Yale School of Nursing Bellos Lecture — A fresh view of racial and ethnic disparities

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This year’s Sybil Bellos Lecture at the Yale School of Nursing, given today by Harvard’s David Williams, PhD, MPH, focused on racial and ethnic disparities as a social construct. His talk titled “Social Sources of Disparities: Patterns, Causes and Interventions” compiled a wealth of research from disparate sources providing a different interpretation of the issue. First, he noted that most Americans are not even aware that health disparities exist – this is our most important barrier to resolving the problem. While the US has enjoyed significant improvements in mortality over the last century, the gaps between blacks and whites has not improved. He outlined the evidence that race is not a genetic or biological construct — that variation in health parameters within races far outweighs variation between races. But racial and ethnic disparities exist and race is a clear and compelling social category. He noted that recent immigrants are in better health than their native-born counterparts across races. He demonstrated that socio economic status is the strongest predictor of health status, stronger than race, smoking and other commonly appreciated variables. Income, and more importantly wealth, explains a large part of racial and ethnic disparities, but not all of it. He made a startling statement that the US is just slightly less segregated than South Africa under apartheid and that segregation is the most important driver of health disparities. The bottom line of his talk was the idea that the solutions for health disparities may not at first seem to have anything to do with health – poverty, education, environment, housing and other issues having more to do with social context than access to health care. It echoes what I hear from other states much farther along in reforming health care systems than CT – it’s not all about coverage.
For more reading, go to RWJ’s Commission to Build a Healthier America.
Ellen Andrews