Causes of Health Disparities are Socioeconomic and Structural
Cincinnati has a violence problem. And clustered with violence are disproportionately high rates of infant mortality, low infant birth weights, asthma, obesity, unwed mothers, unintentional injuries, and domestic abuse.
Conservatives point to individual failure to embrace mainstream cultural values; liberals blame systemic racism and say focusing on the individual is “blaming the victim.”
The population-based health disparities and social ills, which remain interrelated major issues today, have been addressed at length by the famous contemporary sociologist, William Julius Wilson. He calls these disparities the most significant policy issue of our time. As a health care provider on the front lines of treating adolescents with gunshot wounds and necrotizing enterocolitis in premature infants, I soundly agree.
Based on sound research and a longitudinal study of inner-city poverty elucidating the systems at work, Wilson challenged dogma regarding poverty alleviation and made the case that the focus should be on promoting work opportunities and alleviating poverty concentration rather than simply fighting racism or promoting punitive policies of mass incarceration.
Wilson sheds vitally needed light on ghetto poverty and the consequences of decades of increasing concentrations of disadvantage and how these fuel the health disparities in the community that surrounds us.
If a young man’s father and grandfathers were all dead before he was 5 years of age and the same was the case for most of his acquaintances, discounting the future is probably a normal adaptive reaction. Moreover, if much of this mortality seems to represent “bad luck,” then accepting more risks in pursuit of immediate advantage would also make sense.
We as a community would do better to listen to serious scholars who have studied and thought deeply about not only the manifestations of ghetto poverty, but also the impact durable poverty has had on culture and, most importantly, the health of the community.
If we are finally to bring forth sustainable change, we have to face the truth and recognize and acknowledge the functions at work.
In net, the work of Wilson and other urban sociologists have enormous social implications for the way we understand and react to race and inequality in America. Wilson for one, and I heartily agree, says addressing joblessness is first priority. The benefits that jobs programs and vocational training have on the cultural front are palpable. More directly, increasing employment reduces the number of people who might promote or even condone deviant behavior. Doing so via race-neutral social policies and a jobs-first agenda should be attractive to most concerned and thoughtful citizens.
Victor F. Garcia, MD, developed Cincinnati Children’s first regional Level 1 Pediatric Trauma Center and served as the director from 1991 to 2009. After seeing an increase in children admitted to Cincinnati Children’s with gunshot wounds, Dr. Garcia led the development of the Cincinnati Initiative to Reduce Violence and served as the Co-Chair until 2008. He is an integral part of ongoing efforts to reduce violence in Cincinnati’s inner-city core.