Role of Racism in Health Inequalities

Lower levels of education and income are often associated with worse health outcomes. However, research by Associate Professor Cynthia Colen reveals that even among nonpoor residents of the U.S., African Americans and Latinos often have worse health outcomes than white Americans, likely due to chronic and widespread discrimination.

“People assume that as your socioeconomic status improves, your health will improve as well. Unfortunately, that doesn’t appear to be the case for Americans who aren’t white,” said Colen, the lead author of the study.

Colen and her co-authors, Ohio State sociology professor and director of the Center for Human Resources Research Elizabeth Cooksey; former Ohio State sociology graduate student David Ramey, now assistant professor at Penn State; and David Williams, professor at Harvard University, found a significant connection between discrimination and poor health for those who were young, black and upwardly mobile, challenging the idea that poverty is at the root of black Americans’ experiences, in health care and beyond.

“Upward mobility is certainly better than the alternative,” Colen said, “but it doesn’t make everything better — particularly health outcomes.”

The study evaluated responses from participants in the 1979 National Longitudinal Survey of Youth. It combined 33 years of data, which allowed the researchers to analyze how socioeconomic status changed over time.

According to the data, more money isn’t enough to rid black Americans of higher rates of chronic disease or shorter life expectancy. Black women with a graduate degree are still at higher risk for preterm birth and infant and maternal mortality than white women with a high school diploma. Black women with a PhD and high take-home pay are also more likely than white women who have only a high school diploma to die from birthrelated complications.

The study, published in the February 2018 issue of Social Science & Medicine (available to read here: go.osu.edu/soc-health), highlights the importance of tackling health inequities with an eye on discrimination and racism and not just poverty.

Colen and her colleagues looked at both acute discrimination (being fired from a job without good cause or being passed over for a deserved promotion) and chronic discrimination (daily slights such as being treated with less respect than others, or as if others fear you). They found higher acute discrimination scores for blacks on an upward socioeconomic trajectory and higher chronic discrimination scores for Hispanics whose incomes increased over time.

According to Colen, this type of data is vital to improving future health initiatives — by examining both the nuances in the disparities between race, and why those disparities exist, researchers can begin to more accurately address the root of these issues. It also reminds policymakers of the importance of tailoring projects to focus on the oftenoverlooked black middle class.

“Too often what happens when we are designing health and prevention programs is we ignore the needs of nonpoor racial and ethnic minorities,” Colen said. “These disparities are not going to go away simply by anti-poverty campaigns.”