Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

Optimal Retirement Portfolios: Social Security Personal Accounts in the Context of the Four Pillars

The United States debate on Social Security reform is centered on the transition of the public pension system from a pure defined benefit plan to one that would include individual defined contribution accounts. Largely missing from the debate on personal accounts are analyses of potential interactions with other Social Security programmes and the aggregate shift in risk burdens concerning retirement security. This paper provides insights into both issues within the context of personal accounts and the four pillars. We argue that a transition to a personal account system places additional stress on other Social Security programmes and shifts retirement security risk burdens from the national government to individual households. As well, the change would not effectively reduce potential long-run liabilities for the national government since U.S. society is unlikely to tolerate increases in elderly poverty or homelessness. Indeed, potential long-run liabilities may be greater due to the increased investment and longevity risks that would be borne by households. The Geneva Papers (2005) 30, 565–580. doi:10.1057/palgrave.gpp.2510056