The Sick Side of Town

Persistent Racial Health Disparities

Persistent Racial Health Disparities

PERSISTENT AND PERVASIVE racial/ethnic health disparities in the United States are a major public health concern. In 2012, the life expectancy of Black men was nearly 10 years shorter than the life expectancy of white women and infant mortality was twice as high for Black infants compared to white infants. Today, narratives about Shalon Irving, an epidemiologist at the Centers for Disease Control and Prevention with doctoral degrees in both sociology and gerontology who died from postpartum complications, and Serena Williams, the professional tennis player who experienced life-threatening blood clots the day after an emergency C-section delivery, illustrate the persistence of racial disparities in maternal mortality, postpartum complications, and medical care despite high educational achievement, physical strength, fame, and wealth. 

Much of the existing health disparities research presents individual-level risk factors such as genetics, biology, income, and behaviors as explanations for differences in health outcomes.7 This research encourages leading health associations, like the American Heart Association, to recommend individual-level risk-assessment, such as instructing patients to use the online Heart Risk Calculator8 to predict their 10-year risk of heart disease or stroke, and individual behavior changes such as counting steps with a pedometer to decrease risk of obesity and heart disease.9

There is nothing incorrect about the American Heart Association’s recommendations, but they will only reduce poor health outcomes among individuals who have the resources, opportunities of choice, and the will to make the change.10 Improving health for people who lack such resources requires a different strategy and a different understanding of the underlying causes of risk and disease.

What makes these disparities especially troubling to policymakers, researchers, and public health officials, is their continued existence in the face of long-term national strategies to reduce them. Research cluster faculty Osagie K. Obasogie and Mahasin S. Mujahid, with Irene Headen from UC Berkeley School of Public Health, describe this paradox in a paper recently published in the Annual Review of Law and Social Science. Over the past 30 years, the US Department of Health and Human Service’s Office of Disease Prevention and Health Promotion has created 10-year strategic plans for improving population health and eliminating health disparities. A report summarizing progress towards the 2010 Healthy People goals shows improvements for many of the leading health indicators, but disparities between racial/ethnic groups and whites remain. American Indians, Alaska Natives, Hispanics, and Blacks had disparities amounting to 10 percent or greater for approximately 68 percent of the 111 Healthy People objectives assessed.11

Racial/ethnic health disparities also persist despite increasing investments in socioeconomic position. As explained by Health Disparities cluster member and UC Berkeley Epidemiology and Community Health Sciences Associate Professor Amani Nuru-Jeter, along with other researchers from UC Berkeley, Johns Hopkins University, and George Washington University in a recent Annual Review of Public Health publication, high socioeconomic position “does not buy the same level of health for African Americans relative to Whites”.12 In fact, research shows that significant racial health disparities exist at very high levels of income and education, which may be due to racism-related stress faced by people like Serena Williams and Shalon Irving who climb the social ladder. These differences can be difficult to see and are often underestimated, according to Nuru-Jeter et al.13

The cluster members’ observations point towards a need for new strategies to address the causes of racial/ethnic health disparities, which requires new research frameworks and methodologies.

Figure 1 includes a graph comparing infant morality rates by race and Hispanic origin of mother in the United States from 2005-2014.

  • 7. Kramer et al., 2004; Mensah et al., 2005; Weinsier et al., 1998
  • 8.
  • 9. American Heart Association, 2018
  • 10. Cutler, 2004; Frohlich & Potvin, 2008
  • 11. Obasogie, et al., 2017; Keppel, 2007; National Center for Health Statistics, 2012
  • 12. Nuru-Jeter et al., 2018
  • 13. Nuru-Jeter et al., 2018