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Cited by 1,522Racial and Ethnic Identity ResearchHealth disparities and outcomesGender, Health, and Social Inequality

Race, socioeconomic status, and health. The added effects of racism and discrimination

Open access
WILLIAMS, DAVID R.·1999·Annals of the New York Academy of Sciences
DOI 10.1111/j.1749-6632.1999.tb08114.x
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Abstract

A bstract : Higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death. Other racial/ethnic minority populations also have elevated disease risk for some health conditions. This paper considers the complex ways in which race and socioeconomic status (SES) combine to affect health. SES accounts for much of the observed racial disparities in health. Nonetheless, racial differences often persist even at “equivalent” levels of SES. Racism is an added burden for nondominant populations. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health by restricting socioeconomic opportunities and mobility. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.

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Crossref · 10.1111/j.1749-6632.1999.tb08114.x

Cites

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  • Even African-Americans with a higher SES experience similar social stressors (e.g., racism) as those in a lower SES and, when compared to Whites with an 'equivalent' SES, they still have higher morbidity and mortality rates.

    “As studies with African-Americans show, even those with a higher SES experience similar social stressors (for example, racism) as those in a lower SES and, when compared to Whites with an 'equivalent' SES, they still have higher morbidity and mortality rates (Williams, 1999).”

    From Social Justice as a Public Health Imperative for Kānaka Maoli (2009) · cites this paper as Williams, 1999

    In “RACE, SES, AND HEALTH” (page unavailable), Williams reports lower life expectancy for African Americans than for similarly situated whites at every income level and says the pattern extends to multiple health outcomes. “RACISM AND HEALTH: DIRECT EFFECTS” describes discrimination as a health-related stressor. The copy does not establish that higher- and lower-SES African Americans experience similar levels of those stressors. (LLM, conf=0.85)

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  • Economic and social deprivation is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(1) economic and social deprivation : for example, residential and occupational segregation lead to greater economic deprivation among African Americans and increased likelihood of living in neighbourhoods without good supermarkets”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [8]

    The RACISM AND SES section (page unavailable) links discriminatory residential segregation to economic disadvantage for African Americans, and RACISM AND HEALTH: DIRECT EFFECTS describes an indirect pathway from racism to poorer health through socioeconomic position. Our copy does not identify hypertension as an outcome of that pathway or substantiate the citing sentence’s specific example about neighbourhoods without good supermarkets (searched: hypertension, blood pressure, supermarket). (LLM, conf=0.85)

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  • Toxic substances and hazardous conditions is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(2) toxic substances and hazardous conditions : residential segregation increases risk of exposure to lead paint in older houses and to soil contaminated by lead from car exhaust”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [8]

    In “Racism and Health: Direct Effects” (page unavailable), the paper says residential segregation can create poor-quality housing and disproportionate exposure to environmental toxins. It does not identify lead paint or lead-contaminated soil as the exposures, or link this pathway specifically to hypertension among African Americans. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Socially inflicted trauma is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(3) socially inflicted trauma : perceiving, recalling or anticipating interpersonal racial discrimination provokes fear and anger, triggering the 'flight-or-fight' response”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [8]

    In “Racism and Health: Direct Effects” (page unavailable), the paper describes discrimination as a potential source of stress and reports cardiovascular and psychological reactivity to laboratory stress among Black participants. It does not identify socially inflicted trauma or the specific sequence of anticipating discrimination, fear or anger, and a fight-or-flight response; nor does it link that pathway to increased hypertension risk. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • African Americans and Latinos make up the largest proportion of the minority populations who experience the most severe and concentrated types of health disparities.

    “African Americans and Latinos make up the largest proportion of the minority populations who experience the most severe and concentrated types of health disparities.3-5”

    From Pre-experience Perceptions About Telemedicine Among African Americans and Latinos in South Central Los Angeles (2009) · cites this paper as [3]

    The RACE, SES, AND HEALTH section reports substantially higher overall mortality for African Americans and higher Hispanic mortality for diabetes, cirrhosis, and HIV/AIDS. It also says overall Hispanic mortality is lower than white mortality, and it does not establish that African Americans and Latinos make up the largest proportion of minority populations or jointly experience the most severe health disparities. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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Cites

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Research works printed but not linked: 4

  1. Hyattsville, MD. U.S. Life Tables 1(1): 12-29.
  2. SCHUMAN, H., CH. STEEH, L. BOBO & M. KRYSAN. 1997. Racial Attitudes in America: Trends and Interpretations. Rev. edit. Harvard University Press, Cambridge.
  3. ORFIELD, G. & S.E. EATON. 1996. Dismantling desegregation: The Quiet Reversal of Brown v. Board of Education. The New Press, New York.
  4. FISCHER, C.S., M. HOUT, M.S. JANKOWSKI, S.R. LUCAS, A. SWIDLER & K. VOSS. 1996. Race, ethnicity and intelligence. In Inequality by Design: Cracking the Bell Curve Myth. C.S. Fischer, M. Hout, M.S. Jankowski, S.R. Lucas, A. Swidler & K. Voss, Eds. Princeton University Press, Princeton.

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Authors
WILLIAMS, D. R.
Affiliations
University of Michigan (US)
Corresponding author
WILLIAMS, DAVID R.
ORCID
WILLIAMS, DAVID R.
Venue
Annals of the New York Academy of Sciences
Publisher
Wiley
Published
1999-12
Volume
896
Issue
1
Pages
173-188
ISSN
  • 0077-8923 (ISSN-L)
  • 1749-6632
DOI
10.1111/j.1749-6632.1999.tb08114.x
OpenAlex
W1977593169
Cited by
1,522
References
44
Citations by year
2026: 30 · 2025: 40 · 2024: 58 · 2023: 78 · 2022: 76 · 2021: 77 · 2020: 79 · 2019: 73 · 2018: 77 · 2017: 64 · 2016: 58 · 2015: 65 · 2014: 67 · 2013: 61 · 2012: 73
FWCI
96.90
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2259 d)
Locations
  • Annals of the New York Academy of Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
  • John D. and Catherine T. MacArthur Foundation
  • National Institute of Mental Health (1 RO1 MH59575, R01MH059575)
Topics
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
Keywords
racism, discrimination, racial disparities in health, socioeconomic status, African Americans, neighborhood disadvantage, stress, health disparities, socioeconomic mobility
MeSH terms
Black or African American, Cause of Death, Educational Status, Female, Health Status, Humans, Income, Life Expectancy, Male, Middle Aged, Morbidity, Mortality, Poverty, Prejudice, Residence Characteristics, Social Class, Social Dominance, Social Mobility, Stress, Psychological, United States, White People

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