Income, not just race, explains much of the health gap between groups of Americans

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Income, not just race, explains much of the health gap between groups of Americans, and a “health equity impact” statement should accompany government policy proposals, suggests a Harvard professor in the current edition of the prestigious journal Health Affairs.

Conventional wisdom about the gap between the health status of blacks and whites has looked to race as the answer, based on either biological or socioeconomic differences. But Ichiro Kawachi, a professor of social epidemiology, and colleagues say income – or class – is also a determinant of health and should be combined with race when policy makers investigate differences.

Kawachi proposes looking at health disparities as being equally based on class as on race in order to help devise policies to shrink the differences in care because even with no racial discrimination blacks would still fare worse based on their class position.

“Low-income black Americans have more in common – as far as their risk of heart disease is concerned – with low-income white Americans than with middle class or affluent black Americans,” the authors say. Yet the black-white disparity in low birthweight, a major cause of infant mortality, increases with more education (and presumably income) the mother has, leaving race as a possible explanation.

Using both race and class measurements in health analysis “would lead to more lasting and effective approaches to reducing and ultimately eliminating health disparities in this country than concentration on racial inequalities alone,” Kawachi says.

In addition to standardizing the way existing records are kept, the authors urge that new records be accompanied by “health equity impact assessment” to help lawmakers project how new programs would affect both racial and economic disparities in health.

“It is not far-fetched to expect that health equity impact assessments might eventually be applied not only to health-sector policy proposals … but also to other social-sector policies (such as Social Security reform),” they say.

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