The color of money: Race-ethnicity, socioeconomics, culture and discrimination. What really matters for health?

Abstract

A basic tenet of public health is that the relationship between socioeconomic status and health is robust, whereby health improves rapidly from the lowest levels of income, education or occupation to average or median levels, with a detectable, if diminishing, gradient at even higher levels of socioeconomic status. However, the literature on which this tenet is based is largely research studying white men. The magnitude and, in some cases, direction of this relationship varies considerably for other demographic groups. Research on racial and ethnic health disparities has focused almost exclusively and uncritically on negative differences between Blacks and Whites. The potential positive contributions associated with a more diverse sample of races, ethnic differences within racial groups, and the role of White racial privilege are often overlooked. These practices highlight the liberal application of impoverished race and ethnicity variables in racial and ethnic health disparities research. I argue failure to clearly qualify study conclusions when they are restricted to the study of white men and the continued application of poorly conceptualized and untheorized race and ethnicity variables are an impediment to integrating the range of findings on social characteristics and health. Frameworks and models based on traditional socioeconomic measures and poorly conceptualized race and ethnicity measures may mask heterogeneity, overestimate the benefits of material resources, underestimate psycho-social and physical health costs of resource acquisition, and miss the value of alternative socio-cultural orientations. In this work I develop, introduce and test a dynamic and responsive theoretical framework that considers the health implications of racial categorization, ethnic identity, discrimination and alternative socio-cultural orientations along with traditional socioeconomic resources. This framework provides an alternative to existing static and culturally biased frameworks. Application of this framework to a racially and ethnically diverse sample suggests that it holds promise for contributing to understanding of the multi-dimensional and multi-level nature of social inequalities and resultant health disparities.