If you live in a community with a proliferation of liquor stores, check-cashing joints, mom and pop fish fries and few, if any, grocery stores, pharmacies or doctors in private practice, your health may be in trouble.
"Anyone in that environment is going to be sick," said Thomas LaVeist, the director of the Johns Hopkins Center for Health Disparity Solutions. "Think about it --who lives in those types of environments? Race determines place, and place determines health disparities."
LaVeist spoke last week to nearly 300 researchers and public policy experts from across the Triangle and beyond for the "Social Determinants of Health Disparities" conference, sponsored by Duke's Research Network on Racial and Ethnic Inequality, held Aug. 9-11.
According to the Centers for Disease Control and Prevention, infant mortality among African-Americans is more than twice the national average, African-Americans are twice as likely to suffer from diabetes, and also more likely to die from cancer and cardiovascular disease.
The conference sought to answer some of the questions facing those who study the social factors that influence these disparities. Panelists discussed, among other things, the relationship between racialized stress and the incidence of cardiovascular diseases like hypertension, the magnitude and impact of discriminatory behavior by doctors, and the status of research on genes and the environment as a contributor to unequal outcomes.
"We felt Duke is especially well positioned to hold a conference like this because of the interdisciplinarity between the social and medical sciences," said William Darity, a public policy professor and conference organizer. Researchers from the University of North Carolina at Chapel Hill and North Carolina State University attended the two-day conference.
LaVeist , the keynote speaker, began with a talk in the Sanford School of Public Policy's Fleishman Commons.
He compared the United States health system to the doomed Titanic, saying it is "destined to hit an iceberg and crash."
He also used an image of the more recent U.S. Airways Hudson River landing with passengers huddled on a half-submerged wing to prove the point that those with first-class seating are more likely to survive a disaster. Class, he explained, determines life and death.
Although researchers, policymakers, and politicians are aware that social disparities exist in health care, LaVeist said there "has been an incorrect diagnosis of the problem" with poorly allocated resources.
He said that many blame the disparities on biological differences between ethnic groups, on poverty, and/or uneven access to health care, none of which is fully to blame, LaVeist said.
"Segregated communities were most likely to determine health outcomes," he said. "Studies have consistently shown social class has more to do with it than race."
LaVeist found that when people of different races and social classes are exposed to the same "risk scapes" -- liquor stores, tobacco, toxic waste, environmental pollution, for example -- the results are the same: People are more likely to get sick. These "risk scapes" are commonly found in segregated neighborhoods.
If blacks and whites were completely integrated and lived in the same types of communities with the same educational backgrounds and income, their health outcomes would be more similar, he said.
"Much of what we are doing" to close health care gaps "will absolutely fail," LaVeist said of attempts to reduce disparities. "This is my prediction and I'm going on the record."