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

1. Racism and Health:Collecting Evidenceto address root causes of disparities

2. Racism and Health:Collecting Evidenceto 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

3. 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

4. What is racism?

5. What is racism? A system

6. What is racism? A system of structuring opportunity and assigning value

7. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of phenotype (“race”)

8. 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

9. 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

10. 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 Source: Jones CP, Phylon 2003

11. “Reactions to Race” module • Six-question optional module on the Behavioral Risk Factor Surveillance System • Piloted in 2002 • Now available to all states

12. States using “Reactions to Race” Arkansas 2004 California 2002 Colorado 2004 Delaware 2002 2004 2005 District of Columbia 2004 Florida 2002 Mississippi 2004 New Hampshire 2002 New Mexico 2002 North Carolina 2002 Ohio 2003 2005 Rhode Island 2004 South Carolina 2003 2004 Wisconsin 2004 2005

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

14. General health status • Would you say that in general your health is: • Excellent • Very good • Good • Fair • Poor

15. 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

19. General health status and “race” • “White” social experience associated with better health

20. Self-identified ethnicity • Are you Hispanic or Latino? • Yes • No

21. 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?

22. 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”

23. Two measures of “race” How usually classified by others How self-identify

24. Two measures of “race” How usually classified by others How self-identify

25. Two measures of “race” How usually classified by others How self-identify

26. Two measures of “race” How usually classified by others How self-identify

27. Two measures of “race” How usually classified by others How self-identify

28. General health status, by self-identified and socially-assigned "race", 2004 100 80 60 58.6 53.7 percent of respondents 39.8 40 20 0 Hispanic-Hispanic Hispanic-White White-White Report excellent or very good health

29. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus White-White p < 0.0001 80 60 58.6 percent of respondents 39.8 40 20 0 Hispanic-Hispanic White-White Report excellent or very good health

30. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus Hispanic-White p = 0.0019 80 60 53.7 percent of respondents 39.8 40 20 0 Hispanic-Hispanic Hispanic-White Report excellent or very good health

31. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-White versus White-White p = 0.1895 80 60 58.6 53.7 percent of respondents 40 20 0 Hispanic-White White-White Report excellent or very good health

32. General health status, by self-identified and socially-assigned "race", 2004 Report fair or poor health 100 13.6 80 17 20.8 60 58.6 53.7 percent of respondents percent of respondents 39.8 40 20 0 Hispanic-Hispanic Hispanic-White White-White Report excellent or very good health

33. Two measures of “race” How usually classified by others How self-identify

34. Two measures of “race” How usually classified by others How self-identify

35. General health status, by self-identified and socially-assigned "race", 2004 100 80 60 58.6 52.6 percent of respondents 40 32 20 0 AIAN-AIAN AIAN-White White-White Report excellent or very good health

36. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-AIAN versus White-White p < 0.0001 80 60 58.6 percent of respondents 40 32 20 0 AIAN-AIAN White-White Report excellent or very good health

37. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-AIAN versus AIAN-White p = 0.0122 80 60 52.6 percent of respondents 40 32 20 0 AIAN-AIAN AIAN-White Report excellent or very good health

38. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-White versus White-White p = 0.3070 80 60 58.6 52.6 percent of respondents 40 20 0 AIAN-White White-White Report excellent or very good health

39. General health status, by self-identified and socially-assigned "race", 2004 Report fair or poor health 100 13.6 80 19.2 20.6 60 58.6 52.6 percent of respondents percent of respondents 40 32 20 0 AIAN-AIAN AIAN-White White-White Report excellent or very good health

40. General health status and “race” • “White” social experience associated with better health • Even within the same self-identified “race”/ethnic group

45. 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

49. 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

50. 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?