Racism and Health: Collecting Evidence to address root causes of disparities

Camara Phyllis Jones, MD, MPH, PhD Research Director on Social Determinants of Health Emerging Investigations and Analytic Methods Branch Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention

Acknowledgments Benedict Truman, MD, MPH Associate Director for Science Office of Minority Health and Health Disparities Centers for Disease Control and Prevention Susan Rumisha Project Imhotep Intern, Summer 2005 Public Health Sciences Institute, Morehouse College and National Institute for Medical Research, Dar es Salaam, Tanzania

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 2002 Now available to all states

States using Reactions to Race Arkansas2004 California2002 Colorado2004 Delaware District of Columbia2004 Florida2002 Mississippi2004 New Hampshire2002 New Mexico2002 North Carolina2002 Ohio Rhode Island2004 South Carolina Wisconsin

Arkansas, Colorado, Delaware, District of Columbia, Mississippi, Rhode Island, South Carolina, Wisconsin States using Reactions to Race module on 2004 BRFSS

General health status Would 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

General health status and race White social experience associated with better health

Self-identified ethnicity Are 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/ethnicity White 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 Black Hispanic AIAN How self-identify Two measures of race How usually classified by others

WhiteBlackHispanicAIAN... White 26, How self-identify Two measures of race How usually classified by others

WhiteBlackHispanicAIAN... White 26, Black 5, How self-identify Two measures of race How usually classified by others

WhiteBlackHispanicAIAN... White 26, Black 5, Hispanic 1, How self-identify Two measures of race How usually classified by others

WhiteBlackHispanicAIAN... White 26, Black 5, Hispanic 1, How self-identify Two measures of race How usually classified by others

percent of respondents Report excellent or very good health Hispanic-HispanicHispanic-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004

percent of respondents Report excellent or very good health Hispanic-HispanicWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus White-White p <

percent of respondents Report excellent or very good health Hispanic-HispanicHispanic-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus Hispanic-White p =

percent of respondents Report excellent or very good health Hispanic-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-White versus White-White p =

percent of respondents Report excellent or very good health Hispanic-HispanicHispanic-WhiteWhite-White General health status, by self-identified and socially-assigned "race", percent of respondents Report fair or poor health

WhiteBlackHispanicAIAN... White 26, Black 5, Hispanic 1, AIAN How self-identify Two measures of race How usually classified by others

WhiteBlackHispanicAIAN... White 26, Black 5, Hispanic 1, AIAN How self-identify Two measures of race How usually classified by others

percent of respondents Report excellent or very good health AIAN-AIANAIAN-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004

percent of respondents Report excellent or very good health AIAN-AIANWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-AIAN versus White-White p <

percent of respondents Report excellent or very good health AIAN-AIANAIAN-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-AIAN versus AIAN-White p =

percent of respondents Report excellent or very good health AIAN-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-White versus White-White p =

percent of respondents Report excellent or very good health AIAN-AIANAIAN-WhiteWhite-White General health status, by self-identified and socially-assigned "race", percent of respondents 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

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

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 questions Why 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 racism Ask, How is racism operating here? Organize and strategize to act

BRFSS coordinators ArkansasNeha Thakkar ColoradoJason Gannon DelawareFred Breukelman District of ColumbiaJohn Davies-Cole MississippiRon McAnally Rhode IslandJana Hesser South CarolinaBeili Dong WisconsinAnne Ziege

Limitations BRFSS 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