Effect of discrimination on African American health & Constituency-based health movement

1. Effect of discrimination on African American health &Constituency-based health movement BaoBinh Huynh Ha Nguyen

2. The table of contents • African American • Social norms • Social values • Three factors that affect African American’s health • Education • Income • Low social value • Disparities in American healthcare • Stereotype • Prejudice • Constituency-based health movement • Background • Impact of the movement on African American • Organization: the Disparities Solutions Center • Background • Work and strategies of the organization

3. Social values and norms of African American “Values are grounded in beliefs about the way the world should be rather assumptions about the way the world is (Hall, 2005, p.49-50).” Social values: White Americans tend to think that they are higher than African Americans. E.g.: “In the 19th century, differences between races were usually assumed to be biological, were interpreted to show the superiority of white races, and were used to justify policies that subordinated “colored” groups.” (Bhopal, 1998) “Norms are social rules for what certain types of people should and should not do (Hall, 2005, p.52).” Social Norms: White Americans tend to treat African Americans unequally. E.g.: “Health services may offer a worse service to minority groups because staff treat patients unequally on account of their race or ethnicity, policies are based on the needs of the racial/ethnic majority, and specialist resources required to meet the needs of minority groups do not exist .” (Bhopal, 1998) => Because of social values and social norms, African Americans become to have low-esteems. They tend to have lack of knowledge and it affects their heath somehow indirectly.

4. Education • How racial discrimination affects education in America Racial discrimination in learning environment makes academic path more vulnerable. More specific, African American students struggle with unfair treatments from teachers and classmates. • “Not surprising then is that African American youths report racially biased treatment within the classroom as a common occurrence, for example, perceiving that they received poor grades or evaluations from teachers and other adults at school or harsher discipline due to race.” (Chavous, Drake, Smalls, Griffin & Cogburn, 2008). • “Black doctoral students hfaceave also reported feeling invisible, isolated, and undervalued.” (Barker, 2011). Author Barker then mentions that black students as the result consistently the need of outperforming their works’ quality. • How low-education affects health of African American School drop-out expose to serious health issue because of lacking essential health knowledge. • “Those without a high school diploma had more than triple the death rate from chronic noncommunicale disease (e.g, heart disease), more than 3 ½ times the death rate from injury and nearly six times the death rate from HIV/AIDS, compared to those with at least some college.” (Reuss, 2007, p. 387) • “an additional four years of schooling would improve self-rated health by 0.46 points.34 Similarly, an additional four years of schooling at the sample mean of the pupil–teacher ratio would reduce the probability of being obese by 0.051…” (Frisvold, Golberstein, 2011)

5. Income • How racism affects African American’s income • Compare to whites, African Americans receive less income at the same levels of education. • E.g.: “Estimates from a variety of social surveys suggest that the black-white difference in hourly wages among men usually range between about 10 and 20 percent (Cancio, Evans, and Maume 1996; Darity and Meyers 1998; Neal and Johnson 1996).” (Pager, Western & Bonikowski, 2009, October 1) • Minority applicants were rejected more likely than whites with identical skills and experiences. • E.g.: “Black and Latino applicants were routinely channeled into positions requiring less customer contact and more manual work than their white counterparts. In interactions between applicants and employers, we see a small number of cases that reflect employers’ seemingly rigid racial preferences. More often, differential treatment emerged in the social interaction of the job interview. Employers appeared to see more potential in the stated qualifications of white applicants, and they more commonly viewed white applicants as a better fit for more desirable jobs” (Pager, Western & Bonikowski, 2009, October 1). • → African Americans do not have a lot of chances to have good jobs and same incomes as Whites.

6. How income affects health status in the U.S., especially for African American • People with incomes below the poverty line were nearly twice as likely to have had an asthma attack in the previous year as people with incomes at least twice the poverty line. • African Americans under age 65 were about 1 ½ times as likely as whites to lack health insurance. • African Americans have higher death rates than whites from cancer (1/4 higher), heart disease (1/5 higher), stroke( ½ higher), diabetes (twice as high), homicide (more than 5 times as high), and AIDS (more than 8 times as high.) (Peek, Young, Quinn, Gorawara-Bhat, Wilson, & Chin, 2010, July) • The infant mortality rate for African American was, in 2002-2003, over twice as high as for whites. (Reuss,2007, p.387-390) • African-American women have the highest breast cancer death rates of all racial/ethnic groups in the US. (Peek, Young, Quinn, Gorawara-Bhat, Wilson, & Chin, 2010, July) →Based on the statistics, because of low incomes, African Americans do not have enough abilities to protect their health. An important key to remember: Poverty and inequality are likes partners in crime. “Whether public policy focuses primarily on the elimination of poverty or on reduction in income disparity,” Argue Wilkinson critics Kevin Fiscella and Peter Franks, “neither goals is likely to be achieved in the absence of the other.” (Reuss,2007, p.389)

7. Low social value • How racial hierarchy affects African American health Social groups in the bottom of the racial hierarchy, like African American, experience more serious physical and psychological health issue as the result of being discriminated. • “U.S researchers are beginning to explore the relationship between high blood pressure among African Americans and the racism of the surrounding society. African American tend to suffer from high blood pressure, a risk factor for circulatory disease more often then whites” (Reuss, 2007, p. 390) • “African-American pregnant women also have the highest incidence of bacterial vaginosis, a urogenita infection linked to premature rupture of membranes, preterm labor and preterm delivery [40 , 41 ], which has been associated recently with chronic stress in pregnant women [42 ]. Racism-related stress may also damage maternal and infant health by contributing to unhealthy coping behaviors, such as smoking [43 ] and alcohol consumption [44 ], both of which may be harmful to pregnancy.”(Carty, Kruger, Turner, Campbell, DeLoney, & Lewis, 2011)

8. Disparity in American healthcare African Americans are treated poorly and unequally in American healthcare system. The disparities in healthcare reflect social inequality such as stereotype and prejudice. • According to Hall, “One specific type of stereotype is called a sociotype, and from a statistical standpoint these are quite accurate. It may be discovered, for example, that a certain group has a particular average level of formal education or a ceratin average amount of income.” (Hall, 2005, p.196) • “For example, one study found that physicians were more likely, after controlling for confounding variables, to rate their African–Americans patients as less educated, less intelligent, more likely to abuse drugs and alcohol, and less likely to adhere to treatment regimens (van Ryn & Burke, 2000). Green et al. (2007) documented the association between implicit physician bias and racial disparities in treatment recommendations for acute myocardial infarctions.” (Peek, Odoms-Young, Quinn, Gorawara-Bhat, Wilson, & Chin, 2010) • Hall describes prejudice as “the belief that outgroup is in some way inferior to the ingroup and, therefore, not worthy of decent treatment.” (Hall, 2005, p.204) • “The consistent and repeated findings that black Americans receive less health care than white Americans—particularly where this involves expensive new technology—is an indictment of American health care.” (Bhopal, 1998)

9. Video • Racial Health disparities http://www.google.com/imgres?hl=en&sa=X&biw=1277&bih=592&tbm=isch&prmd=imvns&tbnid=siAk1QwPswYo_M:&imgrefurl=http://equity.lsnc.net/2009/10/the-economic-case-for-fixing-racial-health-disparities/&docid=BmPndAyqI_jPRM&imgurl=http://equity.lsnc.net/wp-content/uploads/2009/10/photo_blood_pressure_1.jpg&w=383&h=300&ei=TuvjTrzAMabdiAKB0u2VBg&zoom=1

10. Constituency-based health movement’s background Constituency-based health movement is a part of Health social movements. Background of health social movements: • “Health social movements (HSMs) are an important political force concerning health access and quality of care, as well as for broader social change. We define HSMs as collective challenges to medical policy, public health policy and politics, belief systems, research and practice which include an array of formal and informal organizations, supporters, networks of co-operation and media. HSMs make many challenges to political power, professional authority and personal and collective identity. These movements address (a) access to, or provision of, health-care services; (b) disease, illness experience, disability and contested illness; and (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality.” (Brown, & Zavestoski, 2004) Background of Constituency-based health movement: • “Constituency-based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. They include the women's health movement, gay and lesbian health movement and environmental justice movement.” (Brown, & Zavestoski, 2004)

11. How constituency-based health movement helps African American • “First, they produce changes in the health care and public health systems, both in terms of health care delivery, social policy and regulation. • Second, they produce changes in medical science, through the promotion of innovative hypotheses, new methodological approaches to research and changes in funding priorities. • Third, health social movements produce changes in civil society by pushing to democratize those institutions that shape medical research and policy-making (for examples of these three categories of HSMs.” (Brown, & Zavestoski, 2004) => Those activities help African Americans have a chance to deserve better healthcare. http://www.google.com/imgres?q=Constituency-based+health+movement&hl=en&biw=1366&bih=632&tbm=isch&tbnid=YVm4cmSSx4B7OM:&imgrefurl=http://www.phmovement.org/en/campaigns/145/page&docid=K9khspnlF8iFRM&imgurl=http://www.phmovement.org/files/PHMSAlaunch2edit

12. The Disparities Solution Center • Background of the Center: • “Massachusetts General Hospital first established a system-wide Committee on Racial and Ethnic Disparities in 2003 to focus internal attention on the challenge of disparities, improve the collection of race/ethnicity data, and implement quality improvement programs to reduce disparities” (n.d.). • Massachusetts General Hospital and Partners HealthCare created funding commitment to build the disparities solution center on behalf of reducing unequal treatment in healthcare system. (n.d.) • The center works closely with Harvard Medical School’s Department of Medicine and the Massachusetts General Hospital Division of General Medicine to effectively diminish disparities in health care. (n.d.)

13. Disparities Solutions Center’s work Hall writes “The point of identifying variation of conflict is not so you can put a label on a conflict. Instead, it is to point out issues that need to be considered when trying to deal in productive ways with conflict” (Hall, 2005, p. 253). Racial discrimination can’t disappear itself but require actions and effort of individuals and organizations. Disparities solution center highly aware of this and have actively collaborate with other hospitals, organizations and medical groups or services to create projects to reduce health disparity. According to the website of the center, “The DSC is dedicated to the development and implementation of strategies that advance policy and practice to eliminate racial and ethnic disparities in health care” (n.d.) The Disparities Solutions Center will achieve this mission by: • Serving as a change agent by developing new research and translating innovative research findings into policy and practice (n.d.). • Providing education and leadership training to expand the community of skilled individuals dedicated to eliminating health care disparities.” (n.d.) • By several strategies, the DSC can help African Americans have better health conditions even though they have low-incomes. DSC has several projects that help eliminate disparities in health care.ba • The Disparities Leadership Program: The program helps the leaders from hospitals, health plans, and health care organizations know how to implement practical strategies in order to eliminate racial and ethnic disparities in healthcare. (n.d.) • Multicultural Affairs Office and Disparities Solutions Center Film Series: The Schwartz Center, MGH Multicultural Affairs Office, and the DSC, collaborates to produce a film series to raise awareness around the issues of racial and ethnic disparities and cross-cultural care. (n.d.) For more information or to take an action to help., everyone can go to the website www.massgeneral.org

14. Learning outcome Our team’s research work meet all four of Cascadia’s College-wide learning outcomes, which are learn actively, think critically, creatively and reflectively, communicate with clarity and originality and interact in diverse and complex environments. • Learn actively reflects on the way we take advantage of understanding of the course’s materials, such as readings and the assigned movies, to do research for the final project. For example, from the concepts of racial discrimination, social norms and stereotype, we have researched and learned that they significantly affect African American health. In addition, we meet learn actively since we have received helps from the instructor and librarian when we asked for helps. we complete our final project on time. • Our research project show the second element, think critically, creatively and reflectively, when we apply history or background of social movements and issues to interpret and explain current unequal treatment in American healthcare system now. For instance, racism in healthcare was traced back to the history of capitalism, where American established the social idea of whiteness to enslave African American and took their natural resources. • The third learning outcome, communicate with clarity and originality, is achieved because we are able to use all the concepts that we learned to make a PowerPoint presentation, which shows understanding, coherence and organization. Moreover, we take advantages of internet, and computer as resources to help with the research process, team communication and creating affective presentation. • Last but not least, we meet our fourth outcome, interact with diverse and complex environment, through successful communication with each other. We distribute our own ideas and openly listen to other’s opinion. We respect each other’s difference and always use respect to treat each others. We use peaceful discussion to solve disagreement and avoid sensitive words that may hurt each other’s feeling.

15. References • Barker, M. J. (2011). Racial context, currency and connections: Black doctoral student and white advisor perspectives on cross-race advising. Innovations In Education & Teaching International, 48(4), 387-400. doi:10.1080/14703297.2011.617092 • Bhopal, R. (1998). Spectre of racism in health and health care: Lessons from history and the United States. BMJ: British Medical Journal (International Edition), 316(7149), 1970-197 • Brown, P., & Zavestoski, S. (2004, September 20). Social movements in health: an introduction - Brown - 2004 - Sociology of Health & Illness - Wiley Online Library. Wiley Online Library. Retrieved December 10, 2011, from http://onlinelibrary.wiley.com/doi/10.1111/j.0141-9889.2004.00413.x/fullReuss, A. (2007). Cause of Death: Inequality. Race, class, and gender in the United States: an integrated study (7th ed., p. 387). New York: Worth Publishers. • Carty, D., Kruger, D., Turner, T., Campbell, B., DeLoney, E. E., & Lewis, E. E. (2011). Racism, Health Status, and Birth Outcomes: Results of a Participatory Community-Based Intervention and Health Survey. Journal Of Urban Health, 88(1), 84-97. doi:10.1007/s11524-010-9530-9 • Chavous, T. M., Rivas-Drake, D., Smalls, C., Griffin, T., & Cogburn, C. (2008). Gender Matters, Too: The Influences of School Racial Discrimination and Racial Identity on Academic Engagement Outcomes Among African American Adolescents. Developmental Psychology, 44(3), 637-654. doi:10.1037/0012-1649.44.3.637 • Disparities Solutions Center. (n.d.). Massachusetts General Hospital Home. Retrieved December 12, 2011, from http://www2.massgeneral.org/disparitiessolutions/bkg.html • Frisvold, D., & Golberstein, E. (2011). School quality and the education–health relationship: Evidence from Blacks in segregated schools. Journal Of Health Economics, 30(6), 1232-1245. doi:10.1016/j.jhealeco.2011.08.003 • Hall, B. J. (2005). Among cultures: the challenge of communication (2nd ed.). Belmont, CA: Thomson Wadsworth. • Pager, D., Western, B., & Bonikowski, B. (2009, October 1). Discrimination in a Low-Wage Labor Market: A Field Experiment. National Center for Biotechnology Information. Retrieved December 10, 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915472/ • Peek, M. E., Odoms-Young, A., Quinn, M. T., Gorawara-Bhat, R., Wilson, S. C., & Chin, M. H. (2010, July). Racism in healthcare: Its relationship to shared decision-making and health disparities: A response to Bradby. Social Science & Medicine. pp. 13-17. doi:10.1016/j.socscimed.2010.03.018. • Rothenberg, P. S. (1992). Race, class, and gender in the United States: an integrated study (2nd ed.).  New York: St. Martin's Press.