Disparities in Health and Hope

Jason PurnellJason Purnell, PhD, assistant professor at the Brown School

Months before the eyes of the world were fixed on St. Louis, seven African-American scholars from Washington University and St. Louis University embarked on a project to report on the health and well-being of African-Americans in the region. The project, titled “For the Sake of All,” had four major goals:

• To inform the public about what are called the “social determinants of health,” factors like education, employment and housing that have a more significant impact on health than many realize;

• To present the regional economic and health consequences of intervening — or failing to intervene — on these social determinants;

• To provide evidence of the impact of persistent disparities on all members of the region, regardless of race or social class; and

• To influence the policy agenda on health disparities by broadening the conversation beyond personal responsibility and the delivery of medical care alone.

We reported that social and economic factors were strongly linked to health outcomes like disease, disability and death, and that addressing these factors is the most powerful means of tackling differences in health. We also noted that historical trends, including long-standing gaps in educational attainment, poverty and unemployment, help to explain racial differences in health and well-being in St. Louis. Among these factors, we highlighted education as one of the strongest and most consistent predictors of later health and described the unequal distribution of educational opportunities for African-American students in our region.

We found that social and economic patterns provided crucial context for understanding why African-Americans are more likely than whites to experience chronic disease, violence and injury, emergency mental health treatment and hospitalization, sexually transmitted disease, adverse pregnancy and birth-related outcomes, and risk factors for diseases like obesity and high blood pressure. Given that behaviors like maintaining a healthy diet and exercising are so important for preventing disease and prolonging life, we pointed to the lack of resources and amenities in neighborhoods where many African-Americans live, which makes engaging in health-promoting behaviors much more difficult. And on page 4 of the report we released on May 30, we wrote: “We cannot afford to continue like this.”

We had no idea how timely that sentiment and the release of our findings would prove to be. In the days following the fatal shooting of Michael Brown and the ensuing turmoil in Ferguson, there has been great interest in “For the Sake of All.” People in St. Louis and around the world are using the final report to explore racial disparities in the St. Louis region that may help to explain the origins of the current crisis. In particular, they are noting the large gaps in life expectancy between areas of our region separated by only a few miles. They might also note the hundreds of deaths each year that we estimate to be associated with factors like poverty and low levels of education and the considerable human and economic toll of this loss of life. This search for answers within our briefs and final report is entirely appropriate, but our goal was always to raise awareness about problems while pointing to solutions.

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