Social Determinants of Health Among African-American Men

Henrie M. Treadwell, Clare Xanthos, Kisha B. Holden

• Publisher: Jossey-Bass
• Year: 2012
• ISBN:
  9781118235188
• Edition: 2
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This groundbreaking book applies the concept of social determinants of health to the health of African- American men.While there have been significant efforts in recent years to eliminate health disparities, serious disparities continue to exist especially with regard to African–American men who continue to suffer disproportionately from poor health when compared to other racial, ethnic, and gender groups in the United States. This bookcovers the most important issues relating to social determinants of health and also offers viable strategies for reducing health disparities.

Chapter 1

Introduction to Social Determinants of Health among African-American Men

Clare Xanthos
Henrie M. Treadwell
Kisha B. Holden

Learning Objectives

• Acquire an overview of the health inequities affecting African-American men.
• Appreciate the significance of socially determined health inequities faced by African-American men.
• Understand the concept of “social determinants of health status” with reference to African-American men.
• Understand the concept of “social determinants of health behavior” with reference to African-American men.
• Understand the concept of “social determinants of health care” with reference to African-American men.
• Gain an awareness of potential strategies for addressing socially determined health inequities faced by African-American men.

This chapter is an introduction to the social determinants of health among African-American men, and lays the foundation for the book.¹ It starts by presenting an overview of the serious health inequities affecting African-American men, and then describes why this volume is needed. Next, it considers the social determinants of health among African-American men in relation to health status, health behavior, and health care, subdividing this concept into three interrelated components—the social determinants of health status, the social determinants of health behavior, and the social determinants of health care. Finally, suggestions are offered for addressing these socially determined health inequities affecting African-American men. These consist of recommendations for research and programs that address the social determinants of health among African-American men, social policies that tackle social and environmental issues affecting African-American men's health, and health policies that promote health equity among this and other vulnerable populations.

The Health Status of African-American Men

African-American men have the lowest life expectancy and highest mortality rate among all other racial, ethnic, and gender groups in the United States. The life expectancy of black men is 70 years as compared with 76 years for white men, 76 years for black women, and 81 years for white women (National Center for Health Statistics, 2007). African-American men's mortality rate is 1.3 times greater than white men, 1.7 times greater than American Indian/Alaska Native men, 1.8 times greater than Hispanic men, and 2.4 times greater than Asian or Pacific Islander men (Henry J. Kaiser Family Foundation, 2007). To cite some examples:

• With regard to cardiovascular disease, African-American men's mortality risk for stroke is 60 percent greater than white men (Office of Minority Health, 2008a). Additionally, among 30- to 39-year-olds, the likelihood of African-American men developing kidney failure as a result of hypertension is approximately 14 times greater than their white counterparts (USRDS, 2005). Moreover, the mortality rate for heart disease among African-American men is 30 percent greater than their white counterparts (Office of Minority Health, 2008b).
• With respect to cancer, black men in the United States suffer significantly greater rates of prostate cancer than their male counterparts worldwide (Zerhouni, 2002). In addition, African-American men's chances of developing lung cancer are 37 percent greater than white men (American Lung Association, 2007). Also, oral (mouth) cancer occurs far more frequently among African-American men than other population groups in the United States (NIDCR, 2008). The disparities in the survival rates for oral cancer are striking, with only 36 percent of African-American men surviving five years or more as compared with 61 percent of their white counterparts (National Institute of Dental and Craniofacial Research, 2010).
• Among African-American men, the death rate for diabetes is 51.7 per 100,000 as compared to 25.6 per 100,000 among white men (Office of Minority Health, 2008b).
• African-American men are more than seven times more likely to develop AIDS, and more than nine times as likely to die from AIDS as their white counterparts (Office of Minority Health, 2008b).
• Among young African-American men, the mortality rate for homicides is 84.6 per 100,000 of the population compared with 5 per 100,000 of the population for their white counterparts (Henry J. Kaiser Family Foundation, 2006). To put it another way, the mortality rate for homicides among young black men aged 15 to 19 is 46 times greater than young white men (National Urban League, 2007). Homicide-related mortality rates are not as high among older African-American men, but the rates among the 25-to-44 age group are still overwhelming (61 per 100,000 of the population) as compared with 5.1 per 100,000 among their white counterparts (Henry J. Kaiser Family Foundation, 2006).

Why This Book Is Needed: Social Determinants of Health and African-American Men

As has just been demonstrated, the health inequities affecting African-American men are staggering when compared to other racial, ethnic, and gender groups in the United States. Although there have been considerable efforts in recent years to tackle health disparities (Mullins, Blatt, Gbarayor, Yang, & Baquet, 2005), serious inequities persist, especially with regard to African-American men, who continue to face worse health outcomes than other racial, ethnic, and gender groups in the United States. At the same time, it is becoming increasingly clear that social determinants or social factors (e.g., low socioeconomic status, poor neighborhood conditions, discrimination, reduced access to quality education, reduced access to employment, incarceration, reduced access to quality health care) have a major impact on the health inequities affecting this population (Xanthos, Treadwell, & Braithwaite-Holden, 2010).

Although the social determinants of health are increasingly recognized as a critical issue in the public health debate, this topic has been largely neglected in much of the public health literature relating to African-American men. Indeed, the literature on African-American men's health has often been informed by a “health behavior framework” as opposed to a “social determinants of health framework.” Research and programs relating to African-American men's health often concentrate on individual health behavior (e.g., unhealthy diet, lack of exercise, failure to participate in health screenings) (Gadson, 2006). What is missing from this framework is a recognition of African-American men's often difficult life circumstances. African-American men typically face more life adversity (e.g., reduced access to quality education, reduced access to employment, disproportionate rates of incarceration) than less vulnerable population groups (see Gehlert et al., 2008). In addition, African-American men are among the most underserved populations in the United States with regard to access to quality health and mental health services, which similarly contributes to their poor health outcomes (see Smedley, Stith, & Nelson, 2003). Although health behavior determines health to a certain degree, it is important to acknowledge that negative social and environmental factors play a critical role in negatively impacting the health of vulnerable minorities such as African-American men. As such, ascribing the health inequities affecting African-American men to health behavior only is not an adequate explanation (Gadson, 2006). Indeed, the health behavior framework can be problematic in that it can lead to “blaming the victims” for their unhealthy behavior, without taking into account the social and environmental factors that cause poor health (see Raphael et al., 2003). Exploring the social determinants of health allows us to reconceptualize the debate around African-American men's health by drawing attention to the critical impact of social and environmental factors on health.

In this volume, we seek to fill this gap by moving beyond a simple examination of health disparities among this population; we highlight the social determinants of health inequities affecting African-American men, and offer solutions to address these socially determined inequities. Further, the concept of social determinants of health is subdivided into three interrelated components—“social determinants of health status,” “social determinants of health behavior,” “social determinants of health care”—to allow for a comprehensive understanding of this issue among African-American men. In this vein, the book introduces students, faculty, researchers, policy makers, and professionals to the following major areas:

• The social determinants of health status among African-American men
• The social determinants of health behavior among African-American men
• The social determinants of health care among African-American men
• Addressing the social determinants of health inequities affecting African-American men

These themes are reflected in the subsequent chapters in this volume and are discussed next.

Social Determinants of Health Status

African-American men are exposed to a multitude of social and environmental conditions that have the potential to affect their health status, including both physical and mental health (Xanthos, 2008, 2009). For the purpose of this chapter, the focus is on three key social determinants of health that are particularly relevant to African-American men: low socioeconomic status, racial discrimination, and incarceration. These should not be seen as discrete factors; there is significant interplay between them, as is apparent in the following discussion. No list can be exhaustive, so these three social determinants encompass a broad array of some of the most significant stressors and negative life events affecting African-American men's health.

Low Socioeconomic Status

African-American men are disproportionately impacted by low socioeconomic status (SES). First, African Americans are three times more likely to live below the poverty line (approximately 25 percent of African Americans) than their white counterparts (National Urban League, 2007). Indeed, African-American men are paid less than 75 percent of what their white counterparts are paid; 9.5 percent of African-American men are unemployed as compared with 4 percent of white males. Additionally, African-American men are more likely to be in lower-income jobs as compared with their white counterparts (National Urban League, 2007). Due to lower incomes when compared with other racial/ethnic groups, African-American men are often forced to reside in disadvantaged communities, with poor neighborhood conditions (e.g., crime, substandard housing, crowding, noise pollution) (Adler & Snibbe, 2003) and environmental hazards (Bullard, 1990).

Concurrently, the relationship between low SES and poor health is well documented (Baum, Garofalo, & Yali, 1999; Marmot & Shipley, 1996). It has been suggested that the conditions associated with low SES lead to stress, and that in turn, stress leads to poor health outcomes (Baum et al., 1999). As such it is clear that reduced access to socioeconomic opportunities among African-American men is an important social determinant of health.

Finally, it is important to note that the relationship between SES and race is complex. For example, socioeconomic status is an importa...

Table of contents

• Cover
• Title Page
• Copyright
• Figures and Tables
• Foreword
• Preface
• Acknowledgments
• The Editors
• Contributors
• Chapter 1: Introduction to Social Determinants of Health among African-American Men
• Part One: Social Determinants of Health Status
• Part Two: Social Determinants of Health Behavior
• Part Three: Social Determinants of Health Care
• Part Four: Addressing Social Determinants of Health Inequities
• Afterword
• Index