Now Reading: Place, not race: disparities dissipate when blacks and whites live under similar conditions

When I was reading about social determinants recently, I came across an error in one of Sir Michael Marmot’s writings, in this JAMA article (“Action on Health Disparities in the United States“). In it, he says:

The gap in life expectancy between men in Washington, DC, and in suburban Maryland is 17 years.

The error he made is that the 17-year gap is for African American men in Washington, DC, compared to men in Montgomery County, MD (I assume that’s the suburban he’s talking about), not the average of all men in Washington, DC. That gap is 9.1 years (as of 2007).

This paper is useful because it calls the racial distinction into question. It might be more accurate to say “a man living in Ward 8, Washington, DC” above, taking race out of the picture altogether, and therefore focus more on the Ward 8 neighborhood.

What the authors did was choose a community with a mix of African American and white residents with similar income, education, and location (they’re in the same community), interviewed 42 percent of them (1,489 people), and took their blood pressure. They then compared what they found to national statistics for the measures they assessed.

  • And….whites and African Americans with the same social determinants looked a lot more similar than different. There were a few notable differences.
  • African Americans still had higher blood pressure, albeit not as higher in this matched community
  • African Americans were no more obese, no more likely to have diabetes than their white counterparts
  • African Americans smoked less than their white counterparts
  • African Americans were  more likely to have a health care visit within the past year

With this conclusion:

When whites are exposed to the health risks of a challenging urban environment,15 their health status is compromised similarly to that of blacks, who more commonly live in such communities.

I wonder even further if whites are less able to tolerate an unhealthy neighborhood environment, given that they smoke more and use health care less. This is just speculation on my part, though.

The study points out and reinforced what’s being discussed about social determinants already, which is that local conditions have a huge bearing on health and looking to customize interventions based on an individual’s genetics or behavior may not be as useful as taking a walk down the street where they live.

Tying this all back to Washington, DC, there’s a vibrant neighborhood blog scene here, so you can electronically walk the neighborhoods in an authentic, personal way. I’ve put together a link cloud of the major ones. Anacostia is Ward 8. See if you see the differences in place. If the differences aren’t obvious there, you can check out this post on local blog TheFightBack for a more intense view of life in Ward 8.


@tedeytan I love your website, how did you do the “now-reading” section? I’d love to make one for my research reading!

@rdjfraser thank you! I have inappropriately crossed the line as an MD and taught myself PHP and plugin writing :). Happy to fill u in.

Your close reading makes all the difference! It’s also true that when socio-economic status is equal between whites and African Americans, health disparities persist. Health doesn’t follow wealth as it should, a the social gradient persists (shown by Marmot et al.).

I’ve just posted a related reflection on my blog I hope that you’ll take a look and comment. I also appreciate your insight.

@katellington Hi Kate, I took a look thanks for sending along. I think the people I most interact with would not have much space for this becoming too technical of a discussion, Human Development Index seems to kick it up a notch and make the dialogue more complex than maybe it needs to be. That’s my reflection.

I loved the paper that you linked to at the bottom of your post – it was a great read and had a nice concrete “to do” for health systems:

“there are three important roles for the health-care system (webappendix p 1). First is to ensure universal access to high-quality care, with increased focus on prevention and health promotion.13 Second, people in the health sector—from the Minister of Health to primary care professionals and medical and health organisations—should be the advocates for action on social determinants of health. There are good examples of cooperative working between health and other sectors. Third, ensure that routine monitoring systems are in place for health equity and the social determinants of health, undertake evaluation of policies on these topics, and increase the knowledge base.”

This is important because I think health systems, especially US ones, do not have the scope of action that European systems do. I’ll post about this paper separately because I think this is an important point. Thanks again,


Ted Eytan, MD