Civil Rights & Discrimination Law as Health Policy Flashcards
Intersectionality
Multiplicity
E.g., position of black women within an institutional setting diminished on two accounts – black, women
Institutional context important here
‘Structural’ discrimination/racism
Ideological ideas
Not necessarily about individual acts of racism/discrimination – a set of ideological practices have justified the existing structure, which then reproduces itself
Discrimination and health
Stress
Residential segregation
Macro- and micro-segregation
o Macro: less segregation at the level of US states
o Micro: more segregation at the neighborhood level
Doctor-patient interactions
o RCT found black doctors much better at treating black men than white doctors
Criminal justice
Accessibility
o Social model of disability: physical impairments not a disability – the way in which society is constructed disables
Education
o Admission
o Experience
Poverty
o Structural racism –> dispossession, economic exclusion –> poverty
o Inherited/accumulated wealth (see: Thomas Shapiro, “Toxic Inequality”)
- Intergenerational inequality
Stigma
o Collectivizing experience?
De jure vs. de facto discrimination
De jure = laws technically in place
De facto = laws as they exist in practice; lived experiences, prevailing norms/values
Emerging debate around the ability of institutional/formal/de jure mechanisms to effectively legislate against de facto racism/discrimination/inequality
Black maternal and infant mortality: the fatal consequences of social injustice
Government data indicates that this racial disparity in infant mortality rates has far outlasted the legal practice of slavery in the United States, with significantly greater deaths among black infants a reality even in the present day
Black babies remain more than twice as likely as their white counterparts to die within the first year of life, even when adjusting for maternal education and income level; in fact, as reported by the Centers for Disease Control and Prevention, a black woman in the United States with an advanced/professional degree faces a higher probability of losing her infant than does a white woman who possesses an eighth-grade education or less (Matthew, Rodrigue, and Reeves, 2016; Reeves and Matthew, 2016)
Maternal mortality also disproportionately affects black women, perhaps to an even greater extent than infant mortality—between the years 2011 and 2013, pregnancy-related mortality ratios for non-Hispanic black women in the U.S. exceeded those of non-Hispanic white women by a factor of 3.4, with similar trends evident in the period 2006-2010 (Creanga et al., 2017)
Particularly in the context of the United States, the medical establishment finds itself increasingly forced to confront the fact that the fundamental underpinnings of this black-white divide arise from social rather than genetic inequities, with the prevailing theory now being that the societal and systemic racism which so thoroughly permeates life as a black woman in America leads to acute physiological stress, which in turn manifests as the conditions (such as pre-eclampsia and gestational hypertension) that ultimately result in heightened rates of infant and maternal mortality for the group in question
Representative of the consensus forged by the field at large in recent years, Richard David and James Collins conclude that “[o]verall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms” (David and Collins, 2007)
Social injustice = “the denial or violation of economic, sociocultural, political, civil, or human rights of specific populations or groups in the society based on the perception of their inferiority by those with more power or influence” (Levy and Sidel, 2006)
o Insofar as public health is concerned, Levy and Sidel define inequity—injustice—as occurring in the presence of “systematic disparities in health (or in the major social determinants of health) between social groups that have different levels of underlying social advantage or disadvantage—that is, different positions in a social hierarchy”
The last decade of the twentieth century saw the publication of studies that challenged or directly contradicted the risk factors traditionally thought responsible for the worsened neonatal outcomes of black babies relative to their white counterparts; namely, poverty and lack of education
o Researchers found that even middle-class, educated black women carried a higher relative risk of giving birth to smaller, premature babies who were less likely to survive, a finding which served to cast significant doubt upon the commonly accepted theory that greater risk of poverty, combined with reduced likelihood of having completed education before bearing children, can account for much of the considerably higher rates of mortality among infants born to black women (Collins and David, 1990)
o Continued research into the potential causes of the relatively poor pregnancy outcomes experienced by this group eventually gave rise to a new dominant narrative—that cumulative exposure to racism and racial discrimination throughout the course of a black woman’s lifetime represents an independent risk factor for preterm delivery and low birthweight, which in turn increases the probability of infant mortality by a large margin (Collins et al., 2004; Mustillo et al., 2004)
Moreover, research suggests that stress-induced “weathering” may actually cause accelerated aging in black women at the molecular level, which, given that maternal age serves as a significant risk factor for a variety of potentially fatal complications associated with pregnancy (e.g., pre-eclampsia and gestational hypertension), means black women likely experience the physical toll of high-risk pregnancies at an earlier age than do white women (Geronimus et al., 2010)
Systemic racism also pervades the physical environments in which black women are likely to give birth, with the enduring realities of past segregation policies still evident in the poor maternal mortality outcomes of high black-serving hospitals (Howell et al., 2015)
SIMPLY DOWN TO ‘GEOGRAPHIC ANCESTRY AND GENETICS’?
Perhaps the rival explanation most commonly offered for the disproportionately high rates of infant and maternal mortality witnessed among African Americans invokes alleged differences in genetic predispositions to various health-related conditions, with one’s race effectively treated as “a proxy for geographic ancestry and genetics” (David and Collins, 2007)
If genetic composition did in fact prove to be the driving force behind racial variations in infant and maternal outcomes, then any claim of social injustice would become much more tenuous, since no “denial or violation of economic, sociocultural, political, civil, or human rights” (Levy and Sidel, 2006) would be occurring, and there would arguably exist no “systematic disparities in health…between social groups [emphasis added]”, at least insofar as we understand ‘systematic’ to refer to the operations of social institutions
However, should we proceed under the assumption that genes and ancestry are primarily responsible for disparities in birth outcomes, then would we expect birthweight patterns of African immigrants to the United States to be comparable to those of native-born black Americans—this is not the case:
o Comparing the birth-weights of US-born white women, US-born black women, and African-born black women over a period of 15 years, David and Collins (2007) find that “[t]he overall birth-weight distributions for infants of US-born White women and African-born women were almost identical, with US-born Black women’s infants comprising a distinctly different population, weighing hundreds of grams less”
o Thus, David determined “there was something about growing up black in the United States and then bearing a child that was associated with lower birth weight” (as cited in Chatterjee and Davis, 2017)
