Health status of White Americans

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White Americans, as the largest racial group in the United States, have historically had better health outcomes than other oppressed racial groups in America. [1] However, in recent years, the scholarly discourse has switched from recognition of the immense positive health outcomes of white Americans towards understanding the growing persistence of negative outcomes unique to this racial group. Scholars have discussed the effects of racial prejudice and its negative effect on health outcomes to not only those being oppressed but also those being given privileges. [2] [3] [4] In addition to the effects of living in a racialized society, white Americans have the highest rate of suicide and lifetime psychiatric disorders of any other ethnicity or racial category. [5] In conjunction with these psychiatric issues, the population presents higher rates of alcohol usage alongside lower levels of psychological flourishing. [2] [6] Given this information, the health status of white Americans has gained increasing importance due to the differences in health outcomes between white Americans and white people from other parts of the world.

Contents

Health advantages

2007, the 15 leading causes of death in the US were recorded with a specific attention toward racial/ethnic health disparities. For 10 of those 15 causes of death, black Americans had higher rates of death. [7]

The following list describes the categories in which non-Hispanic whites have ranked comparatively better than blacks [8] [9] [10] (in order of total deaths [7] ):

  1. Heart disease
  2. Cancer
  3. Stroke
  5. Diabetes
  6. Respiratory infections
  7. Kidney disease
  8. Sepsis
  10. Hypertension
  12. Homicide

They also fare better for:

Life expectancy

Life expectancy can be used to gauge the overall health of a population and is defined as the average number of years a group of infants would live if they were to experience the age-specific death rates that are present in their birth year. [11] White Americans have historically exhibited an advantage over large portions of the US population. From 1980 to 2014, white Americans had the longest life expectancy, [11] black people had the shortest life expectancy in the US, and black men had higher racial differences in life expectancy than black women. [12] These patterns can be identified throughout early childhood until advanced age when the differences become less severe. The differences seen in life expectancy are generally attributed to minority populations having earlier onsets of illness, greater severity of disease, and poorer survival rates. [12]

In recent years, white Americans have collectively experienced a consistently declining life expectancy. In particular, this trend is prevalent among non-college educated whites and is largely related to the deaths of despair phenomenon. [13] After 1998, other first-world countries' mortality rates began to fall by 2% a year, which matched the average rate of decline seen in the US from 1978 to 1998. However, non-Hispanic whites' mortality increased by 0.5%. [13] These changes are specific to the age category within midlife.

Diseases of despair

In the US, there is a classification of behavior-related medical conditions known as diseases of despair, which comprises: drug or alcohol overdose, suicide, and alcoholic liver disease. The frequency of these illnesses is highest among middle-age working class white people. [14] Scholars have raised the idea that diseases of despair are the result of worsening psychosocial problems that extend from the 1980s and are of concern to the US as a whole. [15] Although these behaviors are thought to be seen with groups who experience lack of social and economic mobility, there are increasing risk factors involved with poor mental health. A study published in 2009 found black individuals to have higher rates of psychological flourishing than white individuals. [6] Despite the vastly different economic trends for white and black Americans, whites are more likely to perceive themselves as having lower social class and are less optimistic about their financial future. [16] This trend among middle-class whites points to an increased need for research on the health status of whites due to continuing rise in premature death caused by these diseases. [17] Further, this trend exemplifies the problematic nature of research using whites as a comparative standard to other ethnic and racial backgrounds in the US.

Opioid epidemic

From 2010 and into the 2020s, there has been an increase in opioid overdoses among white Americans, specifically in rural areas. [18] Although this epidemic is not limited to white Americans, the increase in overdose deaths, emergency room visits related to opioid usage, and treatment for opioid addictions is well documented to be overwhelmingly white. [19] Andrew Kolodny, director of the Opioid Policy Research Collaborative at Brandeis University, attributes the disparate opioid usage among white Americans to physicians' increased propensity towards prescribing narcotics to white patients. Rhetoric from the War on Drugs has led to the persistent misperception that black and Hispanic individuals are more likely to use and become addicted to drugs. [18]

Effects of racialization

Structural racism is a system composed of a unequal power dynamics that allows members of the dominating social group to obtain unearned societal privilege through ideology and behavior without intention or dislike of the non-dominant group. [3] [20] Due to the racialized environment that people experience in the US, scholars have studied whether living in areas where there are high levels of racialization will negatively impact the health of individuals living there. Pathways that link racialization to poor health outcomes include economic injustice and social deprivation, environmental and occupational health inequalities, psychosocial trauma, inadequate health care, state-sanctioned violence, alienation from property, and political exclusion. [21] [20] While it has been understood that racism and prejudice negatively affect the health of the individuals who are being discriminated against, there is reason to believe that simply living in an area with racial disparities and tension can be harmful regardless of the person's race or beliefs. [4] US states that had higher levels of "collective disrespect" toward black people had higher age-adjusted mortality rates for both black and white people. [22] A study in the American Journal of Public Health identified higher risks of mortality associated with being male, advanced age, lower socioeconomic status, race, and being divorced or widowed. However, when community-level prejudice was added into this model, higher levels of anti-black prejudice increased the odds of participant mortality by as much as 31%. [4] The study found that the highest level of mortality risk was associated with individuals with lower attitudes of racial prejudice who lived in areas of higher community-level prejudice. [4] Consequently, community-level racial prejudice is a stronger predictor of mortality than socioeconomic status or racial residential segregation.

In a study of Hurricane Katrina survivors, researchers measured the relationship between perception of racism against black Americans among both white and black Americans, and similarly found that perceptions of racism against black Americans were associated with negative mental health outcomes for whites. [23] Measuring levels of racial prejudice and racial attitudes is complicated, however, given the different ways prejudice is presented and the implicit bias in an individual's self-evaluation.

Psychiatrist Jonathan Metzl's 2019 book Dying of Whiteness explores the effects of living in areas with high levels of racial resentment and prejudice. The book notes the hypocrisy of white people adopting political views that negatively affect the health outcomes of white Americans. [24] For example, Metzl found that through an anti-government rhetoric, whites tended to reject the Affordable Care Act expansion, oppose adoption of stricter gun laws, and resist tax cuts intended to build infrastructure in areas concentrated with working-class white populations. [25] His ethnographic research for the book suggests that the politics of racial resentment creates sentiments about government that would ultimately harm life expectancy in a variety of ways for white individuals. The book notes the trend in the lack of acknowledgement among white individuals of macro-level social determinants of health due to a focus on individual effort. [26] This nostalgic idea of hard-work and self-sufficiency negates the impacts of larger health factors and further creates an environment that he believes is not conducive to positive health outcomes.

Comparison to other white populations

Compared to other white populations, white Americans are at disparate risk of poor health outcomes partly due to the incidence of diseases of despair. The life expectancy of whites in the US ranks behind countries such as South Korea, Chile, Greece, Cyprus, and Cuba. [27] [2] In addition, when comparing the health of white Americans to white people from other first world countries, there are better health outcomes for all ages up to 75. [28] [ clarification needed ] Furthermore, whites from the highest socioeconomic levels in the US had comparable health outcome rates to whites from England who had the lowest income and education levels. [29] Malat et al. developed a framework in 2016 that aims to understand the relationship between whiteness and health. [2] In a study of health disparities across Canada and the US, the US consistently had far more pronounced racial health inequities. [30] [31] The extent of these inequities are heavily dependent on the society in which they are occur. [31] These researchers describe the US as being characterized by racial and ethnic segregation, and policies that distribute health resources, housing, and education unequally.  

Below is a list of conditions for which the US overall is consistently worse than the average among comparable high-income countries (Australia, Austria, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom): [27]

Related Research Articles

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

Racial discrimination is any discrimination against any individual on the basis of their race, ancestry, ethnicity, and/or skin color and hair texture. Individuals can discriminate by refusing to do business with, socialize with, or share resources with people of a certain group. Governments can discriminate explicitly in law, for example through policies of racial segregation, disparate enforcement of laws, or disproportionate allocation of resources. Some jurisdictions have anti-discrimination laws which prohibit the government or individuals from being discriminated based on race in various circumstances. Some institutions and laws use affirmative action to attempt to overcome or compensate for the effects of racial discrimination. In some cases, this is simply enhanced recruitment of members of underrepresented groups; in other cases, there are firm racial quotas. Opponents of strong remedies like quotas characterize them as reverse discrimination, where members of a dominant or majority group are discriminated against.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

<span class="mw-page-title-main">Hispanic paradox</span> Epidemiological finding

The Hispanic paradox is an epidemiological finding that Hispanic Americans tend to have health outcomes that "paradoxically" are comparable to, or in some cases better than, those of their U.S. non-Hispanic White counterparts, even though Hispanics have lower average income and education, higher rates of disability, as well as a higher incidence of various cardiovascular risk factors and metabolic diseases.

<span class="mw-page-title-main">Rural health</span> Interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

Race and health refers to how being identified with a specific race influences health. Race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and health, scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. "Race" and ethnicity often remain undifferentiated in health research.

Social epidemiology focuses on the patterns in morbidity and mortality rates that emerge as a result of social characteristics. While an individual's lifestyle choices or family history may place him or her at an increased risk for developing certain illnesses, there are social inequalities in health that cannot be explained by individual factors. Variations in health outcomes in the United States are attributed to several social characteristics, such as gender, race, socioeconomic status, the environment, and educational attainment. Inequalities in any or all of these social categories can contribute to health disparities, with some groups placed at an increased risk for acquiring chronic diseases than others.

Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.

Minority stress describes high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses that accrue over time, eventually leading to poor mental and physical health. Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.

In the United States, racial inequality refers to the social inequality and advantages and disparities that affect different races. These can also be seen as a result of historic oppression, inequality of inheritance, or racism and prejudice, especially against minority groups.

Societal racism is a type of racism based on a set of institutional, historical, cultural and interpersonal practices within a society that places one or more social or ethnic groups in a better position to succeed and disadvantages other groups so that disparities develop between the groups. Societal racism has also been called structural racism, because, according to Carl E. James, society is structured in a way that excludes substantial numbers of people from minority backgrounds from taking part in social institutions. Societal racism is sometimes referred to as systemic racism as well.

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic, and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion, and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging.

A disease of despair is one of three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic prospects are bleak. The three disease types are drug overdose, suicide, and alcoholic liver disease.

Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as how the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on African diaspora</span>

The COVID-19 pandemic has revealed race-based health care disparities in many countries, including the United States, United Kingdom, Norway, Sweden, Canada, and Singapore. These disparities are believed to originate from structural racism in these countries which pre-dates the pandemic; a commentary in The BMJ noted that "ethnoracialised differences in health outcomes have become the new normal across the world" as a result of ethnic and racial disparities in COVID-19 healthcare, determined by social factors. Data from the United States and elsewhere shows that minorities, especially black people, have been infected and killed at a disproportionate rate to white people.

Chaniece Wallace, a black woman and physician, died at 30 years of age from complications of pregnancy two days after the birth of her daughter. Her death is seen as preventable and is viewed in the context of high rates of maternal mortality in the United States, particularly among the African American population. It is cited as an example in medical and scholarly publications to call for improved health outcomes in the black U.S. population. Wallace died despite several factors seen as protective: she was "highly educated, employed as a health care practitioner, had access to health care, and had a supportive family." Wallace was a fourth year pediatric chief resident at the Indiana University School of Medicine and was working at Riley Children's Health Hospital at the time of her death.

Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent." Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030. The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death. Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).

The COVID-19 pandemic has had an unequal impact on different racial and ethnic groups in the United States, resulting in new disparities of health outcomes as well as exacerbating existing health and economic disparities.

Medical racism in the United States encompasses discriminatory and targeted medical practices and misrepresentations in medical teachings driven by biases based on characteristics of patients' race and ethnicity. In American history, it has impacted various racial and ethnic groups and affected their health outcomes. Vulnerable subgroups within these racial and ethnic groups such as women, children and the poor have been especially endangered over the years. An ongoing phenomenon since at least the 18th century in the United States, medical racism has been evident on a widespread basis through various unethical studies, forced procedures, and differential treatments administered by health care providers, researchers, and even sometimes government entities. Whether medical racism is always caused by explicitly prejudiced beliefs about patients based on race or by unconscious bias is not widely agreed upon.

The psychological impact of discrimination on health refers to the cognitive pathways through which discrimination impacts mental and physical health in members of marginalized, subordinate, and low-status groups. Research on the relation between discrimination and health became a topic of interest in the 1990s, when researchers proposed that persisting racial/ethnic disparities in health outcomes could potentially be explained by racial/ethnic differences in experiences with discrimination. Although the bulk of the research tend to focus on the interactions between interpersonal discrimination and health, researchers studying discrimination and health in the United States have proposed that institutional discrimination and cultural racism also give rise to conditions that contribute to persisting racial and economic health disparities.

References

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  25. ↑ Metzl, Jonathan, 1964-, Dying of whiteness : how the politics of racial resentment is killing America's Heartland, ISBN   978-1-5491-2581-2, OCLC   1090799098 , retrieved 2021-04-21{{citation}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
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