Sociology 170 Test 2

Incarceration on the International Scale

-The US has way higher incarceration rates than other countries. 1) US- 707 2) Russia- 470 3) Ukraine- 286

BLL

Blood lead levels in children under 5 vary significantly within and between wards in Flint, MI

Features of Fundamental Social Causes of Mortality

(1) Influences multiple disease outcomes (2) Affects these disease outcomes through multiple risk factors (3) Association between fundamental cause and mortality is reproduced over time via the replacement of intervening mechanisms (4) Involve access to resources that can be used to avoid risks or to minimize the consequences of disease once it occurs -The more resources you have, the more able you are to be able to prevent and treat diseases and maintain your health

Domains of Health where the US is Worse

(from 2008) Men: homicide, transportation accidents, noncommunicable diseases Women: perinatal conditions, noncommunicable diseases, unintentional injuries -Now drug related deaths are the leading cause of death before 50 in the US

Incarceration Within the US

-Incarceration rates are much higher for all races in the South due to different sentencing policies -The black/white incarceration ratio is highest in Midwestern states, WI is 2nd (blacks 11x more likely to be in prison), this is due to much lower rates of white incarceration than the national average

Rate of Health Deterioration

-A person who experiences chronic stress may experience health declines at earlier ages and at a faster rate -At age 40 blacks had higher probability of experiencing a high allostatic load than white at age 40, and the same probability of whites at age 50 -That essentially means that blacks are aging faster

2) Actual vs. Perceived Attributes

-An outsider's observations may be different from an insider's observations. This could be the difference between sending in someone to take measurements and sending out surveys

Impact of Medicaid Expansion on Health of Low Income Americans

-Arkansas and Kentucky accepted medicaid expansion associated with the Affordable Care Act while Texas rejected it. The percent of low income adults without health care decreased in the former and remained the same in the latter. -There were significant increases in affordability, regular care for adults with chronic conditions, and self-rated health

Incarceration in the US

-Before the 1980s policies focused on making sure sentencing was fair and consistent across states -The Sentencing Reform Act of 1984 led to harsher sentencing and created minimum required sentences for crimes -Anti-Drug Abuse Act of 1986- made crack cocaine sentencing harsher than for powder cocaine causing more blacks to be in jail -In 1995 24 states adopted 3 strikes legislation meaning there was mandatory prison time on the 3rd run in with the law -Incarceration rates peaked in 2008 then started to decline after civil rights suit in California caused them to depopulate their prisons

Race and Prevalence of Stressors

-Blacks and American-born Hispanics have higher levels of stressors than whites -Racial differences in poor health are partly explained by greater prevalence of stressors among non-whites, SES also accounts for it

Incarceration By Education and Race

-Blacks have higher rates at every education level -There have been basically no changes for college graduates in incarceration rates -People with only a high school degree have higher rates today -People who dropped out of high school are much more likely to be in jail today, black drop-outs have the biggest increase in incarceration widening the gap and increasing class and race inequalities over time

Income and Health By Race

-Blacks have larger differences in heart disease prevalence by income than whites, and they have higher rates of heart disease than whites in the same income category meaning its not just income, it has to be racial as well. Racial gaps decreased as income went up so very rich whites and blacks had similar heart disease prevalence -Blacks have higher lead blood levels (pointing to worse housing) than whites in the same wealth category. Racial gaps increased with income pointing to residential segregation where even well of blacks are living in worse neighborhoods than whites

Health Disparities from Income by Gender

-Income inequalities in life expectancy were higher for men than women. (Larger gap between men at low and high income levels) -Gender disparities are larger at low income (Bigger gap between men and women at low income than high)

Physical Environment

-Built environment: physical characteristics of buildings, streets, and other constructed features •Proximity to facilities that produce or store hazardous substances (poor air and water quality) •Quality of affordable housing (exposure to lead paint, mold, dust, or pest infestation) •Lack of access to affordable, nutritious food •Lack of access to safe places for exercise and recreation •Adverse traffic conditions

Index of Dissimilarity

-Captures the degree to which two groups are found in equal proportion in all neighborhoods -Scale 0-100 -0 means that every neighborhood is just as diverse as the population as a whole, no segregaation -100 means that individuals with different characteristics never share neighborhoods -Interpretation: the percent of group members that would have to change neighborhoods in order to achieve perfect integration

1) Defining Neighborhoods

-Census tracts are often used but these may not represent how people are really interacting. They don't match up with the neighborhood associations in Madison. -Some neighborhoods have large differences in health and life expectancy. 15.9 years in one neighborhood. Is that really representative of a neighborhood?

Social Environment

-Characteristics of the social relationships among their residents, esp. degree of mutual trust and feelings of connectedness •Do neighbors work together to achieve common goals? •Are there opportunities to exchange information? •Do neighbors maintain informal social controls? •Are there opportunities for social interactions?

Racial Classification

-Complicated political and social process rather than a biological one -Fluid: changes in response to social and political factors -Social context shapes what racial identities are possible and reasonable ex) One drop rule

Why Study Neighborhood Effects?

-Do people's health differ by neighborhood/does it change if they are moved? -Are people who live in poor neighborhoods less healthy because they are poor or do features of the neighborhood have an additional independent effect?

What's Missing from the Poverty Threshold?

-Doesn't reflect modern experiences: excludes taxes, work expenses, child care, out-of-pocket medical expenses -Doesn't vary by geographical differences in the cost of living -Identifies only the share of people who fall below the poverty threshold but does not measure the depth of need (some people may be way below, some may be just over or just below and have very different opportunities)

Barker Hypothesis / Developmental Origins of Disease

-Early events may be as or more important than later events and/or may interact with later factors -Impaired fetal growth permanently changes the body's structure and physiology (in-utero programming) -Impaired fetal growth (due to a poor intra-uterine environment) causes adult disease -Early (esp. in utero) environmental exposures change physiological development and gene expression = epigenetics

Colorblindness

-Emphasis on the individual rather than group experience to point out that some minorities are very successful so there isn't still racism -Does not recognize how racial disparities are generated and supported by society -Relies on culturally based explanations rather than structural explanations -Denial that racism persists while opportunities for non-whites continue to be limited

Incarceration Rates

-Fraction of population in prison or jail on an average day 1980 = 221 per 100,000 2008 = 762 per 100,000 2013 = 716 per 100,000 -Driven by: • Crime rates- not this, crime rates have gone down • Number of prison sentences per number of crimes committed • Expected time served in prison by those sentenced → Evidence indicates that growth in incarceration due to policy changes

Weathering Hypothesis

-Geronimus: the stress inherent in living in a race-conscious society that stigmatizes and disadvantages black individuals may cause disproportionate physiological deterioration -Physical consequences of chronic exposure to social, economic, and political exclusion arising from racial discrimination and accumulated socioeconomic disadvantage -This persists across the life course leading to greater disparities with age

What do genetics tell us about race?

-Groups are more physically distinct when geographic or social barriers prevent intermarriages across generations. These isolated groups are used for genetic reference -Genetics tells the story of human movement and mixing -Lived experiences can be much more real than the kinds of genetic differences race is based on

Cumulative Risk

-Higher probability of being incarcerated before age 34 for younger cohorts, greatly increased for high school dropouts White: 3.8→28% Black: 14.7→68% -Incarceration leaves an enduring status that disrupts early adulthood

Neighborhood Effects on Health

-How spacial contexts affect health of residents -Research motivated by 1) Individual-level explanations of health are insufficient 2) Interest in understanding causes of social inequalities and racial/ethnic differences in health 3) Disease prevention efforts need to understand consequences of non-health policies like housing and urban development

Potential Relationship Between Increased Inequalities and Health

-If there isn't much difference in income levels in the society, there will be a smaller disparity by income -If there is a larger income gap, there will be a larger disparity in health by income -Suggests that there is a threshold above which additional income does not significantly influence health -Larger disparities when relationship between income and health is more dramatic ex) NY and Detroit

When in the Life Course does Neighborhood Matter?

-In the MTO experiment children who moved before age 13 were more likely to have positive outcomes while children who moved after age 13 were more likely to have negative outcomes or no effect -This suggests importance of age and duration of exposure for outcomes -Neighborhood effects on health begin in utero

Incarceration and Health

-Incarceration has a huge negative impact on adult health. Partially due to lower probability of being married, in the labor force, and having a good education. -The difference between black and white health decreases when controlling for incarceration -Black men in prisons have lower mortality rates than black men in overall population because of access to health care while in prison. This isn't seen for white men -For male prisoners, there is no difference in mortality by race -5 years in prison=10 years lost in life expectancy

Self vs. Societal Race and Health

-Individuals who are socially assigned as white have a health advantage over individuals socially assigned as non-white. Those who self identified as Hispanic or black and were perceived as this race, had worse health than those who identified as this race but were seen as white by others -Social assignment of race matters more for health than self-identification

Income Inequality

-It can aggravate the conditions in low-income communities and add to psychological stressors -Social status influences stress and the amount of coping resources a person has. Together these influence health outcomes. Poor people have more stress and less coping resources so they have worse health outcomes.

Maternal and Infant Mortality

-Maternal mortality is rising in the US even though it is declining elsewhere, similar to that of Kazakstan -Infant mortality is highest in the US compared to peer countries even though the US has the most specialists and facilities for neonatal care, maybe due to access to prenatal care -Driven by postneonatal (after 1 month) mortality, postneonatal mortality disadvantage is driven by higher mortality among infants from lower income families

Segregation in the US

-Milwaukee is the most segregated city in the US, 81.5, this means that % of black people would have to move to achieve perfect integration -Hispanic-white segregation is not as severe as black-white segregation, it is highest in Springfield MA, 63.4

Death Rates by Race from 1950-2000

-Mortality from heart disease decreased for blacks and whites, but it decreased faster for whites leading to a widening of the gap between races -Mortality from cancer has increased for blacks and whites but it has increased faster for blacks leading to a gap between races -This points to blacks having a disadvantage in ability to influence health outcomes

Fetal Exposure and Long Term Effects

-Nutrient deprivation, Radiation, Heavy alcohol use, Cigarette smoke, Cocaine, Maternal chronic stress (e.g. poverty and racism) -Pesticides impact motor skills and neurodevelopment -Low birth weight/in-utero growth restraint lead to increased risk of Type II diabetes, cardiovascular disease, and chronic inflamation -Maternal infections can increase risk of heart disease and schizophrenia -In some cases, exposures may generate forms of adaptations to local conditions that are advantageous to the fetus but can be pathological once in a normal environment -Some can carry across multiple generations ex) People born with low birth weight are more likely to have low birth weight babies

Race is a Social Construct

-People believe that there are distinct differences between races and classify them based on physical, geographical, and cultural ques -Physical differences are assumed to the the cause of cultural and behavioral differences -Social Hierarchy: racial groups are seen as ranked which justifies inequality like slavery and colonialism -Regardless of whether there are significant biological differences, things that are believed to be real have real social, economic, political, and health consequences

Why Health is Worse in US

-Potential role of policy differences such as social safety nets and public health expenditures -Primary care in Europe vs specialist care in US -Access to medical care, health insurance coverage, health care affordability, primary care, access to facilities, timeliness of care -Practicing physicians per 1000 and annual physician visits per capita is lower in the US -Access to health care in the US is much more dependent on individual's ability to pay since there is no universal health care

Health Care and Life Expectancy Disparities

-Problems with health care can only explain part of the difference -Some causes of death are higher in the US even though they aren't closely related to health care ex) Homicide, suicide -Some causes of death that are closely related to health care have higher survival rates in the US ex) Heart attack, stroke -Conditions that are treated by medical care have origins in social and economic conditions

Fair Housing Act of 1968

-Prohibited discrimination on the basis of race/color, religion, national origin, family status, or age -Applied to all sales, rentals, and financial dwelling BUT problems with enforcement still persist

Colorblind Racism

-Racial ideology that explains current racial inequalities as outcomes of nonracial dynamics such as market dynamics, naturally occurring phenomena, and non-whites assumed cultural limitations. "Racism without racists" -Ignores the structural processes that lead to inequality

Moving to Opportunity Experiment

-Randomized experiment provided vouchers for households to move out of public housing into low poverty neighborhoods -Results: 1) Children in households who received vouchers had a reduced likelihood of injuries, asthma attacks, and victimizations by crime 2) No effect on children's test scores 3) Improvements in adult mental health 4) In mid 20s, children had significantly higher incomes

Socioeconomic Status (SES)

-Refers to the social standing or class of individuals or group. -Common indicators include educational attainment, occupation, income, wealth/net worth, categorically (in/out of poverty). -Analyses of SES often reveal inequities in access to resources and raise issues related to power and privilege

Poverty

-Social Security Administration created a formula to define poverty threshold -They multiplied the cost of a USDA economic food plan by 3 to calculate the minimal yearly income a family would need to survive -Thresholds vary by family size, composition, and age of household

Distribution of Stress

-Stress is unevenly distributed in society -The working poor have more exposure to stressors and less social support than upper and middle classes -Minorities also have higher stress

Feeling Poor

-Subjective status takes into account objective status and other factors like satisfaction and anxiety about the future -Feeling poor can be as important as actually being poor -People who see themselves as having low economic status had higher prevalence of ill health -Places with high levels of income inequality have higher mortality because the poor are made to feel poor more since there are people with so much more than them

Colorblind Policies Reproducing Inequalities

-Tax credits for mortgage interest: favors whites who are more likely to be homeowners allowing them to accumulate more wealth -Sentencing disparities for crack vs. powder cocaine makes blacks get harsher punishments -Race-Neutral criteria for historic preservation sites leads to more buildings of social significance for whites being preserved

Health Inequalities: Genetic?

-The inequalities in health are not due to genetic determinants. African Americans have a much higher rate of hypertension than white Americans but the hypertension rates in Africa are equal or lower than rates among white Americans, so the inequality cannot be due to African descent. -Also, the convergence in mortality rates across racial and ethnic groups over time indicate that historical differences in access to treatment and exposure to risk play a bigger role than pre-disposition

Employment and Incarceration

-The percent of blacks aged 20-24 employed without a high school degree has been declining. Now only 50% of free blacks in this group are employed. If you count those in jail only 30% are employed. -The invisibility of the incarcerated in official employment statistics underestimates this inequality in many studies

Life Expectancy vs. Income

-There is a clear gradient for life expectancy in regards to income for whites and blacks -There is also a clear race inequality between blacks and whites at all income levels -Hispanic health paradox: there isn't a clear trend for hispanics in regards to income and health. Even at low income they have good health

How Definition of SES Matters

-There is a clear increase in the risk of death according to income, but if you keep educational levels constant there is less of a difference between health and income levels. This suggests that some of the disadvantage for people with low income was due to them having less education

Fundamental Causes of Health

-Threats to good health change over time -The means of improving health change over time -When this happens, who faces these threats and who has access to these means will continue to widen disparities

How we construct race in everyday life

-We categorize others into ascribed racial categories -We assert our own racial identities

Fetal Origin Effects

-We identify fetal origin effects by comparing exposed to unexposed cohorts at some later point the life course -Birth weight and weight at age one are significantly associated with the risk of dying from heart disease -Cohorts who were in utero during the 1918 influenza epidemic had higher disability rates in 1980 than other cohorts

Cultural Essentialism

-blaming disadvantaged racial groups lack of success on their behavior and culture ex) family disintegration, lacking work ethic, culture of poverty -Main Critiques: ignores structural factors that influence behaviors such as history, public policies, and racial institutions -Form of Victim-Blaming

Systemic Racism

-diverse association of racist practices -pervasiveness of everyday acts of discrimination combined with the legacy of unequal distribution or resources -built from daily microaggressions, deep-seated inequalities, and racist ideologies

Allostatic Load

-frequent activation of body's stress response can damage the body in the long run -allostatic load is the physical consequence of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress -Measure of the wear and tear on the body's systems (e.g. cardiovascular, metabolic, and immune) due to repeated responses to stressors

Consequences of Redlining

-had long term effects on opportunities for affordable home ownership, which disproportionately benefitted suburban white areas -areas that were redlined in the past are still more likely to contain populations with high poverty and low home ownership -redlining destroyed the possibility of investment wherever black people lived

Biological Racism

-idea that whites are genetically superior Eugenics- movement to limit the reproduction of non-white or preserve the "purity of superior groups", ex) laws banning interracial marriage, one-drop rule, forced sterilization attempts -This idea has been rejected, genetic variation is complex and the idea of a few natural categories is oversimplified -Health disparities across racial groups are caused by the environment, not genetic traits

Institutional Practices

-policies, laws, and institutions that reproduce racial inequalities -going beyond individual acts of discrimination to include the institutionalization of racial discrimination in arenas like the criminal justice system, educational system, housing markets, and corporations

Residential Segregation

-refers to the way that two or more subpopulations are sorted into neighborhoods -measured by comparing the spatial distribution of some characteristic to its prevalence in the population ex) % of non-whites in different neighborhoods

Racialized Social Systems

-societies in which economic, political, social, and ideological levels are structured by placement of people in racial categories -societies differentially allocate resources along racial lines

Wealth Disparities

-there has been almost no growth among median family wealth for blacks and hispanics but it has tripled for whites, which was already higher to begin with -Net Wealth by Race- White: $141,900 Black: $11,000 Hispanic: $14,000

Stress

-when a person perceives that the environmental demands are taxing or exceeding their adaptive capacity The poor have a disproportionate share of -Physical Stressors- hunger, manual labor, chronic sleep deprivation, bad mattresses -Psychological- lack of control at work, uncertain income

Life Course Models

1) Critical Period / Biological Imprinting = Early-life exposures biologically imprint or program health in ways that manifest in adulthood ex) Poor prenatal care increases risk of disease 2) Cumulative / Chains of risk = Exposures to risk factors during childhood lead to higher risk exposures in adulthood ex) Being born poor means you get a worse education, a worse job, less money, and worse healthcare so you have worse health

Race Discrimination System

1) Disparities systematically favor certain groups 2) Disparities across subsystems reinforce one another 3) One source of disparities is discrimination -Since all subsystems are connected, discrimination in only one area creates disparities in others ex) Even in there is no discrimination in the housing market, if there is discrimination in the labor market it will lead to less wealth for minorities so they have to live in poorer neighborhoods which may have worse schools...

Two Types of Disparities

1) Disparities that suggest a threshold at or near the poverty line- suggest need for policies that address the poor 2) Disparities that follow a socioeconomic gradient- suggest need for policies that address relative standing, indicate that additional social or economic resources mitigate adverse health outcomes

Types of Neighborhood Effects

1) Endogenous: effect of aggregate outcomes at neighborhood level affect individual probability of acquiring that outcome (e.g., community HIV prevalence associated with individual HIV infection) 2) Compositional: attributes that describe neighborhood composition, combination of individual characteristics (e.g., percent owning their homes, percent living below the poverty line) 3) Contextual: attributes that are not compositional, physical and social environment (e.g., collective efficacy, presence of a grocery store or a high school)

How and Why does Segregation Happen?

1) Income and Wealth Differences- it is not just by SES because segregation is just as high among individuals with high income as it is among individuals in poverty 2) Different Preferences- in a study where people were asked where they wanted to live, black respondents preferred to live in neighborhoods with equal proportions of black and white people. White respondents have become more comfortable living in integrated neighborhoods over time but still prefer mostly white neighborhoods 3) Racism and Discrimination- definitely exists in the form of institutionalized racism which disadvantages blacks in the housing market

Other Institutional Practices

1) Jim Crow Laws- state and local laws enforcing racial segregation, mandated racial segregation of public facilities 2) Racial Restrictive Covenants- legally enforceable contracts imposed upon the buyer of a property, buyer risked forfeiting property if violated, allowed for houses to not be sold to blacks and if they bought it they could lose the property and the money to buy it 3) Sundown Towns- all-white towns excluding non-whites via discriminatory local laws, intimidation, and violence. There were laws that said if non-whites were around after sundown residents and police could force them to leave

How Incarceration Decreases Economic Opportunities

1) Stigma of a criminal record decreases ability to find a job 2) Time in prison decreases accumulated work experience 3) Removes individuals from social networks that might help them find work; also strengthens ties with others who have weak employment prospects 4) Conditions of imprisonment may promote habits and behaviors poorly suited to routines of regular work

Biomarkers of Allostatic Load

1) Substances the body releases in response to stress: norepinephrine, epinephrine, cortisol, and dehydroiandeosterone sulfate (DHEA-S) 2) Effects that result from these substances - elevated systolic and diastolic blood pressures, higher levels of cholesterol and glycated hemoglobin, and a larger waist-to-hip ratio -Can use this to study many types of health disparities - education, wealth, as well as race

Why are Neighborhood Effects Difficult to Measure

1) We need to define what a neighborhood is, this is ambiguous 2) You can measure attributes or perception of attributes, they may be different 3) Problem of causal influence: people at least partially choose where to live

Racism as a Fundamental Cause of Health

1)Racism is a fundamental cause of racial inequalities in SES 2)SES is a fundamental cause of health inequalities 3)Racism has a fundamental association with health independent of SES via inequalities in power, prestige, freedom, neighborhood context, and health care (legacy of slavery has perpetuated systemic racism)

Types of Stress

Acute: resulting from specific events and situations. It is an adaptive response which releases stress hormones to help the mind and body deal with the situation. Chronic: repeated exposure to situations, unrelenting demands and pressures with uncertain end point. It is a pathogenic response as continuous activation of stress response creates wear and tear on the body.

Social Construct of Race and Health

Although race is a social construction, it has very real consequences on health and mortality reflecting a social influence on health rather than a genetic one. Racial disparities reflect an impact on health due to past and present discrimination.

US Government Definitions of Races

American Indian or Alaskan Native: Having origins NA and who maintain cultural identification through tribal affiliations or community recognition (cultural aspect requirement) Asian or Pacific Islander: having origins the Far East, Southeast Asia, India, or Pacific Islands. Black: having origins in any of the black racial groups of Africa Hispanic: of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, REGARDLESS OF RACE White: having origins in Europe, North Africa, or Middle East -Categories change over time, sometimes in the past due to Supreme Court rulings about citizenship rights requiring white or black race

Social Gradient of Health

Assumes you can divide people into meaningful social groups. There are definite health inequalities, but if it is an inequity is up to judgement call.

Genes and Race

Bio-Genetic Ancestry: based on clusters of "ancestry informative" genetic markers. Two ways: 1) Select loci that vary more than others between populations that have been predefined to represent ancestry groups 2) Use statistics to infer ancestry groups using the whole genome

Wealth/Net Worth Trends

Black and Hispanic wealth has stayed the same over time while white wealth has increased. This has caused the gap in wealth to widen. This is mostly driven by increased net worth for whites due to more and better home ownership

1870s and 1880s Census

Black, mullato, and white were the three races and instead of people giving their race the person taking the census looked at them and assigned race based on their perception. Because of this, some people identified as one race in 1870 were identified as another race in 1880.

Blacks risk for disease

Blacks have a higher risk for hypertension, diabetes, and stroke even when controlling for education and behavioral risk factors (smoking, etc.). However, when controlling for SES the health disparities for hypertension and stroke become insignificant pointing to SES being a strong contributor to health outcomes

How to Address Health Inequalities

Collective Approach: structural responsibility Individual Approach: personal responsibility

Mass Incarceration

Defined by the comparatively and historically extreme rates of imprisonment and by the concentration of imprisonment among young, African American men living in neighborhoods of concentrated disadvantage

Systemic Racism as a Fundamental Cause

Embodies a set of flexible resources that advantage whites •Structural factors (government and commercial institutions, education, criminal justice and incarceration, real estate, health care) •Individual resources (money, knowledge, power, prestige, beneficial social connections) •Social-psychological advantages (beliefs of white superiority, desire of whites for social distance from blacks, chronic stress of discrimination)

Change in Income vs. Change in Health over Time

Even though the income gap has widened over time, and there is a relationship between health and income, overall health has continued to increase over time

Discrimination in the Labor Market

Ex) They did a study where they sent out equal applications where the only difference was black or white and more whites got callbacks. They did the same thing adding a criminal record and the same pattern was seen, plus the blacks without a criminal records still got less callbacks than whites with a criminal record

Heart Disease

Heart disease in whites is much higher than in peer countries, though cancer rates are similar. In 1995 the US had similar heart disease prevalence but by 2013 we were at the top due to less improvements.

Mortality and Education

Highly preventative causes of death have large disparities in survival rates for people at different levels of education, while causes of death that are hard to prevent have a smaller disparity. This points to people who are more educated having higher access to resources and knowledge about preventing disease.

Housing Disparities

Homeownership- Whites: 70% plus houses are worth more, Blacks: 40%, Hispanics: 45%

Racial Ideology

Ideology: set of ideas that shapes our worldview Racial Ideology: ideas about race that explain or justify racial inequalities "racial ideologies have not disappeared but changed from biological racism, to cultural racism, to color-blind racism"

Redlining

In the 1930s the Home Owner Loan Corporation (HOLC) was established -refinanced mortgages for millions of struggling home owners -assessors rated neighborhoods of major cities based on risk of investing in area -rating criteria increased housing stock, sales and rental rates, physical attributes of the land, and "threat of infiltration of foreigners, negro, or lower grade people" -a red color was given to areas that were considered to be at greatest risk and home loans were systematically denied to residents of these neighborhoods which was normally black people

Racial Composition in America

In the 1960s it was 85% white and 10% black. By 2010 the Hispanic population grew to 16% and is projected to reach 31% by 2060 being the fastest growing group in America. The percent of Asians and other races has also increased. In 2010 the black population was similar at 12% and whites had decreased to 64% and are projected to decreased to 42% by 2060.

Health Disparities by County

In the US there is much higher cardiovascular disease and cancer mortality in the Appalachia region. While heart disease mortality decreased across all regions cancer mortality has increased here. Substance abuse mortality is also high in the Appalachia and western regions. It has increased greatly in areas around Virginia and Ohio

How Neighborhoods Influence Health

Residential segregation and inequalities in resources are reciprocally linked and influence the physical and social environment which are reciprocally linked. These influence behavior and stress which are reciprocally linked which influence health. Individual resources and characteristics influence everything.

Income Trends

Income levels at all races have remained pretty stable accounting for inflation, only a small increase. Highest is Asians, then whites, then hispanics, then blacks. Gap between white and blacks has been unchanging.

Incarceration as Institutional Inequality

Inequality created by incarceration is: 1) Invisible - incarcerated populations are omitted from official statistics of disadvantage (e.g., poverty rate, unemployment) results in underestimates of disadvantage 2) Cumulative - social and economic penalties are accrued by those with the weakest economic opportunities 3) Intergenerational - consequences of incarceration are experienced by the families and children of the incarcerated

Changes in Health Disparities by Race Over Time

Life expectancies for all races have increased over time. The difference in life expectancy for blacks and whites has decreased over time. However, the difference in life expectancy for Hispanics and whites has increased over time, with Hispanics being the ones with higher life expectancy.

Life Expectancy Disparities of the US at Birth

Life expectancy in the US was pretty comparable to other high income countries in the 1980s but since it has fallen to the lowest. Similar life expectancies are seen in Finland, Chile, and Portugal for men and Singapore and Denmark for women. After the opioid epidemic life expectancy further declined.

Educational Trends

Overall rate of college completion has increased. Women's rate of college completion has increased by more than men's, and surpassed men around 1990 even though it started lower. In 2015, 40% of women between 25-29 completed their college degree, and 30% of men.

3) Why do people live where they do and don't move?

People live where they can afford, where they are allowed to live, and where they want to live. These all influence where they end up living and may limit their ability to move

Mortality Trends in the US vs. Europe

Mortality improvements for blacks and hispanics is equal to European countries but mortality has remained the same or decreased for whites in the US. By 2030 the life expectancy is expected to fall even further behind so men are close to Singapore and the Czech Republic, and women are close to Mexico, Poland, and Croatia.

Obama and Race

Mosts whites and hispanics classify Obama as mixed race while most blacks classify him as black.

Health and Wealth

People with less wealth have lower health, so public health interventions are implemented to mitigate the unequal access by helping out the poor. However, differential access to new resources will cause the gap to widen again.

Risk of Heart Disease vs. Education

Not a clear education gradient in the prevalence of heart disease but an income gradient in heart disease exists. However, people with less than a high school degree have a higher risk compared to those with a degree and beyond, suggesting a threshold effect.

Reasons the US does not have worse health

Not not enough health care, not poor choices of racial and ethnic minorities (their health has improved more than whites), not poor choices of the poor (its is worse at all wealth levels), not obesity or smoking

Health Inequalities

Objective. Measurable differences in the distribution of health among groups or individuals within a population

Race, SES, and Health

Race is neither a biologically meaningful category nor simply a proxy for class. Both race and low SES matter for health independently and jointly because of their roles in exposing people to multiple sources of stress and risk

Race and Class Disparities

Racial disparities • Late 19th century - African Americans 2x higher incarceration rate than white Americans • by 1960s - African Americans 7x higher incarceration rate than white Americans •2014 - African Americans 5x higher incarceration rate than white Americans Class disparities • Deteriorating labor market opportunities for men with less than a high school degree

Racialized Institutions

Social Institutions: govern the behavior of groups of individuals in core areas of society such as marriage, family, education, economy, government Racialized Institutions: ones where experiences differ based on people's racial categorization

Is Race a Proxy for SES

Some argue that African Americans have lower life expectancies and higher prevalence of chronic diseases because they are more likely to be poorly educated and have lower incomes BUT: SES differences among racial groups account for a substantial component of racial differences in health, but not all ex) Diabetes

Stressors and the Stress Response

Stressors activate the stress response when individuals -Feel like they have minimal control over the stressor -Feel they have no information on the duration or intensity of the stressor -Have few outlets for their frustration -Interpret stressor as evidence of circumstances getting worse -Lack social support

Health Inequities

Subjective. Subset of health inequalities that are modifiable, associated with social disadvantage and deemed to be unfair/stemming from injustice. Can be linked to forms of disadvantages due to poverty, discrimination, and lack of access to services or goods.

Earnings Mobility

The ability to move out of low income groups is greatly reduced by incarceration. Incarceration reproduces disadvantages.

Hispanics and Race

The classification of hispanic as a race has changes many times on the census. In 1930 Mexican was a race, in 1940 they were counted as white, in 1970 it was added again, and since 1980 it has been a separate question asking about hispanic ethnicity. When hispanic then select their race, 1/2 select white, and a 1/3 select other. 1/4 of Hispanic Americans identify as Hispanic, 1/4 as American, and 1/2 by their country of origin.

Geography and Health

The magnitude of gradients in life expectancy varies by geography. There is a higher health disparity by income for people in Detroit than New York meaning someone very poor in Detroit has a lower life expectancy than someone just as poor in New York

Health Disparities by Wealth

The prevalence of chronic diseases were higher in the US than Europe at all levels of wealth, there was a much greater gap between Europeans at low income levels and Americans at low income levels meaning that there are greater health disparities by wealth in the US

Key Disparity: Probability of Survival to Age 50

The probability of surviving to age 50 was similar for Americans and Europeans earlier, but as they improved the US lagged behind. The YLL before age 50 is much higher in the US. 2/3 of the disadvantage in life expectancy for men and 2/5 for women occurs before age 50. The US is much further behind the leaders in probability of living to age 50, about 50 years behind

Is race biological?

There is greater variation within races than between them. They are not unambiguous, distinct groups.

Aspects of Race

ancestry, DNA, unaltered body, altered body (hairstyle, tanning, etc.), reflected race (how others see you), SES/social status, culture, feeling

Relative Income Hypothesis

health depends on not just one's own level of income, but also on incomes of others in society. Depends on rank

Absolute Income Hypothesis

individual health depends on their own (and only their own) income level

New Racism

overtly racist statements are unacceptable and most people don't see themselves as racists, yet racial inequality persists

Contemporary Stereotypes

race shapes who is seen as -competent vs. incompetent -rich vs. poor -deserving vs. undeserving of help -attractive vs. unattractive -motivated vs. unmotivated -honest vs. corrupt

Consequences for School Segregation

when they are exposed to more segregation, the black-white achievement gap is larger

Pathways Linking Incarceration and Poor Health

• Exposure to infectious diseases • Incarceration as an acute and chronic stressor • Incarceration as an impediment to social integration • Difficult to maintain family and social networks • Social and psychological adaptations to prison make re-integration into community life difficult • Impact on employment and earnings

Race and Class Interactions

•Race should not be conceptualized as a proxy for class •Racial disparities should not be analyzed without simultaneously considering the contribution of other disparities •Potential interactions between race- and class-based disparities should be considered

How do fundamental causes work?

•Resources influence whether people know about, have access to, can afford, and are motivated to engage in health-enhancing behaviors •Resources shape access to broad contexts (e.g., neighborhoods, occupations, social networks) that vary in their protective and risk factors •The deliberate use of resources to benefit health is essential to producing the enduring association between socioeconomic status and health •Resources have a greater impact on health outcomes when a condition is preventable and treatable