Understanding associations among race, socioeconomic status, and health: Patterns and prospects.

Abstract

Race/ethnicity and socioeconomic status (SES) are social categories that capture differential exposure to conditions of life that have health consequences. Race/ethnicity and SES are linked to each other, but race matters for health even after SES is considered. This commentary considers the complex ways in which race combines with SES to affect health. There is a need for greater attention to understanding how risks and resources in the social environment are systematically patterned by race, ethnicity and SES, and how they combine to influence cardiovascular disease and other health outcomes. Future research needs to examine how the levels, timing and accumulation of institutional and interpersonal racism combine with other toxic exposures, over the life-course, to influence the onset and course of illness. There is also an urgent need for research that seeks to build the science base that will identify the multilevel interventions that are likely to enhance the health of all, even while they improve the health of disadvantaged groups more rapidly than the rest of the population so that inequities in health can be reduced and ultimately eliminated. We also need sustained research attention to identifying how to build the political support to reduce the large shortfalls in health.

Relative Roles of Race Versus Socioeconomic Position in Studies of Health Inequalities: A Matter of Interpretation

“…As we have discussed, racism, rather than race, has been proposed as a more salient quantity of interest in explaining racial health inequities (28,58,59,101,124,125). Racism affects health by structuring the distribution of socioeconomic resources between racial groups, as well as through nonmaterial mechanisms such as psychosocial stress and hence has been proposed as a fundamental cause of health (101).…”

“…In contrast with the historically dominant understanding of race as a biologic category (33), many view race as a social-contextual and relational construct shaped by systems of power and privilege-i.e., racism (59,123,124). The latter emphasizes that racial categories, and the meanings ascribed to them, are socially produced and vary across time and place (59).…”

“…The high degree of confounding between race and SEP has motivated an extensive literature seeking to disentangle these two social determinants of health (79,101,123,124). Studies often statistically adjust for SEP to isolate the unique (i.e., unconfounded) effect of race on a given health outcome (12,20,41,42,50,51,59,64,81,103,112,118).…”

Increasing Disparities in Mortality by Socioeconomic Status

“…Although race/ethnicity and SES are clearly related, much of the research on mortality views them as distinct characteristics because the various SES indicators differ within and among racial and ethnic groups (11,28,50,51).…”

“…Waldron (47) worked with administrative records that contained information on career earnings (average over ages [45][46][47][48][49][50][51][52][53][54][55]) and age at death to measure the widening disparities for men covered by Social Security. Her measure of differential mortality was based on data for the 1912 and 1941 birth cohorts, with an increase of 4.7 years in the differential between the top and bottom half of the earnings distribution between the two birth cohorts.…”