RACE AS MYTH AND REALITY
Although it is viewed as a social and political construct, Smedley and Smedley (2005) argue that the effects of race are nonetheless very real in American society and for some population groups may extend over the entire life cycle, from the “cradle to the grave.” According to data from the Office of Minority Health, African Americans are almost four times as likely to die as infants due to complications related to low birth weight compared to non-Hispanic white infants. Further, the rates for all major causes of death are higher for African Americans than for whites; this discrepancy accounts in part for the lower life expectancy for African American men and women (U.S. Department of Health & Human Services, 2013). The contributing authors present a more detailed statistical description of the disparate outcomes for various populations under discussion, and as they appear across various fields of practice in the health and human services.
THE INTERSECTION OF RACE, CLASS, AND POVERTY
Racial and ethnic disparities are explained in part because of the disproportionate representation of people of color among the poor, which place them at greater risk for being impacted by the far-ranging consequences of poverty. African Americans and Hispanics are four times more likely to live in poverty than whites, are disproportionately impacted by social problems of concern to health and human service providers, and consequently have high visibility on the caseloads of practitioners in the helping professions. Children of color have historically been and continue to be the most disadvantaged age population of Americans. Findings from a recent report of the Citizens Committee on Children, an advocacy organization that tracks well-being outcomes for children in New York City, were not significantly different from the statistical picture of child well-being outcomes in urban communities across the country. According to this report's analysis of changing geographic patterns of poverty, more than 298,000 New Yorkers citywide are living in concentrated poverty. This number includes an estimated 124,000, or 1 in every 10 children, who are living in neighborhoods where the poverty rates exceed 40% and in which the majority of the population is black and Hispanic (Citizens Committee for Children, 2012).
While socioeconomic status plays an undisputable role in shaping the life course of individuals and provides an explanation of racial and ethnic disparities, it does not tell the full story. African Americans of all socioeconomic groups are found to be especially vulnerable to the adverse effects of race-based discrimination in health and human services systems that may be either real or perceived. They are also found to harbor feelings of mistrust of the health system based on ethical transgressions by the medical field in the interest of scientific discovery. The most blatant of these transgressions, which continues to fuel mistrust of the system among blacks, is the Tuskegee Study conducted by the U.S. Office of Public Health between 1932 and 1972. The study, which is common knowledge among blacks, involved 600 uneducated tenant farmers who were either infected or not infected with syphilis. The infected men were not told they had the disease, and during the study treatment was withheld from those infected, even though it became known that penicillin was an effective cure.
Unsurprisingly, cultural mistrust is identified as an important consideration for understanding service-using behaviors and in the diagnosis and treatment of African Americans (Snowden, 2001; U.S. Department of Health & Human Services, 2001). One of the social determinants accounting for the fact that African American women are more likely to die from breast cancer than all other women is their lack of trust in the health care system (Gerend & Pai, 2008). Increasing attention is being given to the adverse effects of perceived discrimination and racism on health and mental health outcomes for African Americans when controlling for socioeconomic status.
A meta-analytic review of the research conducted by Pieterse and colleagues (2012) on the mental health of African Americans found a relationship between perceived racism and adverse psychological outcomes, expressed as increased levels of anxiety, depression, and other psychiatric symptoms. Pascoe and Smart Richman(2009) made similar findings, concluding that the multiple forms of perceived discrimination have a significant negative effect on both physical and psychological health and also produce high levels of stress that are associated with unhealthy behaviors. Similarly, a study conducted by Franklin-Jackson and Carter (2007) found that race-related stress has implication for mental health and for the development of a positive racial identity for black Americans.
The negative impact of racism has been found to begin as early as the womb and to play a role in adverse outcomes for the infants of African American women. For example, African American infants are found to be at greater risk for low birth weight, which is a significant predictor of poor outcomes in early and later childhood. Giscombe and Lobel (2005) examined five explanations for the adverse birth outcomes among African American women that included the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; all were found to be contributing factors to adverse outcomes.
Focusing on children and youth growing up in poverty, Abramowitz and Mingus in Chapter 14 examine the detrimental impacts of race-based discrimination on schoolchildren that they argue contribute to a predictable school-to- prison pipeline. Research findings also indicate that schoolchildren, irrespective of their socioeconomic status, are equally impacted by the adverse effects of perceived racism or race-based discrimination. A study of ethnically and socioeconomically diverse elementary school-age children found that they developed an awareness of racial differences and stereotypes very early, and these perceptions impacted their responses to a variety of situations, including social relationships and test taking. Similar findings were noted in the comprehensive report of the Presidential Task Force of the American Psychological Association on Educational Disparities (2012). Beyond the reporting of well-documented gaps in the academic performance of African American, Hispanic, and some Asian populations in comparison to their white counterparts, the study identified the complex connection between racial identity and academic adjustment. Findings indicate that disparities in educational outcomes are associated with a variety of variables that included the awareness on the part of children and adolescents of discrimination and their stigmatized racial status. Other findings highlighted the complex connections between ethnic and racial identity and academic adjustment.