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January 30, 2013 9:50 AM Race, Income and Health

By Ed Kilgore

There’s been a long-standing debate in U.S. policy circles about the intersection of race, economics and health care quality. In the January/February issue of the Washington Monthly, senior editor Phillip Longman offers three articles that reflect the most recent research on this subject.

The first, entitled “Is Inequality Shortening Your Lifespan?”, reviews the basic statistics on health conditions and concludes income is the most important differentiating factor:

[T]he health status of both blacks and whites improves dramatically with higher income while the gap between them remains small. Among blacks and whites living at just four times the poverty rate, for example, the percent who report poor or fair health drops to 8 percent and 6 percent respectively. Your race per se, in other words, plays little role in predicting your health compared to your income.
What explains the residual difference in the health status of blacks and whites who have the same-size pay check? Researchers suggest it may reflect in part the reality that at any given income level, blacks tend to have fewer assets than whites, such as home equity and financial savings…. Middle-class black families are also more likely than middle-class white families to bear the health consequences of having lived in poverty in the past.

In “To Live Longer, Move To a New Zip Code,” Longmann reviews a study by HUD which found that moving out of inner-city low-income neighborhoods had a significant positive effect on obesity levels and thus health conditions:

Though it might seem strange to say that obesity is contagious…it does seem that people’s risk of it is affected by the weight of their neighbors, as well as by such environmental factors as whether most of the food for sale in their environs is junk food, as is often the case in America’s most impoverished neighborhoods.

Finally, in “Color-Blind Medicine?”, Longman sees evidence that race does affect the quality of medical care received, but not necessarily by way of racism among providers:

[I]t is place, not race, that overwhelmingly determines what specific treatments patients receive for specific ailments. Blacks tend to live in parts of the country that have a disproportionately large share of low-quality providers. But as researchers from Dartmouth Medical School have demonstrated, within poor-quality hospitals, which include not just inner-city “St. Elsewhere”s but often well-known academic medical centers, both whites and blacks tend to be equally mistreated, often by being subjected to unnecessary surgery and unproven treatments.

All of these snapshots of the intersection of different factors could be significantly changed, of course, if the Affordable Care Act is fully implemented. But it’s extremely helpful to know where we are starting: in a system where inequality remains the rule rather than the exception.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

Comments

  • c u n d gulag on January 30, 2013 10:16 AM:

    Excuse me, but, WELL DUH!!!

    Now, factor in diet, in which wealthier people can eat better, more expensive, leaner cuts of "free-range" meats, fresher, healthier, and more natural fruits, vegetables, and grains, have more time to excercise, and, if they drink, drink better quality alcoholic beverages than the rot-gut sh*t the rest of us occasionally swill, to have a laugh, or temporarily forget our troubles.

    The amount of starch and sugar put into the pre-processed foods the poorer people eat, because that's all they can afford, and/or have the time to prepare after a job or two or three, and the chemicals, preservatives, and growth hormones and steroids, are also killing off the people who are less well off far earlier than is necessary.

    I'm starting to wonder how powerful the Mortuary and Cementary lobbies are in DC!?!?!?!?!?

  • exlibra on January 30, 2013 10:45 AM:

    It's strange to think that, for centuries, being fat was an outward sign of being rich and healthy.

  • elisabeth on January 30, 2013 11:27 AM:

    it's true that "income inequality" covers a lot -- in a way it is a marker for social inequality. I have great insurance even though I did not have, when working, a very high income. BUT I did have higher education, and I worked for a university that had excellent health coverage that I was allowed to stay a part of after an early (pre-medicare) retirement. Add to that an excellent university teaching hospital as my main provider, and I've already out-lived the "average" for a woman with my stage-4 cancer diagnosis. And I'll continue to be part of the huge cost of US medical care; some of my medications are thousands/month and have been for more than a year. I try not to feel too guilty (keep remembering all the years in which I didn't use my benefits even up to the deductible AND the insurance company is still posting profits...).
    I do want to add that every time I hear the idea that we spend too much during the last six months of life that it really can be difficult to decide when one's last six months have begun! My doctors refuse to predict -- I keep doing well, they keep inventing new treatments, new drugs keep coming along, and old predictions are continually being proved inaccurate. Looking to the future, I hope to be able to clearly see when we need to move to palliative-only care, but I don't think those issues as clear as many pretend, and I doubt very much that we'll be able to judge in time not to spend some "excess" resources.

  • Sgt. Gym Bunny on January 30, 2013 2:22 PM:

    Yep, I can give first-hand testimony on the effects of socio-geo-economics of food. I'm originally from rural eastern North Carolina, but I live/work in Baltimore/DC. And every time I visit NC, I come back bloated and constipated because of the food at my parents' houses and the plethora of fried chicken/BBQ joints. As much as I love some southern BBQ and fried, I can't live on that shit like my parents do.

    And it's not necessarily that there aren't enough fruits/vegetables--it's the country, afterall. Just that there's an epidemic in southern cuisine culture of cooking veggies with a slab of pork and a dump truck of salt, not to mention that even the fruit dishes are drowned in sugar (candied yams, anybody?). I don't even think my mother knows how to just steam a vegetable...

    Not to mention that my parent's only grocery shop for pre-packaged foods because it's cheap and they don't cook anymore. But 90% of the time they just eat out. But I'm actually anal enough to bring my own damn food from Baltimore whenever I visit, because I'm not going to find any "health-food" in those parts (I took my quinoa on my last visit, lol).

    It's even harder to work out back home, too. Maybe I'm too pansy-ass liberal, but I need either a gym or jogging environment where people keep their mutts on leashes or in fenced yards--which ain't all that common in the South. I was chased by more than a couple of Rufus's when I attempted to jog my dad's neighborhood over Thanksgiving... Sheesh! Generally speaking, my first stop when I'm back in Baltimore is always the gym.

  • Doug on January 30, 2013 4:17 PM:

    "...to bear the health consequences of having lived in poverty in the past." Phillip Longman quoted by Ed Kilgore

    Which why we need free school breakfasts/lunches, continued support for food stamps and raise the minimum wage to $10 per hour. To start with.
    Which, unsurprisingly, is why I'm NOT a Republican...