“Love thy neighbour”—it's good for your health: a study of racial homogeneity, mortality and social cohesion in the United States

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Abstract

This paper explores the idea that in societies that experience racial tension, increasing racial heterogeneity will be associated with poorer health outcomes, and this effect will be observable in the health of both the minority and the majority group. Here, the association between mortality and racial homogeneity in the United States is examined. The level of racial homogeneity, indexed by the proportion of blacks in each state of the 50 states in the US, was examined in relation to all-cause mortality, adjusted for age and disaggregated by race and sex. The level of poverty in each state was controlled for in ordinary least squares regression models. The level of racial homogeneity was significantly associated with age adjusted mortality rates for both blacks and whites, accounting for around 30% of the variance in mortality rates in the total population and the white population. Every 1% increase in the percentage of the state population who were black was associated with an increase in the total mortality rate of 5.06 per 100,000 and an increase in the white mortality rate of 3.58 per 100,000. Based on the data, this suggests, for example, that racial heterogeneity in Mississippi accounts for around 14% of the white mortality rate and in New York and Delaware it accounts for around 7%. These results appear to support the social cohesion thesis that in societies that are intolerant, mortality rates will increase as the proportion of racial or ethnic minorities increase in population. Limitations and explanations for the findings are discussed.

Introduction

An increasingly common finding in health inequalities research is that the level of social cohesion within a society is associated with population health (Durkheim, 1952; Kawachi & Kennedy, 1997; Kawachi, Kennedy, & Glass, 1999; Kawachi, Kennedy, & Lochner, 1997; Walberg, McKee, Shkolnikov, Chenet, & Leon, 1998; Whitley, Gunnell, Dorling, & Davey Smith, 1999; Wilkinson, 1996; Wilkinson, Kawachi, & Kennedy, 1998). Social cohesion relates to the degree to which groups of people feel connected, share resources, and provide moral support (Kawachi & Berkman, 2000). The thesis is that societies that lack social cohesion expend effort and resources inefficiently with some parts of the society in competition with other parts. Much of this research has focussed on economic disparities and the effect that these have on social cohesion.

Social cohesion is not, however, going to be mediated by income inequality alone. Other factors such as racial, ethnic or religious tensions within a society are also likely to affect levels of social cohesion (Kawachi & Berkman, 2000).

Kennedy, Kawachi, Lochner, Jones, and Prothrow Stith (1997), in a state-level study of racism in the United States found a positive linear relationship between the prevalence of those who believed blacks lacked innate ability, and the black and the white mortality rates. They suggested that the rise in the white mortality rates (i.e., the majority group) might be explicable in terms of a carryover effect. Members of a majority group “with low levels of respect and trust for members of another [minority] group, may also tend, on average, to hold lower levels of respect for members of their own group” (Kennedy et al., 1997, p. 212). As racism increases, social cohesion reduces, and mortality rises. This explanation for the association between racism and mortality (particularly in the majority group) is not, however, entirely satisfactory. Although I write of ‘race’, I intentionally do not differentiate between race, ethnicity or nationality. The distinctions are arguably spurious, and would miss the general point about the tension between minority groups and majority groups and its affect on social cohesion.

One of the frequently quoted findings by researchers studying social cohesion is the improvement in mortality rates in England during World War II (Wilkinson, 1996). The argument is that the war provided structural changes that made the society more cohesive. One of the changes included the more equitable distribution of money, goods and services. Another change that made the society more cohesive was the identification of a common enemy—an enemy defined by ethnic origin. If racism per se were bad for health, one would expect to have seen a savage deterioration in the health of the English during World War II as they as a society embraced a hatred for the ethnically different Germans. That this did not happen requires further explanation. One explanation is that the positive effects of the improved absolute and relative economic position of the poor out-weighed any negative effects of racism. Another plausible explanation is that there were insufficient Germans actually living within England at the time to create intra-societal division. Indeed, during the war, Germans living in England were interned. As a society, therefore, the English could unite and focus on a common external threat while enjoying the health benefits of a change in economic policy.

If this latter explanation were correct, in racist societies one would expect to see a dose–response relationship between the proportion of the society made up by the minority group and the mortality rate in both the minority and majority group. This is because in racist societies, social cohesion will degrade as minority and majority groups approach balance with respect to their population sizes and the minority group is more and more able to challenge the dominant social order. Thus, a racist society made up of 30% minority group and 70% majority group should experience poorer health outcomes in the majority group than an equally racist society that is made up of 0.1% minority group and 99.9% majority group.

Because, historically, there is a high level of racial tension in the United States (Zinn, 1980) and “blacks” and “whites” are not uniformly distributed, it should be possible to examine the association between mortality rate and racial homogeneity. The state level mortality data, disaggregated by race, provides just such an opportunity. It would be expected that states with more even black and white populations would have higher rates of mortality than states with less even populations.

There has been a related line of inquiry in the health literature that has examined the relationship between what has been described as the group or ethnic density effect and health (Boydell et al., 2001; Cochrane & Bal, 1988; Neeleman & Wessely, 1999; Neeleman, Wilson-Jones, & Wessely, 2001; Rabkin, 1979). This research has examined mental health rather than mortality, and has tended to look at the issue of racial homogeneity (or ethnic density) in small areas such as electoral wards. In general, the finding from this research has been that as the minority group increases in size, so their mental health problems reduce, however, the mental health of the majority group degrades. This makes an interesting counterpoint to the argument I develop, and will be revisited in the Discussion.

Section snippets

Method

The relationship between racial homogeneity and all-cause mortality was studied in the 50 US states. Mortalities were age adjusted to the whole US population in 1990. Relationships were examined separately by racial group controlling for individual states’ levels of poverty.

Results

The proportion of the states’ populations who were black ranged from 0.36 (Mississippi) down to less than 0.01 (e.g., Montana, New Hampshire, and Vermont) with a median of 0.07 (Kentucky and Nevada). The proportion of the total population below the poverty level ranged from as high as 0.25 (Mississippi) down to 0.06 (e.g., New Hampshire) with a median of 0.12 (e.g., Wyoming). These data are consistent with the observation that states with a higher proportion of the population who are black also

Discussion

The purpose of this study was to examine the effect of racial homogeneity on population health in a society that experienced racial tension. In a country as racially divided as the United States it was hypothesised that an increase in the proportion of the population who were black would see a concomitant increase in mortality. The expected effect was observed. It was found that states with lower racial homogeneity, i.e., states with a higher proportion of the population who were black, tended

Acknowledgments

I would like to thank Pascale Allotey for her editing and advice and to the anonymous reviewer whose insight contributed important improvements to the paper.

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