Discuss About The Impact Of Social Determinants On African- Americans In US?
Health is determined by varied factors in an individual in which social (population) determinants are of greater importance because of its direct effect on the people as well as country’s development. The importance of societal- determinants of Health was proposed by Healthy People (2020 AD) in its guidelines by involving ‘develop societal with physical environmental conditions to enhance health for all people’ as one of its goals (NHMDP, 2011). These social- determinants comprises of the living- conditions where an individual has born, currently lives, grows, learns, works, plays and ages. These determinants are affected by man, money, and materialistic resources as well as its distribution at localized, nationalized and internationalized levels. The alterations in its distribution may lead to inequality, gap with inequity in health- care which is unfair but is avoidable.
In 2008, the Commission of WHO on societal- determinants has released a report as ‘closing the gap (inequity) in the generations: to enhance health-equity by controlling the societal- determinants’. This is also supported by the National- collaborations (partnerships) for Action to remove health- disparity (2011) as well as National- prevention with health- promotional strategies (2011). The UDHR definition also addresses the importance of social determinants in improving health- outcomes and also specifies that health as well as societal security is fundamental human- right. The developed nations are very worse than poorer nations in developing societal health (Wilkinson, 2010). In 2008, Ramirez states that health- inequalities are large and persistent in United States. He adds that societal factors such as illiteracy, poverty, unequal economic status and racist discrimination, poor housing facilities and gender- discrimination leads to inequality and can minimize the participation of community in health- care. As per WHO’s statement, health involves physical, emotional as well as societal wellbeing with the attainment of fullest health- standards, which is a basic fundamental right of each and every individuals without discrimination of racism, caste, religion, political aspects, societal and economical conditions. Hence, in this essay, racism (societal- determinants- of- health) is selected to show its impact on African Americans.
Racism is found to play a greater role in acquiring the physical and psychological issues in African- Americans. This racial discrimination brings a feeling of inferiority or superiority among people and results in hatred of a person on other person based on their color, spoken language, beliefs, customs, birth place and traditional values. In regard to United States Census (2015), nearly 14.8% of the United States population is only Blacks but they have higher mortality rates as compared to other groups with New Jersey as the most racial place (Heinze, 2015, Carrillo, 2016). The PLOS ONE Journal has also published that Northern New Jersey is more racist than its southern part. In the past 15 years many researches were conducted in regard to impact of racist discrimination on health of African- Americans. Over hundreds of studies were published showing the dangerous effect of racism on the men, women and children of African- Americans. They provide several disturbing findings with one result as provision of inferior health-care to Blacks. In United States, racism not only affects the physical and psychological health but also the societal, economical as well as cultural health of a person.
Racist discrimination severely affects the physical health of African- Americans including children. It was found that the mortality with morbidity rates (due to heart diseases, stroke, cancer, diabetes mellitus, increased blood pressure, etc) of African- Americans is significantly higher as compared to others (Heinze, 2015). The life expectancy of Caucasian population was found to be 5 and half times more than that of blacks and the deaths due to chronic disorders were found to be 31% more in Blacks than that of Whites. TheGrio’s publication of Sander’s essay- 2014 (a story of a Black police officer) has also mentioned the localized issues encountered by him because of his black race, which has affected his physical with societal health adversely (Carrillo, 2016). Even racial- discrimination strongly affects the mental health of African- Americans. Pieterse (2012) has conducted a review about the psychological- health of Blacks (African- Americans) and concluded that racism is strongly related to the psychological- health and also causes increased anxious, depressive and other mental- related features. In 2009, Pascoe also suggested that the racial discrimination brings negative effect on both physical- and psychological- health which again brings negativity about self. This negative image starts from mother’s womb affecting the psychological- health of the newborns adversely.
Racism affects the societal and cultural health of African- Americans. When societal- constructionist theory is applied to racial- politics in United States, the preference to color of skin and physical appearance is used as a criterion for assigning people to racial groups (Figure:1). This was found as a main mechanism for unequal distribution of resources. The Blacks Americans were noted to be four times poorer than White Americans that again contributes to racism. Sometimes, cultural mistrust is found to be a significant factor in African- Americans who may not understand the need for particular investigations and management modality (Department of health with human- services of United States, 2001) and most of the women of African- Americans were found to die because of breast cancer as compared to White American women, which might be because of cultural mistrust (Gerendi, 2008).
Racism also affects the legalized structure, societal and behavioral aspect, humanity and culture of United States. They encounter direct, indirect or institutional discrimination wherever they go (Sue, 2010). Even if equal rules are drawn, this may favor superior race than other races (National- research council, 2004). This discrimination has also lead to wars, robberies, slaveries and legalized codes causing disempowerment in Blacks by underestimating their human identity.
Racism affects the economic health of African- Americans and pushes them under other races resulting in physical and psychological ill-health. Racism has a great impact on the car sales, insurance, home- mortgages, medical care, employment (Figure:1, Pager, 2007), housing aspects and even in getting taxis. Roscigno (2007) has analyzed serious claims and found that the discrimination ranges from harassment to exclusion. A report by New Jersey Citizen Action (2005) states that the car dealers has got $339 from blacks (more than whites) from 1993- 2000 (Pager et al, 2008). In 2005, Harris has analyzed the court cases filed for consumer discrimination from 1990 – 2002 and found that needed goods and services were denied for blacks and Hispanics (such as prolonged waiting time, higher prices, verbal and physical attacks). A study conducted by Williams (2005) implies that there is great variability in lending loans and there is deregulation in banking industry for Blacks and even the subprime lenders stated that the African- American’s applicants has to pay higher rates, bank fees with closing- balance costs. Tomaskovic (2005) has suggested that African- Americans spend much time in searching for job than other races and even their residential makeup is different from Whites. The US, Department of housing with urban- development has audited American’s houses to measure the discrimination in housing against blacks, Asians, Latinos and Native Americans and found that 1 in 5 Blacks and 1 in 4 Hispanics has experienced adverse treatment during house search (Turner, 2003). These discriminations make them weak both economically as well as physically.
By analyzing the impact of racism- (societal- determinant- of- Health), it is clear that racial discrimination brings inequities and inequalities in health- care among African- Americans leading to severe consequences. Even though there are greater advancements in science and technology, these racial and ethnical discriminations were left deep into the minds of people and are highly reluctant to change this attitude and indulge the feeling of one. This decimation has to be eradicated step- by- step from international aspects to national and local levels.
Basically, the country’s initiatives taken to reduce the racial discriminations could be more effective only when they are proposed with strict rules. In-order to reduce the racial discrimination, UNESCO has marked 21st March of every year as International- Day for the eradication (elimination) of racial- disparities. It was developed in memory of the adverse events that took place on 21st March, 1960 in South Africa (Sharpeville) during which the police have killed the demonstrators those who were protesting against a particular apartheid regime. United Nations has developed the first international human- rights related instrument named the Universal- Declarations of human- rights (UDHR) that was taken legally by the United- Nation’s (UN) general assembly (1948) (UN- platform, 2015). The UDHR states that all the people should be treated with respect and dignity with economic and social rights (including educational rights) and cultural and political rights in participating election and civil liberty. It also indicated that all the people should have equal right with on discrimination of race, color, gender, spoken language, religious aspect, political related aspects and other thoughts, national or societal origin, personal property, place of birth and other status. The first Health- disparities & inequalities report (CHDIR, 2011), that was released by CDC (the centre for disease- control with prevention) stated that a notable progress is noted in reducing the gap. By reducing this gap, African- Americans will definitely attain their physical, emotional, societal, cultural and economical health.
World Health Organization has taken initiatives to handle the issues in health- inequalities and inequities that arise because of social-determinant of health. It adds that all the Governments are responsible for their people’s health that could be fulfilled only through the implementation of adequate health with societal means (UN- platform, 2015). Improper functioning of health- care systems could be a barrier to health- care and inadequate addressing of racism (societal- determinants) can hold back or reduce the progress of US on globalized health & developmental goals. In 2015, the global agenda addresses the connectedness between societal policies with health in various sectors that was stated by the Rio- political declarations on societal- determinants. It has given action- plans to tackle health- inequities as to adopt an improved governance of health with development, promote community- participation in policy developing with implementing processes, reorient the health- care system so as to promote health and minimize health- disparities, strengthen global collaboration with governance and promote accountability and assess health- care progress (Figure:1, WHO, 2016). The implementation of these policies and promoting accessibility to healthy foods, safer water, adequate housing with supporting networks will enhance the health- outcome of US. The health outcomes may not be achieved by just driving action into health- sectors alone but also should indulge actions in other sectors, which in-turn improves health- outcomes that contribute to attaining goals of other sectors. For ex: the healthiest population will improve the overall productivity in economy, promotes employment opportunities that help to minimize poverty as well as improves school attendance. Hence, if racism (societal- determinants- of- health) is controlled, it will not only promote the health of the Nation but also the wealth of the Nation.
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