Even as Black Americans Get Richer, Their Health Outcomes Remain Poor

Quality of medical care and mortality are frequently linked to socioeconomic success. But for African Americans, that's often not the case.
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One of the prevailing views on the disparities between whites and blacks in terms of medical care and mortality is that people of color suffer from worse health outcomes solely due to a lack of financial resources. It is true that low education and socioeconomic status are often associated with worse health outcomes, and the correlation is quite high. Additionally, people of color are substantially more likely to reside in areas with low economic opportunity, and are also significantly more likely than their white counterparts to be in a position where they lack adequate health coverage and mental-health care.

However, this data has been used only to equate the disparities of struggle and poverty between varying ethnic groups. The resulting logic is that, by targeting income inequality, we can directly solve racism. But the large number of black Americans who don't struggle from economic inequality? They're facing worsened health outcomes too.

Income inequality is not the end-all-be-all of issues experienced by black Americans, yet is often implied to be the case. Believing black American struggles are solely rooted in financial security overlooks the effects that racism has on the physical and mental health of people of color in the United States. Centering the conversation around financial issues also ignores data that relates to the physical and mental health of black Americans with high economic and educational success.

The exact reasons for why educated black Americans with high earnings are still suffering from worsened outcomes aren't fully known, but researchers at Ohio State University are making significant progress in demystifying why. In a recently released study, they look at racial disparities in non-poor African Americans and Hispanics, and analyzed the effects that chronic and widespread discrimination and misinformation has on health outcomes.

"I've had this long-standing theory that members of underrepresented racial minorities would have fewer health returns from upward mobility," says study co-author Cynthia Colen, an associate professor at Ohio State University.

Colen also wanted to dispel the prevailing narrative that poverty is at the root of black Americans' experiences, in health care and beyond. "Upward mobility is certainly better than the alternative," she says, "but it doesn't make everything better—particularly health outcomes."

Colen used decades of research focused on the experiences of middle-class black Americans. According to her data, more money isn't enough to rid black Americans of higher rates of chronic disease or shorter life expectancy. Black women with a graduate education are still at higher risk for pre-term birth and infant and maternal mortality than white women with high school educations. Black women with a Ph.D. and high take-home pay are also more likely than white women who have only a high school diploma to die from birth-related complications.

That finding flies in the face of the assumption by many that racial health disparities are rooted in issues of education and wages. "[When] we talk about racial disparities in health our knee-jerk reaction is to say, 'It's due to exposure to poverty, or exposure to poor neighborhoods, or going to underperforming schools, or not having access to healthy food options,'" Colen says. "Much of the research that I've been doing is aimed at picking that apart. Even among these non-poor populations, you still see racial disparities."

A driving factor is that race uniquely affects life experiences. And for upwardly mobile black Americans, those effects can take a heavy toll on their physical and mental health.

Colen has two theories behind the worsened outcomes: First, that there are increased opportunities for exposure to discrimination that come with moving to mostly white schools or neighborhoods; and, second, that there are prolonged effects of stress from tokenism—that is, when an individual is expected to speak for their entire community. As black Americans climb the corporate ladder, they often find themselves more likely to be tokenized.

Kenesha (not her real name) experienced just that when her family moved to a prosperous yet very white neighborhood in a suburb of Atlanta, Georgia. She was often the only black woman anywhere she went. During those years, the family experienced a host of assumptions, unwarranted police stops, and, often, social exile. She says her workplace experiences were no better. Her interaction with co-workers ranged from being called the wrong name to invasions of personal space.

"At work, as one of three black women in the finance department, I was subject to my own micro-aggressions, like being called the name of the other black woman who worked in HR because our names 'sounded alike.' Yet, we looked nothing alike, nor did we work in the same department," she says.

Co-workers have also touched her natural hair, commenting that it didn't feel as they had expected.

Outside of the office, Kenesha was often assumed to be a teenage mother and received shocked reactions when others found she and her husband weren't struggling financially. Other experiences were much scarier—like the time a driver in a car emblazoned with a Confederate flag pulled up next to Kenesha at a red light to wave a smaller mini Confederate flag out the window at her. Kenesha had no choice but to sit there until the light turned green.

It wasn't long before Kenesha and her husband noticed how these experiences were starting to affect their children's social development.

"The thing that hurt the most was that those that were in our same socioeconomic class would be 'nice' on the outside, but we were still not accepted into their social group. Birthday party invites for our children weren't reciprocated, and no one but parents of other minority children would extend playdate invites," she says. "This was a big problem because our children were often the only black children in their class, [and] they weren't getting the same childhood experience as their white peers."

Ultimately, the family decided to leave the neighborhood to move to a location where they could raise their sons and develop social connections without fear.

Kenesha's story isn't a rare one.

Other upwardly mobile black Americans often report similar experiences.

Prolonged exposure to racism reduces comfort and feelings of safety, meaning adverse health outcomes are not solely tied to class. Yes, rising to the middle class or higher as a black person is difficult. But Colen's work invalidates the bootstrapping myth that brings up the harmful rhetoric behind African-American struggle. No amount of hard work and economic mobility can alleviate racism.

This type of data is vital to improving future health initiatives—by examining both the nuances in the disparities between race, and why those disparities exist, researchers can make demonstrable steps in addressing the root of these issues. It also reminds policymakers of the importance of tailoring projects to focus on the often overlooked black middle class.

"Too often what happens when we are designing these prevention programs and policies is we completely ignore the needs of non-poor racial and ethnic minorities," Colen says. "[These disparities] are not going to go away simply by anti-poverty campaigns."