One core question guides my research: How do we account for persistent racialized, gendered, and class-based health inequities in a capitalist society like the United States? My current research focuses specifically on structural racism as a social determinant of Black-White health inequities. Despite notable declines in health inequities over the twentieth century, Black Americans could still expect to live four years less, on average, than their White peers in 2018. This gap has since widened to six years in the wake of Covid-19. Black Americans are also more likely to suffer from a variety of chronic illnesses over the life course, including hypertension, diabetes, and kidney disease. Moreover, an emerging body of research finds that Black Americans derive fewer health benefits from higher socioeconomic status (SES) than White Americans, suggesting anti-Black racism precludes health equity even in high-status contexts.
Uncovering the social-structural roots of population health inequities demands proficiency in multiple disciplines and methods. Trained as an interdisciplinary biosocial scholar at the Carolina Population Center, my work synthesizes perspectives from the social-behavioral and life sciences to arrive at a holistic, biopsychosocial framework of health and aging. My studies employ advanced statistical methods and leverage a variety of quantitative data sources, including surveys, biomarkers, neighborhood census data, and administrative records.
In a 2020 study, sole-authored in Journal of Health and Social Behavior, I show that Black residents of Nashville, Tennessee report more discrimination and structural barriers to their aspirations than White residents, culminating in higher levels of goal-striving stress. I then show that goal-striving stress predicts better mental health, but increased levels of high-effort coping and stress biomarkers for Black residents. I conclude that structural racism places immense pressures on Black Americans to remain resilient and never cease striving, even when confronting overwhelming barriers to major life goals. The result is that Black Americans are forced to expend much greater psychophysiological resources than White Americans in their strivings for upward mobility, which I argue could help to explain their generally worse health profiles.
I built on the above findings in a follow-up study that was recently published in Social Forces. This second study examines how neighborhood context conditions exposures to unfair treatment and goal-striving stress for Black residents in Nashville. I find that Black residents of affluent and predominantly White block groups initially exhibit lower levels of stress biomarkers, relative to their peers in structurally disadvantaged Black areas. However, the former group also reports more unfair treatment, which then predicts higher levels of goal-striving stress and stress biomarkers. The result is that discrimination-related stress ultimately negates most of the potential health benefits of living in affluent communities for Black residents. I find the opposite patterns for White residents, who report less discrimination in affluent areas and lower stress levels overall.
In a third recent paper, published with co-authors in Demography, I expand on the abovementioned work by accounting for skin tone variation and life course processes among a nationally representative sample. This study analyzes four waves of biosocial data from Add Health, a nationally representative cohort of adolescents who have transitioned to adulthood. We show that White and light-skin Black respondents report improved health after attaining higher SES during the transition to adulthood, while their dark-skin Black peers report declining health. We then show that increased reports of unfair treatment, and related biopsychosocial stress processes, explain why dark-skin Black respondents report declining health after attaining higher SES.
Taken together, these three studies challenge decades of conventional wisdom in academic literatures on race, stratification, health, and the life course. Indeed, a large body of research suggests that residential segregation and diminished SES resources explain why Black Americans continue to exhibit worse health than White Americans. Yet the assumption that improving the economic standing of Black Americans would eliminate health inequities ignores the reality that institutes of higher education, prestigious occupations, and affluent neighborhoods all have been historically dominated by persons racialized as White. As my research shows, Black Americans in high-status contexts continue to suffer gratuitous stress burdens from anti-Black stigma, which can suppress the health benefits of higher SES attainment over the life course.