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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 1998 Jun;75(2):300–321. doi: 10.1007/BF02345099

African-American health: the role of the social environment

David R Williams 1
PMCID: PMC3456239  PMID: 9684243

Conclusion

Cooper and colleagues have noted that the forces affecting the health of minority populations are the same forces, on a less intensive scale, that affect the health of the overall population.90 That is, we can view the health of the African-American population as the visible tip of an iceberg. This tip of the iceberg is a function of the average health of the entire population. Thus, an effective strategy must address not only the tip, but also should attack the entire iceberg and reduce the risk that it is creating throughout the population. Similarly, Wallace and Wallace have shown how the mechanisms of hierarchical diffusion, spatial contagion, and network diffusion lead to the spread of health and social problems initially confined in inner cities to suburban areas and smaller cities.91 That is, because of the economic links typing various communities together, there are mechanisms that will ensure the diffusion of disease and disorder from one area to another. If unaddressed, the problems of stigmatized and marginalized urban populations will have adverse impacts on the health, well-being, and quality of life of the more affluent. Thus, investments that will improve the social conditions of a marginalized population can have long-term positive health and social consequences for the entire society.

In summary, there are large and pervasive racial differences in health. Their causes are not obscure and unknown. The roots of black-white differences in health are not due primarily to differences in beliefs and biology. Instead, they are driven by fundamental societal inequalities. Today, we can make a new commitment to liberty, justice, and equality for all by mustering the political will to eliminate some of the fundamental inequities in society that lie at the foundation of health disparities.

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Footnotes

Preparation of this paper was supported in part by the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health, and by grant 1 RO1 MH57425 from the National Institute of Mental Health.

References

  • 1.Wilson WJ. The Truly Disadvantaged. Chicago, Ill: University of Chicago Press; 1987. [Google Scholar]
  • 2.Hajnal ZL. The nature of concentrated urban poverty in Canada and the United States. Can J Sociol. 1995;20:497–528. [Google Scholar]
  • 3.Vital Statistics of the United States, 1990, Vol 11, Mortality, Part A. Washington, DC: Public Health Service; 1994. [Google Scholar]
  • 4.Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Government Printing Office; 1985. [Google Scholar]
  • 5.Excess Deaths and Other Mortality Measures for the Black Population: 1979–81 and 1991. Hyattsville, Md: Public Health Service; 1994. [Google Scholar]
  • 6.Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med. 1994;39(7):887–903. doi: 10.1016/0277-9536(94)90202-X. [DOI] [PubMed] [Google Scholar]
  • 7.Krieger N. Shades of difference: theoretical underpinnings of the medical controversy on black/white differences in the United States, 1830–1870. Int J Health Serv. 1987;17:259–278. doi: 10.2190/DBY6-VDQ8-HME8-ME3R. [DOI] [PubMed] [Google Scholar]
  • 8.Krieger N, Bassett M. The health of black folk: disease, class, and ideology in science. Monthly Rev. 1986;38:74–85. [Google Scholar]
  • 9.Montagu A. The Concept of Race. New York: Free Press; 1965. [Google Scholar]
  • 10.Gould SJ. Why we should not name human races: a biological view. In: Gould SJ, editor. Ever Since Darwin. New York: WW Norton; 1977. pp. 231–236. [Google Scholar]
  • 11.Lewontin RC. The Genetic Basis of Evolutionary Change. New York: Columbia University Press; 1974. [Google Scholar]
  • 12.Lewontin RC. Human Diversity. New York: Scientific American Books; 1982. [Google Scholar]
  • 13.Jackson FL. Race and ethnicity as biological constructs. Ethn Dis. 1992;2:120–125. [PubMed] [Google Scholar]
  • 14.American Association of Physical Anthropology AAPA statement on biological aspects of race. Am J Phys Anthropol. 1996;101:569–570. [Google Scholar]
  • 15.Lieberman L, Stevenson BW, Reynolds LT. Race and anthropology: a core concept without consensus. Anthropol Educ Q. 1989;20:67–73. [Google Scholar]
  • 16.Littlefield A, Liberman L, Reynolds LT. Redefining race: the potential demise of a concept in physical anthropology. Cur Anthropol. 1982;23:641–655. [Google Scholar]
  • 17.Cooper RS, David R. The biological concept of race and its application to public health and epidemiology. J Health Polit Policy Law. 1986;11:97–116. doi: 10.1215/03616878-11-1-97. [DOI] [PubMed] [Google Scholar]
  • 18.Polednak AP. Racial and Ethnic Differences in Disease. New York: Oxford University Press; 1989. [Google Scholar]
  • 19.Osborne NG, Feit MD. The use of race in medical research. JAMA. 1992;267:275–279. doi: 10.1001/jama.267.2.275. [DOI] [PubMed] [Google Scholar]
  • 20.Witzig R. The medicalization of race: scientific legitimization of a flawed social construct. Ann Int Med. 1996;125:675–679. doi: 10.7326/0003-4819-125-8-199610150-00008. [DOI] [PubMed] [Google Scholar]
  • 21.Huth EJ. Identifying ethnicity in medical papers. Ann Int Med. 1995;122:619–620. doi: 10.7326/0003-4819-122-8-199504150-00012. [DOI] [PubMed] [Google Scholar]
  • 22.Charatz-Litt C. A chronicle of racism: the effects of the white medical community on black health. J Nat Med Assoc. 1992;84(8):717–725. [PMC free article] [PubMed] [Google Scholar]
  • 23.Muntaner C, Nieto FJ, O'Campo P. The bell curve: on race, social class, and epidemiologic research. Am J Epidemiol. 1996;144:531–536. doi: 10.1093/oxfordjournals.aje.a008962. [DOI] [PubMed] [Google Scholar]
  • 24.Caldwell SH, Popenoe R. Perceptions and misperceptions of skin color. Ann Int Med. 1995;122:41–43. doi: 10.7326/0003-4819-122-8-199504150-00010. [DOI] [PubMed] [Google Scholar]
  • 25.Duster T. A social frame for biological knowledge. In: Duster T, Garrett K, editors. Cultural Perspectives on Biological Knowledge. Norwood, NJ: Ablex Publishing; 1984. pp. 1–40. [Google Scholar]
  • 26.Antonovsky A. Social class, life expectancy and overall mortality. Milbank. 1967;45:31–73. [PubMed] [Google Scholar]
  • 27.Adler NE, Boyce T, Chesney MA, Folkman S, Syme SL. Socioeconomic inequalities in health: no easy solution. JAMA. 1993;269:3140–3145. [PubMed] [Google Scholar]
  • 28.Bunker JP, Gomby DS, Kehrer BH, editors. Pathways to Health: The Role of Social Factors. Menlo Park, Calif: Henry J Kaiser Family Foundation; 1989. [Google Scholar]
  • 29.Williams DR. Socioeconomic differentials in health: a review and redirection. Soc Psychol Q. 1990;53:81–99. [Google Scholar]
  • 30.Williams DR. Race/ethnicity and socioeconomic status: measurement and methodological issues. Int J Health Serv. 1996;26(3):483–505. doi: 10.2190/U9QT-7B7Y-HQ15-JT14. [DOI] [PubMed] [Google Scholar]
  • 31.Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet. 1990;336:1238–1240. doi: 10.1016/0140-6736(90)92846-A. [DOI] [PubMed] [Google Scholar]
  • 32.Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993;9(suppl to No. 6):82–122. [PubMed] [Google Scholar]
  • 33.Lillie-Blanton M, Parsons PE, Gayle H, Dievler A. Racial differences in health: not just black and white, but shades of gray. Ann Rev Public Health. 1996;17:411–448. doi: 10.1146/annurev.pu.17.050196.002211. [DOI] [PubMed] [Google Scholar]
  • 34.Ries P. Health of black and white Americans, 1985–1987. Vital Health Statistics. 1990;10(171):55–55. [PubMed] [Google Scholar]
  • 35.Williams DR. Racism and health: a research agenda. Ethn Dis. 1996;6(1,2):1–6. [PubMed] [Google Scholar]
  • 36.Schuman H, Steeh C, Bobo L. Racial Attitudes in America: Trends and Interpretations. Cambridge, Mass: Harvard University Press; 1985. [Google Scholar]
  • 37.Kinder DR, Mendelberg T. Cracks in American apartheid: the political impact of prejudice among desegregated whites. J Polit. 1995;57:402–424. [Google Scholar]
  • 38.Cell J. The Highest Stage of White Supremacy: The Origin of Segregation in South Africa and the American South. New York: Cambridge University Press; 1982. [Google Scholar]
  • 39.Massey DS, Denton NA. American Apartheid: Segregation and the Making of the Underclass. Cambridge, Mass: Harvard University Press; 1993. [Google Scholar]
  • 40.Williams DR, Collins C. US socioeconomic and racial differences in health. Ann Rev Sociol. 1995;21:349–386. doi: 10.1146/annurev.so.21.080195.002025. [DOI] [Google Scholar]
  • 41.Eller TJ. Household Wealth and Asset Ownership: 1991. US Bureau of the Census, Current Population Reports, P70-34. Washington, DC: US Government Printing Office; 1994. [Google Scholar]
  • 42.Oliver ML, Shapiro TM. Black Wealth/White Wealth: A New Perspective on Racial Inequality. New York: Routledge; 1997. [Google Scholar]
  • 43.Ayres I. Fair driving: gender and race discrimination in retail car negotiations. Harvard Law Rev. 1991;104:817–872. [Google Scholar]
  • 44.Sharpe R. In latest recession, only blacks suffered net employment loss.Wall Street Journal. September 1993;74(233).
  • 45.Kassarda JD. Urban industrial transition and the underclass. In: Wilson WJ, editor. The Ghetto Underclass. Thousand Oaks, Calif: Sage; 1993. [Google Scholar]
  • 46.Council on Ethical and Judicial Affairs Black-white disparities in health care. JAMA. 1990;263:2344–2346. doi: 10.1001/jama.1990.03440170066038. [DOI] [PubMed] [Google Scholar]
  • 47.McBean AM, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financing Rev. 1994;15:77–90. [PMC free article] [PubMed] [Google Scholar]
  • 48.Maynard C, et al. Blacks in the coronary artery surgery (CASS): race and decision making. Am J Public Health. 1986;76:1446–1448. doi: 10.2105/ajph.76.12.1446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs Medical System. New Engl J Med. 1993;329:621–626. doi: 10.1056/NEJM199308263290907. [DOI] [PubMed] [Google Scholar]
  • 50.Giles A, Anda RF, Casper ML, Escobedo LG, Taylor HA. Race and sex differences in rates of invasive cardiac procedures in US hospitals. Arch Int Med. 1995;155:318–324. [PubMed] [Google Scholar]
  • 51.Fischer CS, Hout M, Jankowski MS, Lucas SR, Swidler A, Voss K. Inequality by Design: Cracking the Bell Curve Myth. Princeton, NJ: Princeton University Press; 1996. [Google Scholar]
  • 52.Steele C. Race and the schooling of black Americans. Atlantic Monthly. 1992;269:68–68. [Google Scholar]
  • 53.Steele C, Aronson J. Contending with a stereotype: African-American intellectual test performance and stereotype vulnerability. Seminar on Meritocracy and Equality, University of Chicago, May 1995.
  • 54.Taylor J, Jackson B. Factors affecting alcohol consumption in black women, part II. Int J Addict. 1990;25:1415–1427. doi: 10.3109/10826089009056228. [DOI] [PubMed] [Google Scholar]
  • 55.Taylor J, Henderson D, Jackson BB. A holistic model for understanding and predicting depression in African American women. J Community Psychol. 1991;19:306–320. [Google Scholar]
  • 56.Williams DR, Chung A. Racism and health. In: Gibson R, Jackson JS, eds.Health in Black America. Thousand Oaks, Calif: Sage. In press.
  • 57.Amaro H, Russo NF, Johnson J. Family and work predictors of psychological well-being among Hispanic women professionals. Psychol Women Q. 1987;11:505–521. [Google Scholar]
  • 58.Dion KL, Dion KK, Pak AW. Personality-based hardiness as a buffer for discrimination-related stress in members of Toronto's Chinese community. Can J Behav Sci. 1992;24(4):517–536. [Google Scholar]
  • 59.Salgado de Snyder VN. Factors associated with acculturative stress and depressive symptomatology among married Mexican immigrant women. Psychol Women Q. 1998;11:475–488. [Google Scholar]
  • 60.Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273–1281. doi: 10.1016/0277-9536(90)90307-E. [DOI] [PubMed] [Google Scholar]
  • 61.Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86:1370–1378. doi: 10.2105/ajph.86.10.1370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Jackson JS, Brown TN, Williams DR, Torres M, Sellers SL, Brown K. Racism and the physical and mental health status of African Americans: a thirteen year national panel study. Ethn Dis. 1996;6:132–147. [PubMed] [Google Scholar]
  • 63.Williams DR, Yu Y, Jackson J, Anderson N. Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol. 1997;2:335–351. doi: 10.1177/135910539700200305. [DOI] [PubMed] [Google Scholar]
  • 64.Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Washington, DC: US Government Printing Office; 1979. [Google Scholar]
  • 65.Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Government Printing Office; 1985. [Google Scholar]
  • 66.McKinlay JB. A case for refocusing upstream: the political economy of illness. In: Conrad P, Kern R, editors. The Sociology of Health and Illness: Critical Perspectives. New York: St Martin's Press; 1990. pp. 502–516. [Google Scholar]
  • 67.Seeman M, Anderson CS. Alienation and alcohol: The role of work, mastery, and community in drinking behavior. Amer Sociol Rev. 1983;48:60–77. [PubMed] [Google Scholar]
  • 68.Singer M. Toward a political economy of alcoholism. Soc Sci Med. 1986;23:113–130. doi: 10.1016/0277-9536(86)90360-6. [DOI] [PubMed] [Google Scholar]
  • 69.Rabow J, Watt R. Alcohol availability, alcohol beverage sales, and alcohol-related problems. J Study Alcohol. 1984;43:767–801. doi: 10.15288/jsa.1982.43.767. [DOI] [PubMed] [Google Scholar]
  • 70.Hacker AG, Collins R, Jacobson M. Marketing Booze to Blacks. Washington, DC: Center for Science in the Public Interest; 1987. [Google Scholar]
  • 71.Maxwell B, Jacobson M. Marketing Disease to Hispanics: The Selling of Alcohol, Tobacco, and Junk Foods. Washington, DC: Center for Science in the Public Interest; 1989. [Google Scholar]
  • 72.Sampson RJ, Wilson WJ. Toward a theory of race, crime, and urban inequality. In: Hagan J, Peterson RD, editors. Crime and Inequality. Stanford, Calif: Stanford University Press; 1995. pp. 37–54. [Google Scholar]
  • 73.Polednak A. Trends in US urban black infant mortality, by degree of residential segregation. Am J Public Health. 1996;86:723–726. doi: 10.2105/ajph.86.5.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.Laveist TA. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res. 1993;29:1–16. [PMC free article] [PubMed] [Google Scholar]
  • 75.Lillie-Blanton M, Anthony JC, Schuster C. Probing the meaning of racial or ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269(8):993–997. doi: 10.1001/jama.269.8.993. [DOI] [PubMed] [Google Scholar]
  • 76.Greenberg M, Schneider D. Violence in American cities: young black males is the answer, but what was the question? Soc Sci Med. 1994;39:179–187. doi: 10.1016/0277-9536(94)90326-3. [DOI] [PubMed] [Google Scholar]
  • 77.Bishop J. Jobs, Cash Transfers, and Marital Instability: A Review of the Evidence. Madison, Wisc: Institute for Research on Poverty, University of Wisconsin; 1977. [Google Scholar]
  • 78.Robins LN, Regier DA. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press; 1991. [Google Scholar]
  • 79.Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994;51:8–19. doi: 10.1001/archpsyc.1994.03950010008002. [DOI] [PubMed] [Google Scholar]
  • 80.Lincoln CE, Mamiya LH. The Black Church in the African American Experience. Durham, NC: Duke University Press; 1990. [Google Scholar]
  • 81.Caldwell C, Greene AD, Billingsley A. The black church as a family support system: Instrumental and expressive functions. Nat J Sociol. 1992;6:21–40. [Google Scholar]
  • 82.Williams DR, Griffith EEH, Young J, Collins C, Dodson J. Structure and provision of services in New Haven.Cultural Diversity and Mental Health, in press. [DOI] [PubMed]
  • 83.Chang P, Williams DR, Griffith E, Young JL. Church-agency relationships in the black community. Nonprofit and Voluntary Sector Q. 1994;23:91–105. [Google Scholar]
  • 84.Neighbors HW, Musick M, Williams DR. The African-American minister as a source of help for serious personal crises: bridge or barrier to mental health care?Health Educ Behav. In press. [DOI] [PubMed]
  • 85.Young JL, Williams DR, Griffith EEH, Wilson CM. The impact of education on mental health promotion by African-American clergy.Health Educ Behav. In press.
  • 86.Taylor RJ, Chatters LM. Church members as a source of informal social support. Rev Religious Res. 1988;30:193–203. [Google Scholar]
  • 87.Griffith E, English T, Mayfield V. Possession, prayer and testimony: therapeutic aspects of the Wednesday night meeting in a black church. Psychiatry. 1980;43:120–128. doi: 10.1080/00332747.1980.11024057. [DOI] [PubMed] [Google Scholar]
  • 88.Griffith E, Young J, Smith D. An analysis of the therapeutic elements in a black church service. Hosp Community Psychiatr. 1984;35:464–469. doi: 10.1176/ps.35.5.464. [DOI] [PubMed] [Google Scholar]
  • 89.Gilkes C. The black church as a therapeutic community: suggested areas for research into the black religious experience. J Interdenominational Theological Center. 1980;8:29–44. [Google Scholar]
  • 90.Cooper RS, Steinhauer M., Miller W, David R, Schatzkin A. Racism, society, and disease: an exploration of the social and biological mechanisms of differential mortality. Int J Health Serv. 1981;11:389–414. doi: 10.2190/E437-2KB5-4HM0-7NJ0. [DOI] [PubMed] [Google Scholar]
  • 91.Wallace R, Wallace D. Socioeconomic determinants of health: community marginalisation and the diffusion of disease and disorder in the United States. Br Med J. 1997;314:1341–1345. doi: 10.1136/bmj.314.7090.1341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 92.Health, United States, 1994. Hyattsville, Md: Public Health Service; 1995. pp. 95–1232. [Google Scholar]
  • 93.Health, United States, 1992. Washington, DC: US Government Printing Office; 1993. pp. 93–1232. [Google Scholar]

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