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Report on the Regression Analysis of Asthma Hospitalization Rates and Proximity to Major Air Pollution Sources. Bronx, N.Y.: Albert Einstein College of Medicine, 2006. c05.indd 126c05.indd 126 6/5/09 2:12:49 PM6/5/09 2:12:49 PM CHAPTER 6 RACIAL INEQUALITY IN HEALTH AND THE POLICY - INDUCED BREAKDOWN OF AFRICAN AMERICAN COMMUNITIES ARLINE T. GERONIMUS, J. PHILLIP THOMPSON LEARNING OBJECTIVES ■ Describe how prevailing ideological viewpoints on black health (mis)interpret black behavior. ■ Describe the biological and social pathways by which racial ideologies and poli- cies may undermine the health of African American populations. c06.indd 127c06.indd 127 6/5/09 2:14:12 PM6/5/09 2:14:12 PM 128 Racial Inequality in Health ■ Present policy alternatives that could help to overcome some of the detrimental impact of racialized ideologies and policies and thereby help to promote the health of African Americans and reduce black/white inequalities in health. ■ Discuss the role that democratic movements can play in addressing the detrimental impact of racialized ideologies and creating policies that support health. INTRODUCTION Young through middle - aged adults in high - poverty urban African American populations have a high probability of dying or becoming disabled long before they are old. 1 , 2 Figure 6.1 shows that in Harlem or Chicago ’ s South Side, one - third of African American girls and two - thirds of boys who reach their fi fteenth birthdays do not live to celebrate their sixty - fi fth. In contrast, only 10 percent of girls and about 25 percent of boys nation wide fail to live to age sixty - fi ve. Indeed, African American youth in some urban areas face lower prob- abilities of surviving to age forty - fi ve than white youth nationwide do of surviving to old age. 2 , 3 Stress - related chronic diseases are the primary reasons for this excess mortality in urban African American populations, 3 , 4 and evidence indicates that their nega- tive impact on life expectancy may be growing. For example, excess deaths attributed to circulatory disease or cancer each doubled among young and middle - aged men in Harlem from 1980 to 1990. 4 In contrast, the more publicized homicide rates began to decline. As a general rule, racial differences in health tend to widen after age twenty - fi ve and become most pronounced among those aged thirty - fi ve to sixty - four. 5 – 9 Although racial differentials in infant health are also stark, they often refl ect differences in the health of reproductive - age women, 10 substantial percent- ages of whom already suffer from stress - related diseases that can complicate pregnancies. 1 African American men and women in high - poverty urban areas also have rates of health - induced disabilities at ages thirty - fi ve and fi fty - fi ve that are comparable to the national averages for fi fty - fi ve- and seventy - fi ve - year - olds, respectively. 2 These dis- abilities in young and middle adulthood limit capacity to work, often necessitate caregiving, and lead to premature death. Rates of death or disability are shown in Figure 6.2 , illustrating stunning inequalities between African American residents of Note: An earlier, longer version of this chapter appeared in the DuBois Review, 1 (2004): 247–279. Epigraph. Reprinted with the permission of Cambridge University Press. The greatest danger lies not in the so - called “ problems ” of race, but rather in the integrity of national thinking and in the ethics of national con- duct. — W.E.B. D U BOIS. c06.indd 128c06.indd 128 6/5/09 2:14:12 PM6/5/09 2:14:12 PM Introduction 129 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 25 30 35 40 45 50 Age Probability of dying by various ages in selected populations, men, 1990 Probability of dying by various ages in selected populations, women, 1990 55 60 65 70 25 30 35 40 45 50 Age 55 60 65 70 U.S. Whites U.S. Blacks Harlem Chicago (a) (b) FIGURE 6.1 Mortality Calculations Based on the 1990 U.S. Census and Death Certifi cates for 1989–1991 Note: In the these graphs, Harlem comprises African American residents of the Central Harlem Health Center District in New York City; Chicago comprises African American residents of the South Side community areas of Near South Side, Douglas, Oakland, Fuller Park, Grand Boulevard, and Washington Park in Chicago, Illinois. Harlem or Chicago ’ s South Side and whites or blacks nationwide. Only 30 percent of teenage girls and 20 percent of teenage boys residing in these urban areas can expect to be alive and able - bodied at age sixty - fi ve. Reducing the size of these and other racial inequalities in health has been a high - priority, national public health policy objective for more than two decades. Yet racial c06.indd 129c06.indd 129 6/5/09 2:14:12 PM6/5/09 2:14:12 PM 130 Racial Inequality in Health 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 25 30 35 40 45 50 Age 55 60 65 70 (a) 1.00 Predicted probability of death or disability by age in selected populations, men, 1990 Predicted probability of death or disability by age in selected populations, women, 1990 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 25 30 35 40 45 50 Age 55 60 65 70 (b) U.S. Whites U.S. Blacks Harlem Chicago FIGURE 6.2 Mortality Calculations as in Figure 6.1 Note: Disability calculations are based on 1990 U.S. Census data, using public use microdata areas (PUMAs) that most closely approximate mortality areas for Central Harlem Health Center District in New York City and Chicago’s South Side community areas of Near South Side, Douglas, Oakland, Fuller Park, Grand Boulevard, and Washington Park in Chicago, Illinois. disparities in important health indicators have persisted and, in some cases, grown. 11 This is true even for some health disparities that have been energetically targeted for reduction, such as infant mortality rates. This failure is notable and, we argue, a major indictment of public policies aimed at African American communities. In this chapter, we examine the causes and consequences of inequities in health between African c06.indd 130c06.indd 130 6/5/09 2:14:13 PM6/5/09 2:14:13 PM . community - based participatory research. Community - based participatory research: Conference summary. Agency for Healthcare Research and Quality, Conference on Community - Based Participatory Research, . high - poverty urban areas also have rates of health - induced disabilities at ages thirty - fi ve and fi fty - fi ve that are comparable to the national averages for fi fty - fi ve- and seventy -. Parker, E. A., and Becker, A. B. Community - based par- ticipatory research: Engaging communities as partners in health research. Talk given at the annual conference of Community - Campus Partnerships