Unequal Gain of Equal Resources across Racial Groups

Abstract

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.

History of Non-Fatal Physical Assault Is Associated with Premature Mortality for Whites but Not Blacks

“…Our finding regarding larger effects of history of non-fatal physical assault on risk of mortality in Whites compared to Blacks agrees with other research showing risk and protective factors have stronger effects for Whites than Blacks [20,55], a pattern which is frequently shown for physical and mental health outcomes ( [9,[11][12][13][14][15][16][17][18][19][56][57][58][59][60][61]; see References [20,55] for a review). Stronger effects of low education [17], unemployment [12], poor neighborhood quality [11], depression [16,18,19,62,63], hostility and anger [64], low sense of self efficacy [14], and low perception of control over life [65] were shown for Whites than Blacks.…”

“…In contrast, we argue that cumulative exposure to social stressors generates a systematic resilience, not susceptibility, among Blacks. This is in line with research showing stronger links between stressful life events and health problems for Whites compared to Blacks [20,54]. Habituation may allow Blacks to better cope with additional stressors when needed [54].…”

“…Similarly, we still advocate for provision of healthcare for Blacks who experience trauma and assault. At the same time, public health officials and policy makers should be aware that there might be racial differences in resilience and vulnerability to social stressors [20]; thus, racial groups' health status may respond differently to social policies and programs that reduce exposures. Policies and programs that enhance safety and prevent assault would generate weaker health returns in the Black communities compared to high-socioeconomic, predominantly White neighborhoods.…”

“…Considering the literature on racial differences in exposure to physical assault [2][3][4] as well as racial differences in health effects of social adversities [20,21], this study compared Blacks and Whites for the association between history of non-fatal physical assault and long-term risk of mortality using a nationally representative sample of adults in the United States (US).…”

Educational Attainment Better Reduces Disability for Non-Hispanic than Hispanic Americans

“…The effects of SES on morbidity, CMCs, and disability are also shown to vary between sub-populations [14,15]. According to the Minorities' Diminished Returns (MDRs) [17,18], however, the health of members of marginalized groups [19] is not heavily influenced by SES indicators, particularly educational attainment. Most studies have compared African-American and White individuals, with less research having been conducted on differential health effects of educational attainment for other ethnicities [11,19,20].…”