Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area
Introduction
Differentials in morbidity and mortality between African American and European American women in the United States are persistent and well documented in the social science and epidemiological literatures. African American women experience greater morbidity and mortality at younger ages, and are more likely to experience the death of an infant, than are white women in the same age range (Collins & David 1990; Kreiger, Rowley, Herman, Avery & Phillips, 1993; Geronimus, 1992, Hummer, 1993). These differentials follow general and well-established relationships between socioeconomic position and morbidity and mortality, with lower socioeconomic status consistently related to higher levels of morbidity and mortality (Duleep, 1995, Kaplan et al., 1996, LaVeist, 1996, Lillie-Blanton et al., 1996, Pappas et al., 1993). However, some disparities remain between, as well as within, racial groups after adjusting for socioeconomic status with commonly used indicators such as individual level education or household income (Geronimus et al., 1996, Lillie-Blanton et al., 1996, Polednak, 1993, Williams and Collins, 1995).
Public health researchers have increasingly questioned the utility of race as an explanatory research variable, urging that attention be shifted toward understanding the impact of social and economic divisions of populations based on systems of racial classifications on health (Fullilove, 1998, LaVeist, 1996, Williams, 1997). Women’s experience of these racial classifications may differ from those experienced by men, that is, the forms of discrimination experienced by African American men may differ qualitatively from those experienced by African American women (Collins & David, 1990; Crenshaw, 1993, 1995; Kreiger et al., 1993). Understanding the ways that the particular stressors experienced by women may differ by African American and white racial categories can contribute to an understanding of the pathways through which these differences contribute to racial disparities in health. In this paper we focus on understanding racial differences in subjective experiences of unfair treatment, household income and exposure to acute life events by African American and white women living in the Detroit metropolitan area. We examine the distribution of these experiences and their implications for health across four groups of women: African American women living in an economically marginalized area of Detroit, African American women living in the city of Detroit as a whole, and African American and white women living in Detroit metropolitan area but outside of the city of Detroit.
Section snippets
Stressors and health
The research presented here draws upon a conceptual model of the stress process (Avison and Gotlib, 1994, House, 1981, Israel et al., 1989, Israel and Schurman, 1990, Katz and Kahn, 1978) that identifies the contributions of multiple factors to health outcomes. This model is a comprehensive framework that focuses attention on stressors, conceptualized as “environmental demands (that) tax or exceed the adaptive capacity of an organism resulting in psychological and biological changes that may
Study setting
As one of the most racially segregated cities in the United States (Massey and Denton, 1993, Sugrue, 1996), Detroit offers an important opportunity to examine the combined effects of race-based residential segregation and subjective experiences of discrimination on women’s health.
Over the past four decades, white residents and employers in the Detroit area have increasingly relocated from aging urban industrial areas to the ever-expanding suburban areas. There is evidence that the proportion of
Sample
Data for this study are drawn from two surveys conducted in the Detroit metropolitan area in 1995 and 1996. In 1996 a survey was conducted with 700 women aged 18 and older living in a geographically defined area on the east side of Detroit who care for children under 18 years of age at least five hours a week. This community survey was conducted by the East Side Village Health Worker Partnership under the auspices of the Detroit Community-Academic Urban Research Center (URC) funded by the
Health status
Overall, white women in the sample reported more favorable general health status than did African American women (Table 1). When examined by race and area of residence, the results indicate that African American women, regardless of where they lived, reported significantly poorer health status than white women living outside the city limits (p<0.01). There were not significant differences in self-reported health status between African American women living on the east side, in the city as a
Discussion and limitations
The results reported in this paper generally support the hypothesis that women’s subjective experiences of unfair treatment are associated with racial categories, and that their exposure to the acute life events assessed in this study are associated with both race and with area of residence. African American women report lower mean household incomes at any given level of education than white women, and this effect is exacerbated for African American women who live on the east side of Detroit.
Concluding comments
Despite these limitations, these results contribute to a growing body of evidence that there are multiple pathways through which discrimination influences health. African American women in this study had fewer economic resources at their disposal (both overall, and at any given educational level), reported more frequent experiences with unfair treatment and experienced a greater number of acute life events in the past year than white women. Experiences of unfair treatment and acute life events
Acknowledgements
The authors would like to acknowledge the Butzel Family Center, Detroit Health Department, Kettering Butzel Health Initiative, Mack Alive!, Warren Conner Development Coalition, Henry Ford Health System and Friends of Parkside for their assistance with the implementation of the East Side Detroit survey. We thank Lora Lempert, Debora Paterniti, Pat Smith and Deb Street for comments on earlier versions of this manuscript. In addition, we thank Sue Andersen for her contribution to the development
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