African American Health in Tallahassee

A young boy joins the NAACP March in Tallahassee, FL, on October 23, 2007 (Photo credit: Douglas Monroe).

A young boy joins the NAACP March in Tallahassee, FL, on October 23, 2007 (Photo credit: Douglas Monroe).

In the United States, the burden of sickness and early death is clearly distributed along racial lines. The burden is especially heavy for African Americans, who suffer disproportionately from nearly every major cause of death, including heart disease, diabetes, cancer, pneumonia and influenza, HIV/AIDS, and infant mortality.

The causes of these inequalities are hotly debated. Many people, including some healthcare providers and policy makers, assume that the differences are due to genes. But this view is scientifically unfounded and politically dangerous. By contrast, there is mounting evidence that social and cultural factors are fundamental determinants of racial inequities in health. This evidence implies that there are policy solutions to promote greater equity in health.

Social and Cultural Context of Racial Inequalities in Health

Clarence C. Gravlee (PI) and Christopher McCarty (Co-PI)

Funded by the National Science Foundation (BCS-0724032)

Our current research seeks to improve the understanding of how specific social and cultural factors shape racial inequities in health. The central question is why African Americans suffer disproportionately from hypertension, or chronic high blood pressure. This problem is a key test case for two reasons. First, excess hypertension contributes more to the diminished life expectancy of African Americans than does any other cause of death. Second, it is often attributed to unknown genetic differences between racially defined groups. This project tests the alternative view, supported by previous research, that institutional and interpersonal racism shape the risk of high blood pressure among African Americans.

We draw on a model of the stress process that focuses on both structural inequalities and the experience of culturally meaningful social stressors and resistance resources. The first phase of the project involves participant observation and two rounds of ethnographic interviewing (N = 48 in each round) to understand the diversity of ways that African Americans encounter racism and experience blackness. The second phase involves an epidemiologic survey of adult African Americans in Tallahassee (N = 350) to test the associations between social network characteristics, the experience of culturally defined stressors, and blood pressure variation, above and beyond known risk factors for high blood pressure. We intend to disseminate our findings in a way that informs policy debates at local, state, and national levels.

The research is taking place among African Americans in Tallahassee, FL, following the principles of community-based participatory research (CBPR). The choice of Tallahassee was motivated by two factors. First, Tallahassee has a large and socioeconomically diverse African-American community. This diversity makes it possible to disentangle the health effects of racism from the effects of poverty and economic inequalities. Second, Tallahassee has a rich history of racial struggle and civil rights activism. Much of the current local civil rights activism is framed in terms of health inequalities, and several local agencies and community organizations have identified racial health disparities as a priority for action. We are cultivating relationships with these organizations and with local university researchers to build a long-term partnership for action-oriented research on equity in health.

For more about CBPR and the community-academic partnership we are helping to develop, visit the website of the Health Equity Alliance of Tallahassee (HEAT).