Post on 10-Jan-2016
description
Racism and Health:Collecting Evidence
to address root causes of disparities
Racism and Health:Collecting Evidence
to address root causes of disparities
Camara Phyllis Jones, MD, MPH, PhDResearch Director on Social Determinants of Health
Emerging Investigations and Analytic Methods BranchDivision of Adult and Community Health
National Center for Chronic Disease Prevention and Health PromotionCoordinating Center for Health Promotion
Centers for Disease Control and Prevention
The findings and conclusions in this presentation are those of the authorand do not necessarily represent the views of the Centers for Disease Control and Prevention
AcknowledgmentsBenedict Truman, MD, MPHAssociate Director for Science
Office of Minority Health and Health Disparities
Centers for Disease Control and Prevention
Susan RumishaProject Imhotep Intern, Summer 2005
Public Health Sciences Institute, Morehouse College
and
National Institute for Medical Research, Dar es Salaam, Tanzania
What is racism?
What is racism?
A system
A system of structuring opportunity and assigning value
What is racism?
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”)
What is racism?
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”) Unfairly disadvantages some individuals and
communities
What is racism?
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”) Unfairly disadvantages some individuals and
communities Unfairly advantages other individuals and
communities
What is racism?
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”) Unfairly disadvantages some individuals and
communities Unfairly advantages other individuals and
communities Saps the strength of the whole society through the
waste of human resources
What is racism?
Source: Jones CP, Phylon 2003
“Reactions to Race” module
Six-question optional module on the Behavioral Risk Factor Surveillance System
Piloted in 2002Now available to all states
States using “Reactions to Race”Arkansas 2004California 2002Colorado 2004Delaware 2002 2004 2005District of Columbia 2004
Florida 2002Mississippi 2004New Hampshire 2002New Mexico 2002North Carolina 2002
Ohio 2003 2005Rhode Island 2004South Carolina 2003 2004Wisconsin 2004 2005
Arkansas, Colorado, Delaware, District of Columbia,
Mississippi, Rhode Island, South Carolina, Wisconsin
States using “Reactions to Race” module on 2004 BRFSS
General health statusWould you say that in general your health
is:
Excellent Very good Good Fair Poor
Socially-assigned “race”How do other people usually classify you in
this country? Would you say:
White Black or African-American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Some other group
020
4060
8010
0
58.3 43.7 41.2 36.1
perc
ent
of r
espo
nden
ts
Report excellent or very good healthWhite Black Hispanic AIAN
General health status by socially-assigned "race", 2004 BRFSS
020
4060
8010
0
58.3 43.7 41.2 36.1
perc
ent
of r
espo
nden
ts
Report excellent or very good healthWhite Black Hispanic AIAN
General health status by socially-assigned "race", 2004 BRFSS
020
4060
8010
0
58.3 43.7 41.2 36.1
perc
ent
of r
espo
nden
ts
Report excellent or very good healthWhite Black Hispanic AIAN
General health status by socially-assigned "race", 2004 BRFSS
13.9 21.5 20.9 22.1
perc
ent
of r
espo
nden
ts
Report fair or poor health
General health status and “race”“White” social experience associated with
better health
Self-identified ethnicityAre you Hispanic or Latino?
Yes No
Self-identified “race”Which one or more of the following would
you say is your race?
White Black or African-American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other
Which one of these groups would you say best represents your race?
Self-identified “race”/ethnicityWhite
“No” to Hispanic/Latino ethnicity question Only one response to race question, “White”
Black “No” to Hispanic/Latino ethnicity question Only one response to race question, “Black”
Hispanic “Yes” to Hispanic/Latino ethnicity question Any response to race question
American Indian/Alaska Native “No” to Hispanic/Latino ethnicity question Only one response to race question, “AI/AN”
White
27,034
Black
5,333
Hispanic
1,138
AIAN
191
White 96.0 0.5 7.1 16.2
Black 0.1 93.7 4.2 7.3
Hispanic 1.5 1.4 82.2 7.9
AIAN 0.5 0.4 1.8 56.5
. . . 1.9 4.0 4.6 12.0
How
self-i
den
tify
Two measures of “race”How usually classified by
others
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
Black
5,246 0.5 95.3 0.9 0.3 3.0
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
Black
5,246 0.5 95.3 0.9 0.3 3.0
Hispanic
1,52826.4 4.7 61.3 1.0 6.6
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
Black
5,246 0.5 95.3 0.9 0.3 3.0
Hispanic
1,52826.4 4.7 61.3 1.0 6.6
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
02
04
06
08
01
00
39.8
53.7
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthHispanic-Hispanic Hispanic-White White-White
General health status, by self-identified and socially-assigned "race", 2004
02
04
06
08
01
00
39.8
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthHispanic-Hispanic White-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
Hispanic-Hispanic versus White-White
p < 0.0001
02
04
06
08
01
00
39.8
53.7
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthHispanic-Hispanic Hispanic-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
Hispanic-Hispanic versus Hispanic-White
p = 0.0019
02
04
06
08
01
00
53.7
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthHispanic-White White-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
Hispanic-White versus White-White
p = 0.1895
02
04
06
08
01
00
39.8
53.7
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthHispanic-Hispanic Hispanic-White White-White
General health status, by self-identified and socially-assigned "race", 2004
20.817
13.6
pe
rce
nt
of
resp
on
de
nts
Report fair or poor health
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
Black
5,246 0.5 95.3 0.9 0.3 3.0
Hispanic
1,52826.4 4.7 61.3 1.0 6.6
AIAN
32145.5 6.9 6.5 33.6 7.5
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
White Black Hispanic AIAN . . .
White
26,37398.4 0.1 0.3 0.1 1.1
Black
5,246 0.5 95.3 0.9 0.3 3.0
Hispanic
1,52826.4 4.7 61.3 1.0 6.6
AIAN
32145.5 6.9 6.5 33.6 7.5
How
self
-id
en
tify
Two measures of “race”
How usually classified by others
02
04
06
08
01
00
32
52.6
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthAIAN-AIAN AIAN-White White-White
General health status, by self-identified and socially-assigned "race", 2004
02
04
06
08
01
00
32
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthAIAN-AIAN White-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
AIAN-AIAN versus White-White
p < 0.0001
02
04
06
08
01
00
32
52.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthAIAN-AIAN AIAN-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
AIAN-AIAN versus AIAN-White
p = 0.0122
02
04
06
08
01
00
52.6
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthAIAN-White White-White
General health status, by self-identified and socially-assigned "race", 2004
Test of H0: No difference in proportions
reporting excellent or very good health
AIAN-White versus White-White
p = 0.3070
02
04
06
08
01
00
32
52.6
58.6
pe
rce
nt
of
resp
on
de
nts
Report excellent or very good healthAIAN-AIAN AIAN-White White-White
General health status, by self-identified and socially-assigned "race", 2004
20.6 19.2
13.6
pe
rce
nt
of
resp
on
de
nts
Report fair or poor health
General health status and “race”“White” social experience associated with
better health Even within the same self-identified “race”/ethnic
group
020
4060
8010
0
32.5 27.7
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
Less than high school graduate
General health status by education and "race", 2004 BRFSS
020
4060
8010
0
32.5 27.7
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
Less than high school graduate
020
4060
8010
0
48.1 39.1
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
High school graduate or GED
General health status by education and "race", 2004 BRFSS
020
4060
8010
0
32.5 27.7
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
Less than high school graduate
020
4060
8010
0
48.1 39.1
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
High school graduate or GED
020
4060
8010
0
66.9 54
White Black
Per
cent
"ex
celle
nt"
or "
very
goo
d"
Some college or more
General health status by education and "race", 2004 BRFSS
w
w
w
w
w
02
04
06
08
0
Education level
Pe
rce
nt "
exc
elle
nt"
or
"ve
ry g
oo
d"
16+ 13-15 12 9-11 0-8
bb
b
b
b
General health status by education and "race", 2004 BRFSS
General health status and “race”“White” social experience associated with
better health Even within the same self-identified “race”/ethnic
group Even within the same educational level
w
w
w
w
w
02
04
06
08
0
Education level
Pe
rce
nt "
exc
elle
nt"
or
"ve
ry g
oo
d"
16+ 13-15 12 9-11 0-8
bb
b
b
b0
51
01
52
02
5
16+ 13-15 12 9-11 0-8
Education level
Pe
rce
nt d
istr
ibu
tion
non-blackblack
General health status by education and "race", 2004 BRFSS
w
w
w
w
w
02
04
06
08
0
Education level
Pe
rce
nt "
exc
elle
nt"
or
"ve
ry g
oo
d"
16+ 13-15 12 9-11 0-8
bb
b
b
b0
51
01
52
02
5
16+ 13-15 12 9-11 0-8
Education level
Pe
rce
nt d
istr
ibu
tion
non-blackblack
General health status by education and "race", 2004 BRFSS
w
w
w
w
w
02
04
06
08
0
Education level
Pe
rce
nt "
exc
elle
nt"
or
"ve
ry g
oo
d"
16+ 13-15 12 9-11 0-8
bb
b
b
b0
20
40
60
80
10
0
16+ 13-15 12 9-11 0-8
Education level
Pe
rce
nt d
istr
ibu
tion
non-whitewhite
General health status by education and "race", 2004 BRFSS
General health status and “race”“White” social experience associated with
better health Even within the same self-identified “race”/ethnic
group Even within the same educational level
“White” social experience associated with higher education
Key questionsWhy is socially-assigned “race” associated with
self-reported general health status? Even within the same self-identified “race”/ethnic
group Even within the same educational level
Why is socially-assigned “race” associated with educational level?
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”)
What is racism?
Source: Jones CP, Phylon 2003
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”) Unfairly disadvantages some individuals and
communities Unfairly advantages other individuals and
communities
What is racism?
Source: Jones CP, Phylon 2003
A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”) Unfairly disadvantages some individuals and
communities Unfairly advantages other individuals and
communities Saps the strength of the whole society through the
waste of human resources
What is racism?
Source: Jones CP, Phylon 2003
Our tasks
Name racismAsk, “How is racism operating here?”Organize and strategize to act
BRFSS coordinatorsArkansas Neha Thakkar
Colorado Jason Gannon
Delaware Fred Breukelman
District of Columbia John Davies-Cole
Mississippi Ron McAnally
Rhode Island Jana Hesser
South Carolina Beili Dong
Wisconsin Anne Ziege
LimitationsBRFSS is a telephone survey
Some households do not have land-line phones, and the distribution of land-line phones is differential by “race”
Increased screening of “telemarketers” may impact response rates
Health status data are self-reported, without examination data