Understanding health disparities: Race, class, or both?

African Americans are sicker and dying at a faster rate than white Americans from a number of diseases. As noted in Healthy People 2010,(1) the infant mortality rate for African Americans is more than double that of whites. Coronary heart disease death rates are more than 40 percent higher for African Americans than for whites. African Americans die at a 30 percent higher rate than do whites from cancers, as well. The death rate from HIV/AIDS for African Americans is more than seven times that for whites. Biomedical and social scientists across the country devote countless hours to trying to understand and eliminate these inequities; yet, the problem remains. Why?

In part, it’s because our understanding of racial and ethnic health inequities doesn’t drill down to the root of the problem. One of the many challenges facing researchers in this area is untangling and explaining the relationship between social class and racism and their respective roles in creating and maintaining racial and ethnic health inequities (2–5). Unfortunately, this research endeavor is hampered by a liberal, classless approach to the study of health inequalities. In the period between 1960 and 1990, a substantial body of work assessed the effect of social class relations on population health. This earlier research on health inequities looked at issues of class exploitation and class power. However, funding agencies sought to support an alternative set of hypotheses to this radical perspective. These subsequent studies “focused not on class or even on power relations (terms seen as too ideological) but rather on income and status, referring to income and status differentials, rather than class differentials” (6). In this way, the socioeconomic status (SES) construct became the mainstream framework for discussing population health, and it is the dominant theoretical framework for the study of racial and ethnic health disparities today.

In this blog, I hope to look at issues affecting the health of racial and ethnic minorities from the viewpoint of social class, power relations, and racial discrimination. I hope you’ll join me in the discussion.

1. U.S. Department of Health and Human Services. Healthy People 2010. Washington,
D.C., 2000.
2. Krieger, N., and Bassett, M. The health of black folk: Disease, class, and ideology.
Monthly Rev. 38: 74–85, 1986.
3. Navarro, V. Race or class versus race and class: Mortality differentials in the United
States. Lancet 336: 1238–1240, 1990.
4. Muntaner, C., Nieto, F., and O’Campo, P. The bell curve: On race, social class, and
epidemiologic research. Am. J. Epidemiol. 144: 531–536, 1996.
5. Muntaner, C. Invited commentary: Social mechanisms, race, and social epidemiology.
Am. J. Epidemiol. 150: 121–126, 1999.
6. Navarro, V. The politics of health inequalities research in the United States. Int. J.
Health Serv. 34: 87–99, 2004.

Wednesday, May 13th, 2009 at 14:12