Race class health (asthma)

I have a dream that one day children of all nations, races and ethnicities will have the same (low) rates of asthma.

The other day I linked to a new set of tables and charts from the CDC on health disparities. There are great kernels of sociology lessons (and important actual facts) in there. The table on asthma got me thinking about this.

Health disparities tend to follow the lines one would expect – especially race/ethnicity and social class – and some of the mechanisms for that are straightforward, such as access to health care. Race/ethnicity and class often appear independently important, for example in the pattern that Black-White disparities persist even at equal levels of income or health insurance status, even though income also has important effects of its own.

That could be the case with childhood asthma, for example, which is more common among Blacks and Puerto Ricans than among Whites — across income levels — even as the poor of all three groups have higher rates as well.

Childhood asthma is especially an inner-city disease in America today, for reasons that are not completely understood. That is why it’s not surprising to see such high rates among poor Puerto Rican children, who are largely to be found in the big inner cities, such as Chicago and New York. Some likely causes are indoor allergens (e.g., residue from dust mites, mice and cockroaches), diesel exhaust, and second-hand smoke. Other suspects — such as too much hygiene and infection prevention, so that kids don’t develop the right immunities — don’t seem to fit the inner-city pattern.

I previously reported on a paper about the race of place in health care – that is, the apparent effect of the racial composition of one’s neighborhood on health care access, above and beyond individual race and income. The race of place pattern is consistent with the understanding that race/ethnicity and social class represent other, less easily-measured aspects of social life that have vital effects on health — such as the social environment (e.g., noise, exposure to violence, pollutants), childhood experiences (untreated infections), family history, “culture” (such as mistrusting doctors), and social networks (having someone to help out when you’re sick).

Obviously, it would be better if we could measure directly the different elements of the complex web of race and ethnic relations that create something as simple as a “race effect.” In fact, failing to do that contributes misunderstandings and simplifications about race. One thing we now have a growing number of studies on, which race and class may be indicators of, is stress. If there are uniquely stressful aspects to, say, being a Black child, then that would show up in the data as an effect of race. Stress can affect health hormonally, as human bodies irresponsibly flood themselves with prehistoric remedies — mistaking racial discrimination at work (for example), for saber-tooth tiger attacks.

Stress can also work behaviorally. Since “individuals may cope with perceived stress through unhealthy but often pleasurable behaviors” — and unhealthy behaviors, such as smoking and physical inactivity, are more common responses among the poor — we learn that people who report high levels of stress in their lives suffer worse health effects from stress when they are poor.

Research into stress and health is making great strides, especially with the combination of both self-reported stress levels and measured hormone levels. For example, a very recent study of 174 infants showed that those whose mothers had higher stress levels in their third trimesters were more prone to some illnesses, and more likely to take antibiotics, during their first year of life.

The connections between these hormonal effects and behavioral stress responses are naturally hard to sort out, since they go together. But it appears evidence is accumulating that stress contributes to asthma in children. And that might help explain the race/ethnicity and class patterns we see.

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