Tag: Discrimination

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Indirect Inequality

Covid cares not for
the racial disparity
of heart disease

It was well-known before the pandemic that different racial/ethnic populations in the United States had different burdens of cardiovascular disease, with Black populations the worst affected.

The Covid-19 pandemic, however, has found ways of making bad things even worse, with deaths from heart disease and cerebrovascular disease rising across the whole of the USA. Yet new research by Wadhra et al. (2021) suggests that these increases aren’t evenly distributed across all racial/ethnic populations. Black, Asian and Hispanic populations have experienced a much larger relative increase in deaths (~19%) than the non-Hispanic White population (~2%).

A number of factors could be combining to result in this disproportionate impact of the pandemic on different racial/ethnic groups, including “reduced access to healthcare services, increased health system strain, and hospital avoidance due to fear of contracting the virus in high-burden areas. In addition, inequities in the social determinants of health that are associated with cardiovascular risk, such as poverty and stress, have likely worsened for these groups.”

Whilst depressingly unsurprising, these results make it clear that the United States urgently needs public health and policy strategies to “monitor and mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.”

Original research: https://doi.org/10.1161/CIRCULATIONAHA.121.054378

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Violent Aftershocks

Gender violence.
The ripples of disaster,
exacerbating.

Natural disasters and hazards are increasing in frequency, severity and duration worldwide, with evidence suggesting that the cause is anthropogenic climate change. Whilst this means we need improved and increased disaster management policies and practices for the immediate impacts of disasters (e.g. the collapse of a building during an earthquake), it is just as important to understand the wider implications natural disasters.

Women and girls are disproportionately impacted by natural disasters and hazards, including having higher mortality rates. The causes of this discrepancy include “discriminatory practices in relief efforts, lower access to information and resources, care responsibilities and gendered poverty”, with women’s perspectives in disaster management “not adequately considered and met”.

Yet new research by Thurston et al. (2021) also suggests that violence against women and girls also increases following natural disasters. Reviewing 37 previous studies the team found positive associations between disaster exposure and increased gender-based violence, with 12 of the 20 quantitative studies showing a positive association and all 17 of the qualitative and mixed methods studies describing post-disaster violence against women and girls.

The researchers suggest three reasons behind this increase, with natural disasters and hazards:

  • Increasing stressors that trigger gendered violence (e.g. trauma, mental health issues, financial insecurities).
  • Increasing enabling environments (e.g. the absence of police, health and support services, a breakdown of family structure, social isolation).
  • Exacerbating the underlying drivers of violence against women and girls (e.g. gender and social inequalities, lack of female representation and inclusion).

Whilst the researchers acknowledge their work has some limitations (due to the limitations of the studies they examined), their findings make it clear that disaster risk-reduction policies must be gender sensitive and women need to be included in all aspects of disaster management, from policy to practice.

Original research: http://dx.doi.org/10.1136/bmjgh-2020-004377

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Lost Matters

Birthweight advantage
of Black immigrants: lost in
a generation.

Birthweight can be a predictor of a range of health and socioeconomic outcomes, and in the United States Black women are known to have the highest prevalence of low birthweight babies of all racial groups. Evidence also suggests that immigrant women who give birth in the US have babies with higher weights than women born in the US.

Yet new research suggests that this birthweight advantage of immigrants extends beyond a single generation… for some races.

Andrasfay & Goldman (2020) looked at 1971-2015 Florida birth records to assess intergenerational changes in birthweight. They found that Black immigrants typically have larger babies than US-born Black women but that, in contrast to Hispanic immigrants, this ‘healthy immigrant’ effect is lost within a generation.

Whilst the study did not specifically investigate reasons for this difference, the authors suggest that a “lifetime exposure to discrimination and socioeconomic inequality is associated with adverse health outcomes for Black women.”

Original research: Andrasfay & Goldman (2020) Intergenerational change in birthweight: effects of foreign-born status and race/ethnicity, Epidemiology, https://doi.org/10.1097/EDE.0000000000001217

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Braking Decisions

Too posh to push? No?
How about too rich to brake?
Poor pedestrians!

Road safety and awareness is crucial for pedestrians and drivers alike, particularly when it comes to crossing the road. Yet not everyone is made equal so understanding the decisions and interactions that occur between driver and pedestrian is crucial for public health and safety.

Coughenour et al. (2020) examined driver yielding rates at a midblock crosswalk in Las Vegas. Their results reveal worrying tendencies for road safety based on both the identity of the driver and the pedestrian.

Drivers of more expensive cars were less likely to stop for pedestrians at cross walks, with yielding decreasing by 3% for each $1,000 increase in car cost. The identity of the pedestrian mattered too – cars yielded more frequently for women and white pedestrians compared to males and non-white pedestrians.

Perhaps most worryingly of all, only 28% of drivers actually yielded to pedestrians at the crosswalks, despite being legally obliged to do so.

Original research: http://dx.doi.org/10.1016/j.jth.2020.100831