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Why is it so hard to close the racial health gap in the US?

The ConversationThe racial health gap in the United States is well-documented. The gap starts with the infant mortality rate (11.1 blacks vs. 5.1 whites per 1,000) and extends to almost any health domain. Compared to whites, blacks live shorter and live fewer years free of illness. Blacks develop chronic disease on average one decade earlier than whites. Although the life expectancy gap between black and white Americans has narrowed, disparities are still persistent.

Improvements in the health care system have increased life expectancy for most Americans, but the group that has gained more is white Americans. The larger health gain of whites than blacks results in widening of racial gap in health.

As a researcher, I’ve looked into black-white differences in determinants of health. What I’ve found is that some interventions may even widen the gap.

Closing the gap not so easy

Let’s start by asking this: Why is closing the gap so difficult? My colleagues and I have conducted multiple studies to see how the availability of economic and psychological resources affects health in whites and blacks. Blacks and whites are influenced by the same socioeconomic forces, but the impact is uneven.

Even living in a better neighborhood confers more benefits for whites than African-Americans. From www.shutterstock.com

Education increases life expectancy of every group, but the gain is larger for whites than blacks. Research has shown that education better reduces depressive symptoms, sleep problems, obesity, physical inactivity and suicide in whites than blacks. Living in a better neighborhood also gives more life expectancy to whites than blacks.

The same is true for psychological factors such as mood, anger control, sense of control, self-efficacy and self-rated health. Any intervention that improves these factors would probably result in a larger gain in longevity among whites than blacks. Similar trends have been found in other countries such as the U.K.

A closer look

But why is this so? I have two not mutually exclusive explanations for why socioeconomic resources and psychological assets have stronger protective effects for whites.

First, it is because of many structural barriers that blacks face in their daily lives. Residential and job segregation as well as preferences and practice of the labor market result in different types of jobs blacks and whites enter. In addition to the discrimination by the labor market, lower education quality in black communities, and many other barriers hold blacks behind economically.

Second, possibly due to their adaptation, over the course of years of surviving under oppression, poverty and cruelty of their environment, in my research I have found that blacks have developed a systematic resilience. To find ways to cope with their harsh environment, blacks are now less sensitive to the scarce socioeconomic resources and psychological assets that are available for them. These two reasons are not mutually exclusive, as such adaptation among blacks and other minority groups might be due to the structural barriers.

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