Economic inequality and social differentials in mortality

This paper was presented at the conference "Unequal incomes, unequal outcomes? Economic inequality and measures of well-being" as part of session 1, "Health status of children and households in poverty." The conference was held at the Federal Reserve Bank of New York on May 7, 1999. This paper discusses health as a direct measure of economic well-being and draws attention to those suffering the worst outcomes. The author identifies a set of young people at particular risk of high mortality rates. She observes that in some U.S. communities - especially urban areas in the North - young people cannot expect to survive through middle-adulthood. Whites generally fare substantially better than African-Americans, yet whites in poor neighborhoods in northern cities experience mortality rates roughly comparable to those of African-Americans nationwide. Furthermore, among the urban African-American poor, mortality rates worsened relative to those of whites from 1980 to 1990. The author also indicates that circulatory disease - not homicide - has been the most important contributor to the higher mortality rates across all poor populations.Income distribution ; Medical care

Weathering the Pandemic: Dying Old at a Young Age from Pre-Existing Racist Conditions

Mainstream social epidemiology now acknowledges the contributions of interpersonal racism, racialized stress, and implicit bias to population health inequity. It also increasingly recognizes that current and historical racist policies place barriers in the way of healthy lifestyles by institutionalizing food deserts, housing decay, and austerity urbanism. Essential as these developments are, they only skim the surface of how insidiously structural racism establishes and reproduces population health inequity. I coined the term “weathering” to describe the effects of sustained cultural oppression upon the body. Weathering expands on the more conventional “social determinants of health” approach to understand the contextually fluctuating and historically structured and situated material, environmental and biopsychosocial stressors that wear-out the health of oppressed populations and shape their high effort coping strategies. I call this process “weathering” because that word is a contronym: Weathering can be a sign of deterioration and erosion as in “the rock was weathering;” and weathering can also be the opposite: A sign of strength and endurance as in “the family is weathering the recession.” For health and aging, it can be both

The Socioeconomic Consequences of Teen Childbearing Reconsidered

Teen childbearing is commonly viewed as an irrational behavior that leads to long-term socioeconomic disadvantage for mothers and their children. Cross-sectional studies that estimate relationships between maternal age at first birth and socioeconomic indicators measured later in life form the empirical basis for this view. However1 these studies have failed to account adequately for differences in family background among women who time their births at different ages. We present new estimates of the consequences of teen childbearing that take into account observed and unobserved family background heterogeneity, comparing sisters who have timed their first births at different ages. Sister comparisons suggest that previous estimates are biased by failure to control adequately for family background heterogeneity, and, as a result, have overstated the consequences of early fertility.

Behavioral Mechanisms in HIV Epidemiology and Prevention: Past, Present, and Future Roles

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72261/1/j.1728-4465.2009.00202.x.pd

Accumulating Disadvantage Over the Life Course: Evidence From a Longitudinal Study Investigating the Relationship Between Educational Advantage in Youth and Health in Middle Age

Recent studies suggest the importance of examining cumulative risk or advantage as potential predictors of health over the life course. Researchers investigating the cumulative health effects of education, however, have mainly conceptualized education in years or degrees, often disregarding educational quality and access to educational opportunities that may place individuals on divergent academic trajectories. We investigate whether educational advantages in youth are associated with an individual\u27s health trajectory. We develop a novel index of educational advantage and employ random-intercept modeling using data from the National Longitudinal Survey of Youth. We find a widening health disparity in adulthood between respondents with greater and those with fewer educational advantages in youth. Further, among respondents with few educational advantages, blacks experience a greater health burden as they age compared to whites and Hispanics. These results suggest that differential access to educational advantages during youth may contribute to persisting health disparities in adulthood

WP 2018-389

Recent research has found, in some groups of Americans, dramatic increases in deaths due to drug overdose and suicide and an overall stagnation of trends toward increased longevity. This study examines the link between mortality of older working age (45 to 64) adults and local economic downturns in the U.S. to evaluate the role of economic shifts in various causes of death and their related mortality trends. Specifically, we estimate regression models to test the hypotheses that the longevity effects of poor economic prospects are reflected through (1) increased suicide, drug overdose, and other “deaths of despair” and (2) other causes of death linked to exposure to economic and social stress such as heart and cerebrovascular disease. To avoid the problem of endogeneity of local economic conditions to mortality conditions, we measure the local economic shock of lost employment with predicted employment based on baseline industrial composition and national trends in employment by industry. We find evidence consistent with prior research that among non-Hispanic white adults, midlife mortality has increased since 1990, particularly among those with low educational attainment. We also find that “deaths of despair” are important contributors to that trend. However, we find that while distress in local, area economies does predict increased mortality for chronic disease, it predicts decreased mortality from suicides, opioids, and other substance abuse. This finding suggests caution in the application of the construct of despair in explaining recent mortality patterns.Social Security Adminstration, Award number RRC08098401-10, R-UM18-07https://deepblue.lib.umich.edu/bitstream/2027.42/148126/1/wp389.pdfDescription of wp389.pdf : Working pape

Associations between breast cancer subtype and neighborhood socioeconomic and racial composition among Black and White women

PURPOSE: Studies of Black-White differences in breast cancer subtype often emphasize potential ancestry-associated genetic or lifestyle risk factors without fully considering how the social or economic implications of race in the U.S. may influence risk. We assess whether neighborhood racial composition and/or socioeconomic status are associated with odds of triple-negative breast cancer (TNBC) diagnosis relative to the less-aggressive hormone receptor-positive/HER2-negative subtype (HR+ /HER-), and whether the observed relationships vary across women\u27s race and age groups. METHODS: We use multilevel generalized estimating equation models to evaluate odds of TNBC vs. HR+ /HER2- subtypes in a population-based cohort of 7291 Black and 74,208 White women diagnosed with breast cancer from 2006 to 2014. Final models include both neighborhood-level variables, adjusting for individual demographics and tumor characteristics. RESULTS: Relative to the HR+ /HER- subtype, we found modestly lower odds of TNBC subtype among White women with higher neighborhood median household income (statistically significant within the 45-64 age group, OR = 0.981 per $10,000 increase). Among Black women, both higher neighborhood income and higher percentages of Black neighborhood residents were associated with lower odds of TNBC relative to HR+ /HER2-. The largest reduction was observed among Black women diagnosed at age ≥ 65 (OR = 0.938 per$10,000 increase; OR = 0.942 per 10% increase in Black residents). CONCLUSION: The relationships between neighborhood composition, neighborhood socioeconomic status, and odds of TNBC differ by race and age. Racially patterned social factors warrant further exploration in breast cancer subtype disparities research

Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?

http://dx.doi.org/10.1016/j.jomh.2012.03.00

America’s Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem

Although recent declines in life expectancy among non-Hispanic Whites, coined “deaths of despair,” grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America’s health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans

Jedi public health: Co-creating an identity-safe culture to promote health equity

© 2016 The Authors. The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects on cognition and emotion, undermining self-confidence and diminishing academic performance. This impact reduces opportunities for social mobility, while ensuring those who "beat the odds" pay a physical price for their positive efforts. Recent applications of social identity theory toward closing racial, ethnic, and gender academic achievement gaps through changing features of educational settings, rather than individual students, have proved fruitful. We sought to integrate this evidence with growing social epidemiological evidence that structurally-rooted biopsychosocial processes have population health effects. We explicate an emergent framework, Jedi Public Health (JPH). JPH focuses on changing features of settings in everyday life, rather than individuals, to promote population health equity, a high priority, yet, elusive national public health objective. We call for an expansion and, in some ways, a re-orienting of efforts to eliminate population health inequity. Policies and interventions to remove and replace discrediting cues in everyday settings hold promise for disrupting the repeated physiological stress process activation that fuels population health inequities with potentially wide application.National Institute on Aging (Grant # R01 AG032632)National Institute on Aging (Grant # T32 AG00221