Race, Poverty, and Health

1. Race, Poverty, and Health Tim Monroe, MD, MPH Forsyth County Health Director

2. Race, Ethnicity & the US Census • Race categories • White • Black • American Indian and Alaska Native • Asian and Pacific Islander • Ethnicity categories • Hispanic • Non-Hispanic

3. Race, Ethnicity, and the NC State Center for Health Statistics • Minority “Non-white” (>80% African American in N.C.) • African- , Asian- , or Native- American • Hispanic and non-Hispanic • White • Hispanic and non-Hispanic

4. Racial Inequities in HealthDisease-Specific Death Rates, 1999-2000 Source: NC SCHS

7. Concentrated Poverty and Health • “the fundamental causes of disease…[are]…those that involve access to the resources necessary to maintain health and avoid disease.” • “race-based residential segregation is a fundamental cause of racial disparities in health, isolating many African-Americans in spatially distinct neighborhoods where their access to the resources necessary to maintain health is limited.” Schultz

8. Racial Disparities in Health Outcomes:Consequences of Public Policy • Effects of race-based concentrated poverty on human health and welfare • Deprivation of beneficial and healthful resources • education, health care, recreation, constructive finance and commerce • Concentration of exposure to negative and harmful influences • harmful illegal marketing; harmful legal marketing; industrial sites and brown fields; freeways

9. Racial Disparities in Health Outcomes:Consequences of Unjust Public Policy • Effects of concentrated poverty on human health and welfare (cont.) • Stresses of living in poverty • Stresses of living with racism • Racial barriers to accessing beneficial resources • Constant pressure of harmful marketeering • Result: excess preventable disease and premature death

17. Race, Poverty, and Health • African Americans are nearly five time more likely to live in poverty than whites • Averaging the annual risk of death over a lifetime, an African-American from Forsyth County is 30% more likely to die in any given year of his/her life that a white person from Forsyth County

18. Health and Diet • African-Americans have higher rates of type II diabetes and cardiovascular disease than the white population • Higher proportionate consumption of healthy fruits and vegetables can prevent morbidity and mortality from heart disease and type II diabetes

19. Diet and Community Resources • Consumption of healthy fruits and vegetables increases substantially with increased residential proximity to full service grocery stores • Full service grocery stores are relatively sparse in racially segregated minority neighborhoods

20. Market Resources and Health • Limited access to full service grocery stores or food markets can be understood as a significant contributor to preventable morbidity and mortality from type II diabetes and cardiovascular disease • Food retail marketing is unlikely to meet the needs of racially segregated minority neighborhoods as a consequence of market forces

21. Planning, Health, and Justice • Need public policy-based mechanisms to assure that a resource (grocery stores) important to the welfare (health) of all residents is provided equitably • The American Planning Association’s Policy Guide on Public Redevelopment identifies “social equity and environmental justice” as critical guiding principles

22. Planning and Justice • Social equity: “the expansion of opportunities for betterment that are available to those communities most in need, creating more choices for those who have few” • A legitimate application of the community planning process is to redress the consequences of injustice that have and continue to adversely impact minority neighborhoods and the welfare of their residents.

23. Race, Poverty, and Health • The 1938 Fair Labor Practices Act established a minimum wage as one component of an effort designed to promote the “maintenance of the minimum standard of living necessary for health, efficiency, and general well-being of workers” • The Federal Poverty Guideline was established in 1965 as a budget necessary to prevent starvation in an emergency or temporary situation

24. Race, Poverty, and Health • The Federal Poverty Guideline (FPG) if $9.30/hour (with health benefits, or $12.00 without health benefits) or $19,350/year for a full-time, year round worker supporting a family of four • The FPG for one adult and one child is $6.26/hour or $13,020/year

25. Race, Poverty, and Health • The Federal Minimum Wage is $5.15/hour or $10,712/year • The N.C. Minimum Wage is $6.15/hour or $12,792/year • The Federal Minimum Wage of $1.60 in 1968 would be worth $8.30 in todays dollars

26. Race, Poverty, and Health • The North Carolina Justice Center (NCJC) established a Living Income Standard which is the income level that would provide for the essential needs to live (housing, food, clothing, child care, transportation, education, health care, and taxes) • At a national level this standard is $18.60/hour or $38,688/year for a family of four • It is estimated that 49% of N.C. Families live below this standard

27. Race, Poverty, and Health • Public Policy and Values: • The American work ethic dictates that individuals sustain their families and themselves with gainful employment; i.e., a personal responsibility • Yet we expect individuals to work for half the income necessary on which to do. • Those living in poverty do not have the same opportunity to be healthy as those with means.

28. Poverty and Access to Health Care • Majority in US believe access to health care to be a right: however, not assured by government • In US, private sector is given first dibs on all profitable aspects of the health care market • Public sector and/or charity are expected to fulfill moral obligation to assure care for all • Public sector will never be given adequate resources to meet the need until we recognize that it is a responsibility of government