Love, sexuality, and (non)marriage

Slavery, segregation, and economic disadvantage have historically undermined the functionality and resilience of African-American families, and the post-industrial turn in the economy exasperated those difficulties. This chapter looks at the health consequences of the ‘love and trouble’ tradition between black men and women, especially in terms of non-marriage, loneliness, sexuality, sexual diseases, and unwanted pregnancies.

Economic decline and incarceration

The post-industrial turn in the economy during the 1970s has had a lasting impact on black communities, leading to high rates of crime, unemployment, gang violence, and illicit drug use. The ‘war on drugs’ disproportionately affected African-American communities, leading to spiralling rates of incarceration. Incarceration takes a toll on the health of inmates, but also on their entire families. This chapter looks at the health and family consequences of illicit drug use and especially mass incarceration.

Conclusion

Within the US, racial disparities in health have remained stark: Blacks have higher rates of sickness and infant mortality than other races, and the shortest life spans. Racial stereotypes, exclusion and discrimination are chronic stressors and take a toll on black health. Institutionalized racism operates in less visible ways to undermine health, such as less spending on public services in black neighbourhoods. The adverse effects of these policies are compounded in a society that emphasizes social mobility through hard work yet offers limited opportunities for the disadvantaged to achieve that mobility. The nation’s poor health outcomes reflect racial and class inequalities in access to health care and decent living conditions, and tarnishes the reputation of its medical system and its image as a world leader.

Introduction

This book explores how the health of African Americans is influenced by numerous social settings and policies that reinforce racial inequality. The author accomplishes this by expanding on existing literature and research on the health deficit experienced by African Americans, as well as drawing on interviews with a class-diverse group of African-American women and men about health attitudes and experiences. This chapter introduces the structure of the author’s research and the structure of the remaining chapter of the book.

Children’s health

This chapter looks at parental efforts to provide health and sexual socialization to their children. The socialization efforts of parents are shaped by cultural and social class factors, as are the larger family patterns to affect children’s health. This chapter places the efforts of parents to socialize their children within the larger context of family life –e.g., single-parents, poverty, intergenerational households—as well as neighbourhood context.

Health behaviors in social context

Racial disparities in major chronic illnesses are documented in this chapter, along with an exploration of the health behaviors of black people. Focusing on individual responsibility for maintaining health resonates with the neoliberal agenda for curtailing social spending, but often overlooks how structural barriers and inequalities shape health behaviors and outcomes. This chapter looks at the health belief model and the theory of health behaviors to examine factors that facilitate (e.g., religion) or impede (e.g., neighbourhood disadvantage) healthy behaviors among African Americans.

Medical care and health policy

Substantial data suggests that African Americans, even those who are insured, simply do not get the same quality of medical care as do White Americans. They not only bring to the medical encounter a legacy of medical mistrust, but are often treated disrespectfully by physicians who are less likely to aggressively pursue diagnoses and treatments for their black patients. Unequal access to quality health care is also a product of the dual health care system, with Blacks more likely to experience inferior and impersonal care in the public sector of that system.

Sickness in slavery and freedom

The health deficit of African Americans is explored in a historical context, starting with the abuse, poor treatment, and sub-standard medical care Blacks received during and after slavery. Segregation was the law of the land until the 1960s, and African Americans not only received marginal health care but faced significant barriers in access to medical schools. This chapter looks at the battle to end segregated medicine and the gradual acceptance of black people in medical schools and as members of the American Medical Association.

Race, racism, and health outcomes

Race is irrefutably linked to health outcomes, and this chapter looks at the origins of race along with the growing intraracial diversity of African-Americans. The major argument is that black people live in a highly racialized society where racial stereotypes and discrimination are everyday parts of life, leading to high levels of social stress. Institutional racism operates in many settings and has a dire impact on black health, regardless of socioeconomic position.