March 11, 2008
12:00 a.m. Eastern Time
Black, Latino Children More Than 12 Times As Likely As White Children To Both Be Poor, Live In Poor Neighborhoods, Which May Negatively Affect Their Health
Black And Latino Children In Detroit, Memphis, New Orleans, Birmingham, Chicago, San Antonio, And Los Angeles Suffer Some Of The Greatest Disparities
Health Affairs Issue Examines How Neighborhood, Education, Race, And Ethnicity Affect Health
Bethesda, MD -- Almost 17 percent of black children and 20.5 percent of Latino children in the United States live in “double jeopardy,” meaning that they live in both poor families and poor neighborhoods, according to research released today in the March/April issue of the journal Health Affairs. http://content.healthaffairs.org/current.shtml In contrast, only 1.4 percent of white children live in double jeopardy. According to researchers, the type of neighborhood one lives in plays a significant role in racial and ethnic health disparities. http://content.healthaffairs.org/cgi/content/abstract/27/2/321
In addition, poor white children are more likely than poor black or Latino children to live in better neighborhoods. A typical poor white child lives in a neighborhood where the poverty rate is 13.6 percent, while a typical poor black child lives in a neighborhood where the poverty level is nearly 30 percent. A typical poor Latino child lives in a neighborhood where the poverty rate is 26 percent.
Segregated, disadvantaged neighborhoods affect health in the following ways:
-- By limiting economic advancement for minorities because of poor education, limited job opportunities, and a poor return on housing investment.
-- By exposing minorities to violent crime, environmental hazards, poor municipal services, and a lack of grocery stores and healthy food options.
-- By leading to segregated health care settings with poorer-quality health care.
“This research starkly points out that there are two different worlds for America’s children and that white children -- even the poorest white children -- are more likely to grow up in neighborhoods rich with opportunity,” said lead author Dolores Acevedo-Garcia, an associate professor at the Harvard School of Public Health. “The public health community must address this opportunity disparity and ensure that black and Latino children have an equal chance to grow up in neighborhoods with good schools, safe streets, and healthy environments.”
The study is part of a thematic Health Affairs issue on disparities in health that examines the link between racial and ethnic disparities and health status and health care. http://content.healthaffairs.org/current.shtml The issue was funded by the Robert Wood Johnson Foundation, which recently launched a commission to consider solutions outside the medical care system for reducing health disparities and improving America’s health.
In their review of 100 metropolitan areas, the authors found that some of the areas where the difference in “neighborhood opportunity” between black and white children is most pronounced include the Detroit metropolitan area, Memphis, New Orleans, Birmingham, and Chicago. Areas where the difference in neighborhood opportunity between white and Latino children is most pronounced include McAllen, Texas, El Paso, San Antonio, Los Angeles, and Fresno.
Researchers defined “neighborhood opportunity” based on the neighborhood poverty rate, the neighborhood unemployment rate, the number of households headed by a single woman, and the proportion of adults without a high school diploma. Characteristics of an “opportunity neighborhood” are good schools, sustainable job opportunities, healthy environments, access to high-quality health care and child care, safe streets, adequate transportation, and opportunities for civic engagement.
The authors contend that solving this problem will take a new approach that does not rely on traditional public health interventions. They note that the public health community can play a significant role in addressing health disparities caused by differences in neighborhood opportunity by collaborating with other professional and advocacy communities working to address the social determinants of health, such as neighborhoods and housing. The authors cite examples of policies and programs across the country designed to move people to neighborhoods where opportunities exist and create opportunities for people in low-income and minority neighborhoods.
“Effectively addressing health disparities will require policymakers to go beyond conventional public health approaches to consider policies to improve access to opportunity-rich areas through enhanced housing mobility and to increase the opportunities for healthy living in disadvantaged neighborhoods,” they conclude.
In a related piece, Sarah Gehlert, director of the Center for Interdisciplinary Health Disparities Research, University of Chicago, and colleagues focus on the role of social environments in producing disease disparities. People who live in poor, segregated neighborhoods are at greater risk for adverse health outcomes, they write. For example, black women have markedly higher breast cancer mortality rates than white women. The authors describe a model that looks at everything from the social environment to cellular health, and they provide a tool for policymakers to use in assessing the effectiveness of policies on group differences in health. “We are just beginning to understand how factors at different levels interact to influence population health outcomes,” they write. “Considering these interactions will allow us to choose points of intervention, knowing how the resulting change will affect downstream factors.” http://content.healthaffairs.org/cgi/content/abstract/27/2/339
Other Issue Highlights:
Education Affects Life Expectancy. Despite increased attention during the 1980s and 1990s to reducing disparities in life expectancy among the educationally disadvantaged, the educational gap in life expectancy is rising. Between the 1980s and 2000, life expectancy increases occurred nearly exclusively among highly educated groups, according to research fromEllen Meara, an assistant professor of health economics at Harvard Medical School, and colleagues. http://content.healthaffairs.org/cgi/content/abstract/27/2/350
Comparing 1981-88 with 1991-98, the researchers found that life expectancy at age twenty-five rose 1.4 years for people with a high level of education, but only 0.5 years for people with a low level of education. The researchers defined a “low level of education” as having twelve or fewer years of education, and a “high level of education” as having at least thirteen years of schooling. Between 1990 and 2000, life expectancy rose 1.6 years for the high-education group but remained unchanged for the low-education group. In 2000, life expectancy was fifty years for a twenty-five-year-old with a high school diploma or less. For a person with some college, life expectancy was nearly fifty-seven years.
An exception to this pattern is young black men, for whom education-related mortality disparities narrowed during the study period. However, a five-year gap in life expectancy between blacks and whites remains. In addition, men made more rapid gains in life expectancy than women during the study period. Differential trends in smoking may explain a large part of widening gaps in mortality and life expectancy, according to the authors. “The diseases contributing most to the growing education gap in mortality include diseases of the heart, lung and other cancers, and COPD [chronic obstructive pulmonary disease], all of which share tobacco use as a major risk factor,” they write.
A separate paper in the March/April issue of Health Affairs looks at how the relationship between education and a broad range of health measures vary by race, ethnicity, and whether someone is U.S. or foreign-born. Education is a more powerful determinant of health behaviors and outcomes for some groups than it is for others, according to data from the 2000–2006 National Health Interview Surveys. Although education is a powerful determinant of health for people born in the United States, it is not for immigrants. Despite typically low levels of education, immigrants fare better than the native-born across race/ethnicity groups for almost all health outcomes, Rachel Kimbro, an assistant professor in the Department of Sociology at Rice University, and colleagues found. In contrast, for every U.S.-born group, those with higher levels of education are the healthiest. The researchers also found that the relationship between education and health varies across Hispanic and Asian subgroups. The researchers say that these differences should be taken into account when designing programs to eliminate health disparities. “Interventions targeted at particular groups may be more effective than those aimed at broader populations,” they write. http://content.healthaffairs.org/cgi/content/abstract/27/2/361
Minority Patients Receive Same Standard Of Care As White Patients. When white patients and minority patients are admitted to the same hospital for the same reason or receive the same hospital procedure, they receive the same quality of care, according to a three-year study of inpatient discharge data from thirteen states. Darrell Gaskin, an associate professor of health economics at the University of Maryland, and colleagues examined race/ethnicity–specific quality measures using the Agency for Healthcare Research and Quality’s inpatient quality and patient safety indicators. The researchers note that the AHRQ quality indicators reflect the experience of patients who have received care, but do not include whether hospitals are offering differential access to major surgical and diagnostic procedures on the basis of race and ethnicity. “When it comes to addressing within-hospital disparities in health outcomes, interventions should be targeted toward those hospitals that are lower-performing as opposed to hospitals nationwide. Also, targeted interventions could be designed to address disparities in outcomes for specific conditions,” the researchers write. http://content.healthaffairs.org/cgi/content/abstract/27/2/518
Policymakers Must View Oral Health As Essential. Oral health is not given the same priority as general health in health care policy, despite research that shows links between oral health and overall health, say researchers Susan Fisher-Owens and colleagues. Fisher-Owens, an assistant clinical professor of pediatrics at the University of California, San Francisco, and colleagues reviewed disparities in oral health over the life span. The authors call for more diversity within the dental workforce, incentives for providers to work in areas where there is a shortage of dentists, programs that address inequalities in dental services, and better public insurance coverage for dental care. “To improve oral health and reduce disparities, policies must better integrate oral health and health care, and increase access to preventive and treatment services and health promotion activities, while reducing financial and other access barriers,” the authors write. http://content.healthaffairs.org/cgi/content/abstract/27/2/404
ABOUT HEALTH AFFAIRS:
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.
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