Inequality and Health Disparities

Racism, Discrimination, and Health in the U.S. CCPR researchers have focused on the central role of racism in the U.S., in its structural forms, in driving health disparities. Gilbert Gee (CHS) and Chandra Ford (CHS) have conducted foundational work on structural racism and critical race theory, and they and other CCPR colleagues have empirically tested key mechanisms. For example, Gee studied the connection between self-reported discrimination and illness by examining discrimination and its real-time processing in the brain using functional magnetic imaging resonance (fMRI) on sleep behaviors. Ford has studied how racism influences access to HIV health services and finds that providers often fail to screen those at-risk for HIV infection due to racial discrimination. Courtney Thomas-Tobin’s (CHS) research on psychological resilience, mental health, and physical health across the life course has shown that higher levels of psychosocial resilience among African-American men may, surprisingly, be associated with higher allostatic load because of a tradeoff between physical and mental health produced by racism. Christine Dunkel-Schetter (Psych)examines the effects of racism-related stress and resilience in birth outcomes. She finds that Black and Latina women are at a much greater risk of PTSD in the post-natal period than Whites.

Understudied Populations. CCPR health research often examines social determinants of the health of understudied populations, including (a) the Asian and Asian American population, (b) sexual minority populations, (c) the homeless population, and (d) other marginalized groups, such as day laborers. May Sudhinaraset (CHS) and others study how state-level policies on immigrant safety net inclusion and enforcement create unique health burdens for Asian and Latinx/Latino immigrants. She is also PI in a study that assesses the health status and health care utilization of undocumented Asian and Pacific Islander young adults. Elizabeth Rose Mayeda (Epi) leads an R01-funded study investigating the effects of social factors, cardiometabolic health, and genetic factors on the lower dementia incidence among Asian Americans. With NIH funding, Gee (CHS) examines health inequalities among Asian American populations, including the Health of Philippine Emigrants Study (HoPES). The study follows cohorts of Filipino non-migrants and migrants to the US.  Early results show that migrants report better health both at baseline and at follow-up than non-migrants. Gee has also been a leading academic and public voice on the consequences of anti-Asian rhetoric during the pandemic. Ilan Meyer (Law) and other CCPR colleagues have developed the nation’s first representative longitudinal health study of lesbian, gay, and bisexual populations (Generations) and the first such study of transgender populations (TransPop). They find that sexual minority youth seriously consider suicide more often than heterosexual youth. Ian Hollaway (Soc Wel) examines differentials in HIV infection by sexual identity and social networking. Randall Kuhn (CHS) and colleagues have developed longitudinal health and well-being surveys for people experiencing homelessness and those exiting homelessness into permanent supportive housing to investigate the role of unsheltered homelessness, homeless duration, and specific exposures in weathering, stress, health, and well-being. Kuhn is also studying the effect of life-course exposure to precarious and dangerous employment on poor health outcomes.

Social and Health Policies. CCPR affiliates examine the impact of policy on health and the targeting of health interventions. Roch Nianogo (Epi) has considered the economic benefit and potential cost-savings associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and finds that WIC participation saves money. With R03 funding, May Wang (CHS) has merged data on WIC with Kaiser Hospital data to assess the impact of WIC in L.A. With CCPR seed funding, Akihiro Nishi (Epi) designed a behaviorally- and demographically-based road safety intervention in Thailand that serves as a model of health program targeting through social networks. Adriana Lleras–Muney (Econ) has investigated the long-run impact of historical cash transfers to low-income families in the U.S. on children’s longevity, nutritional status, and other outcomes. She finds that male children participating in the program lived one year longer than non-participants and were less likely to be underweight. Martha Bailey’s (Econ) NIH-funded study of the consequences of the War on Poverty shows it had significant health effects despite its relatively small poverty impacts. Teresa Seeman (Med / Epi) has recently extended her ongoing work on psychosocial factors, allostatic load, and life course health to include policy interventions designed to simultaneously benefit the health of older adults and elementary school-age youth. James Macinko (CHS) investigates the effects of social policies on health and mortality in Brazil, Latin America, and globally. Hiram Beltrán-Sánchez’s (CHS) work shows that very high rates of homicide in Mexico and Colombia have stalled increases in life expectancy, particularly for younger men. He also shows that improvements in life expectancy at older ages in high-income countries are concentrated at the top of the survival distribution and do not reflect common experiences of older adults.

Direct and Indirect Consequences of the COVID-19 Pandemic: CCPR has been a leader in equity-sensitive analysis of coronavirus pandemic effects on vulnerable populations. Sarah Reber (Pub Pol) led one of the first systematic analyses of racial disparities in COVID-19 death rates. Randall Akee (Pub Pol) and Desi Small-Rodriguez (Soc) are documenting the disparate impact of COVID-19 on Black, Indigenous, and other historically marginalized communities. They have created a publicly available resource where tribal nations and states can track the COVID-19 cases and deaths. Randall Kuhn’s (CHS) study highlighting the potential impacts of COVID-19 on homeless populations led directly to congressional appropriations and the design of local programs using hotels to protect older homeless individuals. James Macinko (CHS) developed a nationally representative survey of COVID-19 impacts in Brazil, documenting the disparate impacts on vulnerable communities. May Sudhinaraset (CHS) and Gilbert Gee (CHS) studied effects of COVID-19 on undocumented immigrant populations. Gee examined the direct impacts of COVID-19 on Asian American populations and conducted research and national outreach on the consequences of stigma and hate speech directed at Asian Americans. Ian Holloway (Soc Wel) was the lead author of a study that interviewed 10,000 gay men in 20 countries about their mental health and social networking during the pandemic lockdown. Manisha Shah (Pub Pol) coauthored a report documenting the rise of domestic violence complaints in Indian states with stricter lockdown rules. Anne Pebley (CHS) showed that racial and ethnic disparities in the prevalence of coronavirus were likely due, in part, to differential occupational exposure. Onyebuchi Arah (Epi) and Chad Hazlett (Stat / Pol Sci) collaborated on a project using machine learning techniques and other causal inference methodologies to improve interventions targeting high-risk populations during COVID. Hiram Beltrán-Sánchez (CHS), Patrick Heuveline (Soc), and CCPR statistician Michael Tzen monitored COVID-19 mortality trends across countries and within selected countries. Heuveline has proposed a new measure of the devastating effect of COVID-19 on longevity: the mean unfulfilled lifespan (MUL).