Social Determinants of Health

What are people most likely to die from? How are those diseases affected by: --income --education(social class) --where you live How are those diseases affected by: --race

Life Expectancy - Males RankStateYears 1 San Marino80 2 Japan79 9 Canada78 30 Cuba76 White American Male76 35 Chile75 44 Barbados72 57 Bahamas71 75 Jamaica69 Black American Male69 Feb. 23, 2011Black Health Status Professor Vernellia Randall8

Life Expectancy 2008 World Health Organization and 2008 Health, United States Females RankStateYears 1 Japan86 4 Switzerland84 9 Canada83 29 United Kingdom81 White American Female81 33 Cuba80 39 Barbados79 46 Bosnia and Herzegovina78 55 Bahamas77 Black American Female77 Feb. 23, 2011 Black Health Status Professor Vernellia Randall 9

2008 World Health Organization and 2008 Health, United States Infant Mortality Rate (per 1000 live births) Ran kStateRate 1 Iceland2 2 Japan3 17 Switzerland4 27 Cuba5 White American Chile8 58 Barbados11 65 Bahamas13 Black American13.6 Feb. 23, Black Health Status Professor Vernellia Randall

<20K 20-40K 40-80K >80K 40-80K

Distinguishing Race from Class Is Class an Issue? Control for race by comparing people of the same race but different class Poor Blacks have a shorter life expectancy than Middle class Blacks. Is Race an Issue? Control for class by comparing people of the same class but different race Middle Class Blacks have a shorter life expectancy than Middle Class Whites Feb. 23, 2011Black Health Status Professor Vernellia Randall13 Race and class are both issues.

Hypotheses to account for racial differences: 1.It’s genetic—different races have different genetic predispositions to disease 2.It’s an issue of personal responsibility— different races have different habits with respect to smoking, drinking, unprotected sex, overeating, lack of exercise 3.It’s an issue of social inequality—racism both individual and ingrained in the system causes people of color to suffer from more health problems

Consequences of these hypotheses: If it’s genetic—there’s nothing you can do about it. If it’s personal responsibility—then it’s up to individuals to make better decisions about diet, exercise, staying away from high risk behavior. If it’s social inequality—then it is up to all of us to call out this unfairness and put pressure on institutions to change their practices to be more fair.