Structural Racism, Economic Opportunity, and Racial Health Disparities: Evidence From U.S. Counties
OFH Contributors
Key Takeaways
The racial opportunity gap captures the difference in the adult earnings of Black and white children who were born to similarly low-income families in the same county. For children born to families at the same income level, white boys and girls generally achieve greater mobility outcomes than their black counterparts.
There is a positive association between the racial opportunity gap and the racial mortality gap across U.S. counties. Where the racial opportunity gap (the difference in adult earnings based on income origin) is greater, the gap in mortality between Black and white populations is also greater.
The association between the racial opportunity gap and the racial health gap remains substantively large and statistically significant even after accounting for group differences in standard socioeconomic outcomes (including poverty, unemployment, median income, and education), suggesting that economic opportunity is a unique risk factor for health in America.
Executive Summary
Introduction
Systemic discrimination — defined as patterns of behavior and policies that create and perpetuate disadvantages — has increasingly been linked to poor health outcomes in marginalized populations. The study introduces the ‘racial opportunity gap’ as a measure of systemic discrimination in population health research. Defined as the difference in adult earnings between Black and white children born to families at the same income level in the same county, this metric captures how systems act to produce racial disparities in economic opportunity in American communities. The study examines whether the opportunity gap can help explain the long-standing fact that Black Americans have higher death rates than non-Hispanic whites.
Main Findings
- In counties where the gap in adult earnings between Black and white children born to families at the same income level is greater, so, too, is the gap in mortality between non-Hispanic Black and white adults. For men, moving from the bottom quarter to the top quarter of the racial opportunity gap across counties was associated with an increase in the racial mortality gap of 85 deaths per 100,000.
- For reference, this is equivalent to over 30% of the mortality gap between Black and white men and over 90% of the gap between Black and white women.
- These associations held after accounting for group differences in a wide range of other county-level economic characteristics and state policies.
Conclusion
Larger racial “opportunity gaps” correspond to larger racial mortality gaps, a pattern that remains significant after adjusting for socioeconomic factors and state policies. The study suggests that identifying and intervening the policies and institutions that shape economic mobility can help address racial health disparities.