Welcome back. We continue our week three lecture on health disparities.

In this particular one, we're going to talk about some basic facts of health disparities. This module will be brief. The basic story is, there are health disparities most everywhere, and most always. So I don't want to spend a lot of time going through graph after graph or table after table describing health disparities. One thing you can think about is, where are there not health disparities by race, class, or sex. That's a very interesting question that rarely gets attention. Let's look at this first graph. This is by Harper and Colleagues. And what we see here is life expectancy at birth. On the horizontal axis we have year of birth, 1975 to 2005. And this is age, or life expectancy, ranging from 60 all the way up to 82. This upper line plots the life expectancy for females. So a female born in 1975 has approximately the life expectancy of 77 years. One born more recently has a slightly higher, approximately 8o years of life expectancy. For African American females, there's a big dri, big difference. Life expectancy for someone born in 1975 is a little more than 71, as opposed to 77. A difference of six years. This too goes up at about the same rate. So that a African American female born in 2005 has about 74 years of life expectancy. White males, this line here, even less than African American females and certainly less than white females. A white male born in America in the year 1975 has about a 69. Years of life expectancy. And he goes up as well. Down at the bottom, very importantly, African American, or black males. One born in 1975 has a life expectancy of about 62 years. And this is much more variable, and it goes up, and in the year 2000, to about 66 years.

So, a key question for social epidemiology is first, what are these facts? There are differences in life expectancy and second, why do they occur, how do they occur and are these disparities in outcomes or opportunities for health? We'll have to think about this. Here's a little bit more data. And this is a data about Native American, American Indian, infant mortality by one's neighborhood poverty. In this first row, we see that, in a less impoverished neighborhood, there's about 7.5 deaths per 10,000 babies born. But as the poverty of the neighborhood increases, between 40 and 100%, then the infant mortality rate rises to over 23 babies. Almost a three times increase. And these lower lines are about different types of event from death, the story is the same. As we increase poverty, infant death increases. What is it about poverty that seems to cause infant death? One point I'd like to emphasize, though, as when we think about health disparities, it's important to recognize that most people in America, and this is a graph of 2007, Live long lives, maybe not equally healthy. But the average person, whoever they are, will live to 75 years thereabout. And so what these curves are as, sort of difficult they are or might be to see, is that whether one is Hispanic female, a non-Hispanic black female, white male or whoever else, most people are living long healthy lives. This is the percentage persons dying and you can see that most people live into their 70s or 80s. Very briefly, some international comparisons are worth discussing. Again infant mortality rate, a very important measure in epidemiology United States 7.5 Tanzania, an African country, 91.3, obviously a huge gap. But one point I'd like to make is that within Tanzania there is great variation. So these are counties or regions of Tanzania and out to the right are their death rates which range over 150 All the way back to about 40. So even within a country that has an average under five infant mortality of 91 and some change, there's great variation within.

A social epidemiologic question is why? Why is there so much variation within a country? The final point in this module I'd like to make is there's not much new here. Health disparities are measured as long as we could measure them, seem to occur any time in society over anywhere. Here's a graph from the 1820s, and this is France. And what we have here is age groups and death rate. It's death rate per 100 persons dying, in this case. But what we see is two columns, one for rich persons, however defined, and one for poor persons. And what we notice, in 1820, this tabulation, is that rich persons lived longer. Poor persons had higher death rates, at every single age. The same story we see today, is the same story that existed in France, in 1820. Here's a graph of, again, death rates this is age, and this is year 1968 to 1992. And these lines are different social classes. The solid line is Class one, the dotted line down here is Class five and we see the same story. Death rates are declining over time, that is people are living longer and there's differences by social class. So one question for you is looking at this graph which is the high or advantage class? Two more graphs worth noting. First this graph is deaths from Typhoid over 1890 to 1920 and there is two lines, one is African American and one is white. And these data come from New Orleans in America. What you'll notice here is that the death rates are approximately the same for blacks and whites. Why is this? It's an important social epidemiologic answer. It's because there's no medicine yet in order to treat typhoid. No antivirals. No antibiotics. Not a lot of indoor plumbing. And so typhoid, an infectious disease, affected everyone equally. The impact of society and medicine hasn't done its work yet. Finally, another point about how society

affects health. Here is data about death rates or mortality rates of American slaves. And although this is some controversial research what we see is that this slave death rate compared to the death rate for average Americans in the Pre-Civil War area, era. We see that slaves tend to die in the first few years of life at an alarming rate. Non-slave Americans, far less, but still not insignificant. But what we notice is, as slaves get older, their death rates decline almost to that of an average American. Why would this be so? Well, I think the social epidemiologic answer Is because once a slave becomes 20 approximately he is, as grotesque as it is becomes a valuable asset to the slave owner. And therefore that asset gets invested in, in order for the farmer, the slave owner to produce his profit. So this is the functioning of the social system. It's repugnant to think about but that's important to realize. That's how health disparities come about and that's what they are.