The health effects of economic resources (eg, education, employment, and living place) and psychological assets (eg, self-efficacy, perceived control over life, anger control, and emotions) are well-known. This article summarizes the results of a growing body of evidence documenting Blacks’ diminished return, defined as a systematically smaller health gain from economic resources and psychological assets for Blacks in comparison to Whites. Due to structural barriers that Blacks face in their daily lives, the very same resources and assets generate smaller health gain for Blacks compared to Whites. Even in the presence of equal access to resources and assets, such unequal health gain constantly generates a racial health gap between Blacks and Whites in the United States. In this paper, a number of public policies are recommended based on these findings. First and foremost, public policies should not merely focus on equalizing access to resources and assets, but also reduce the societal and structural barriers that hinder Blacks. Policy solutions should aim to reduce various manifestations of structural racism including but not limited to differential pay, residential segregation, lower quality of education, and crime in Black and urban communities. As income was not found to follow the same pattern demonstrated for other resources and assets (ie, income generated similar decline in risk of mortality for Whites and Blacks), policies that enforce equal income and increase minimum wage for marginalized populations are essential. Improving quality of education of youth and employability of young adults will enable Blacks to compete for high paying jobs. Policies that reduce racism and discrimination in the labor market are also needed. Without such policies, it will be very difficult, if not impossible, to eliminate the sustained racial health gap in the United States.

There are persistent and pervasive disparities in the health of Black people compared to non‐Hispanic Whites in the United States. There are many reasons for this gap; this article explores the role of “Blacks’ diminished gain” as a mechanism behind racial health disparities. Diminished gain is a phenomenon wherein the health effects of certain socioeconomic resources and psychological assets are systematically smaller for Blacks compared to Whites. These patterns are robust, with similar findings across different resources, assets, outcomes, settings, cohorts, and age groups. However, the role of diminished gain as a main contributing mechanism to racial health disparities has been historically overlooked. This article reviews the research literature on diminished gain and discusses possible causes for it, such as the societal barriers created by structural racism. Policy solutions that may reduce Blacks’ diminished gain are discussed.

The protective effect of family structure and socioeconomic status (SES) on physical and mental health is well established. There are reports, however, documenting a smaller return of SES among Blacks compared to Whites, also known as Blacks' diminished return. Using a national sample, this study investigated race by gender differences in the effects of family structure and family SES on subsequent body mass index (BMI) over a 15-year period. This 15-year longitudinal study used data from the Fragile Families and Child Wellbeing Study (FFCWS), in-home survey. This study followed 1781 youth from birth to age 15. The sample was composed of White males (n = 241, 13.5%), White females (n = 224, 12.6%), Black males (n = 667, 37.5%), and Black females (n = 649, 36.4%). Family structure and family SES (maternal education and income to need ratio) at birth were the independent variables. BMI at age 15 was the outcome. Race and gender were the moderators. Linear regression models were run in the pooled sample, in addition to race by gender groups. In the pooled sample, married parents, more maternal education, and income to need ratio were all protective against high BMI of youth at 15 years of age. Race interacted with family structure, maternal education, and income to need ratio on BMI, indicating smaller effects for Blacks compared to Whites. Gender did not interact with SES indicators on BMI. Race by gender stratified regressions showed the most consistent associations between family SES and future BMI for White females followed by White males. Family structure, maternal education, and income to need ratio were not associated with lower BMI in Black males or females. The health gain received from family economic resources over time is smaller for male and female Black youth than for male and female White youth. Equalizing access to economic resources may not be enough to eliminate health disparities in obesity. Policies should address qualitative differences in the lives of Whites and Blacks which result in diminished health returns with similar SES resources. Policies should address structural and societal barriers that hold Blacks against translation of their SES resources to health outcomes.

Findings suggest that the intersection of race and gender influences how education is associated with long-term changes in physical and mental health of individuals from baseline to 25 years later. As the shape of the association between education and health depends on the intersection of race and gender, these groups may vary for operant mechanisms by which education operates as a main social determinant of health.

According to the minorities’ diminished returns (MDR) theory, socioeconomic status (SES) indicators such as education attainment have smaller protective effects on health risk behaviors for racial and ethnic minority groups in comparison to the ‘dominant’ social group. However, most studies of MDR theory have been on comparison of Blacks versus Whites. Much less is known about diminished returns of SES in ethnic subpopulations (i.e., Hispanics versus non-Hispanic Whites). To test whether MDR also holds for the social patterning of problematic alcohol use among Hispanic and non-Hispanic Whites, this study investigated ethnic variations in the association between education attainment and alcohol binge drinking frequency in a population-based sample of adults. Los Angeles Family and Neighborhood Survey, 2001, included 907 non-Hispanic White and 2117 Hispanic White adults (≥18 years old). Hispanic ethnicity (moderator), education attainment (independent variable), alcohol binge drinking frequency (dependent variable), and gender, age, immigration status, employment status, self-rated health, and history of depression (confounders) were included in four linear regressions. In the overall sample that included both non-Hispanic and Hispanic Whites, higher education attainment was correlated with lower alcohol binge drinking frequency (b = −0.05, 95% CI = −0.09–−0.02), net of covariates. A significant interaction was found between ethnicity and education attainment (b = 0.09; 95% CI = 0.00–0.17), indicating a stronger protective effect of high education attainment against alcohol binge drinking frequency for non-Hispanic than Hispanic Whites. In ethnic-stratified models, higher level of education attainment was associated with lower binge drinking frequency among non-Hispanic Whites (b = −0.11, 95% CI = −0.19–−0.03), but not among Hispanic Whites (b = −0.01, 95% CI = −0.04–0.03). While, overall, higher education attainment is associated with lower frequency of alcohol binge drinking, this protective effect of education attainment seems to be weaker among Hispanic Whites compared to non-Hispanic Whites, a phenomenon consistent with the MDR theory.

Minorities’ Diminished Return theory suggests that health effects of socioeconomic status (SES) are systemically smaller for racial and ethnic minorities compared to Whites. To test the relevance of Minorities’ Diminished Return theory for youth impulsivity, we investigated Black–White differences in the effects of family SES at birth on subsequent youth impulsivity at age 15. Data came from the Fragile Families and Child Wellbeing Study (FFCWS), 1998–2016, a 15-year longitudinal study of urban families from the birth of their children to age 15. This analysis included 1931 families who were either White (n = 495) or Black (n = 1436). The independent variables of this study were family income, maternal education, and family structure at birth. Youth impulsivity at age 15 was the dependent variable. Gender was the covariate and race was the focal moderator. We ran linear regressions in the overall sample and specific to each race. In the overall sample, higher household income (b = −0.01, 95% CI = −0.01 to 0.00) and maternal education (b = −0.24, 95% CI = −0.44 to −0.04) at birth were associated with lower youth impulsivity at age 15, independent of race, gender, and family structure. A significant interaction was found between race and household income at birth (b = 0.01, 95% CI = 0.00 to 0.02) on subsequent youth impulsivity, which was indicative of a stronger protective effect for Whites compared to Blacks. Blacks’ diminished return exists for the long-term protective effects of family income at birth against subsequent youth impulsivity. The relative disadvantage of Blacks in comparison to Whites is in line with a growing literature showing that Black families gain less from high SES, which is possibly due to the existing structural racism in the US.

Background: Although higher socioeconomic status (SES) indicators such as educational attainment are linked with health behaviors, the Blacks’ Diminished Return theory posits that the protective effects of SES are systemically smaller for Blacks than Whites. Aims: To explore the Black/White differences in the association between education and smoking. Methods: This cross-sectional study used the Health Information National Trends Survey (HINTS) 2017 (n = 3217). HINTS is a national survey of American adults. The current analysis included 2277 adults who were either Whites (n = 1868; 82%) or Blacks (n = 409; 18%). The independent variable was educational attainment, and the dependent variables were ever and current (past 30-day) smoking. Demographic factors (age and gender) were covariates. Race was the focal moderator. Results: In the pooled sample, higher educational attainment was associated with lower odds of ever and current smoking. Race interacted with the effects of higher educational attainment on current smoking, suggesting a stronger protective effect of higher education against current smoking for Whites than Blacks. Race did not interact with the effect of educational attainment on odds of ever smoking. Conclusions: In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks. Smaller protective effects of education on health behaviors may be due to the existing racism across institutions such as the education system and labor market.

BackgroundAlthough the effects of socioeconomic status (SES) on mortality are well established, these effects may vary based on contextual factors such as race and place. Using 25-year follow-up data of a nationally representative sample of adults in the U.S., this study had two aims: (1) to explore separate, additive, and multiplicative effects of race and place (urbanity) on mortality and (2) to test the effects of education and income on all-cause mortality based on race and place.MethodsThe Americans’ Changing Lives (ACL) Study followed Whites and Blacks 25 years and older from 1986 until 2011. The focal predictors were baseline SES (education and income) collected in 1986. The main outcome was time until death due to all causes from 1986 until 2011. Age, gender, behaviors (smoking and exercise), and health (chronic medical conditions, self-rated health, and depressive symptoms) at baseline were potential confounders. A series of survey Cox proportional hazard models were used to test protective effects of education and income on mortality based on race and urbanity.ResultsRace and place had separate but not additive or multiplicative effects on mortality. Higher education and income were protective against all-cause mortality in the pooled sample. Race and urbanity significantly interacted with baseline education but not income on all-cause mortality, suggesting that the protective effect of education but not income depend on race and place. While the protective effect of education were fully explained by baseline health status, the effect of income remained significant beyond health.ConclusionIn the U.S., the health return associated with education depends on race and place. This finding suggests that populations differently benefit from SES resources, particularly education. Differential effect of education on employment and health care may explain the different protective effect of education based on race and place. Findings support the “diminishing returns” hypothesis for Blacks.