress of racial discrimination is not limited to Blacks of lower socioeconomic status, they emphasize. Blacks of higher socioeconomic status are more likely than those of lower status to report being discriminated against, and this perception may contribute to the elevated risk of disease that is sometimes observed among middle-class Blacks.

The persistence of racial differences in health after individual differences in income and education are accounted for may reflect the role of residential segregation and neighborhood quality, according to Williams. "Because of segregation, middle-class Blacks live in poorer areas than whites of similar economic status, and poor whites live in much better neighborhoods than poor Blacks." Other racial and ethnic minority groups are less segregated than Blacks, with the most affluent Blacks experiencing higher levels of residential segregation than the poorest Latinos and Asians.

To narrow the stubborn health gap between Blacks and whites, society must address racial residential segregation, narrow the income gap, and improve medical care, especially preventive services, for vulnerable populations, the authors conclude.  

Related links:

David R. Williams

Pamela Braboy Jackson at Indiana University

Institute for Social Research

John D. and Catherine T. MacArthur Foundation

Robert Wood Johnson Foundation

Health Affairs

Established in 1948, the Institute for Social Research (ISR) is among the world's oldest survey research organizations, and a world leader in the development and application of social science methodology. ISR conducts some of the most widely-cited studies in the nation, including the Survey of Consumer Attitudes, the National Election Studies, the Monitoring the Future Study, the Panel Study of Income Dynamics, the Health and Retirement Study, the Columbia County Longitudinal Study and the National Survey of Black Americans. ISR researchers also collaborate with social scientists in more than 60 nations on the World Values Surveys and other projects, and the Institute has established formal ties with universities in Poland, China, and South Africa. ISR is also home to the Inter-University Consortium for Political and Social Research (ICPSR), the world's largest computerized social science data archive. Visit the ISR Web site at www.isr.umich.edu for more information.

Contact: Diane Swanbrow
Phone: (734) 647-9069
E-mail: Swanbrow@umich.edu