Abstract
Background
Evidence has documented racial wealth inequity as one of the key pathways linking structural racism and racial health inequity. Most prior studies on the wealth-health relationship use net worth as the measure of wealth. This approach provides little evidence on the most effective interventions as various types of assets and debt affect health differently. This paper examines how U.S. young adults’ wealth components (e.g., financial assets, nonfinancial assets, secured debt, and unsecured debt) are associated with physical and mental health, and if the associations differ by race/ethnicity.
Methods
Data were drawn from the National Longitudinal Survey of Youth 1997. Health outcomes were measured by mental health inventory and self-rated health. Logistic regressions and ordinary least square regressions were used to assess the association between wealth components and physical and mental health.
Results
I found that financial assets and secured debt were positively associated with self-rated health and mental health. Unsecured debt was negatively associated with mental health only. The positive associations between financial assets and health outcomes were significantly weaker for non-Hispanic Black respondents. Unsecured debt was protective of self-rated health for non-Hispanic Whites only. For Black young adults, unsecured debt had more severe negative health consequences compared to other racial/ethnic groups.
Conclusion
This study provides a nuanced understanding of the complex relationship among race/ethnicity, wealth components, and health. Findings could inform asset building and financial capability policies and programs to effectively reduce racialized poverty and health disparities.
This is a preview of subscription content, access via your institution.



Data Availability
Data used in this research can be downloaded at https://www.nlsinfo.org/content/cohorts/nlsy97.
References
Addo FR, Houle JN, Simon D. Young, Black, and (still) in the red: parental wealth, race, and student loan debt. Race Soc Probl. 2016;8(1):64–76. https://doi.org/10.1007/s12552-016-9162-0.
Adler NE, Stewart J. Health disparities across the lifespan: meaning, methods, and mechanisms. Ann N Y Acad Sci. 2010;1186(1):5–23. https://doi.org/10.1111/j.1749-6632.2009.05337.x.
Allison PD. Missing data. Sage publications. 2001.
Assari S. Health Disparities due to diminished return among Black Americans: public policy solutions. Soc Issues Policy Rev. 2018;12(1):112–45. https://doi.org/10.1111/sipr.12042.
Barnes DM, Bates LM. Do racial patterns in psychological distress shed light on the Black-White depression paradox? A systematic review. Soc Psychiatry Psychiatr Epidemiol. 2017;52(8):913–28. https://doi.org/10.1007/s00127-017-1394-9.
Berger LM, Houle JN. Parental debt and children’s socioemotional well-being. Pediatrics. 2016;137(2). https://doi.org/10.1542/peds.2015-3059
Berwick DM, Murphy JM, Goldman PA, Ware JE, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76. https://doi.org/10.1097/00005650-199102000-00008.
Beverly SG, Sherraden M. Institutional determinants of saving: implications for low-income households and public policy. J Socio-Econ. 1999;28(4):457–73. https://doi.org/10.1016/S1053-5357(99)00046-3.
Beverly S, Sherraden M, Cramer R, Williams Shanks T, Nam Y, Zhan M. Determinants of asset holdings. Asset building and low-income families. 2008. p. 89–151.
Birkenmaier J, Despard MR, Friedline T. Policy recommendations for financial capability and asset building by increasing access to safe, affordable credit (Grand Challenges for Social Work initiative Policy Brief No. 11–2) 2018. https://csd.wustl.edu/gcpb11-2/
Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. BMJ. 1997;314(7080):572. https://doi.org/10.1136/bmj.314.7080.572.
Boen C. The role of socioeconomic factors in Black-White health inequities across the life course: point-in-time measures, long-term exposures, and differential health returns. Soc Sci Med. 2016;170:63–76. https://doi.org/10.1016/j.socscimed.2016.10.008.
Boen C. Wealth policy as health policy: a population aging and racial equity perspective. In J. M. Wilmoth & A. S. London (Ed.), Life-course implications of U.S. public policies. 2021;Routledge.
Boen C, Keister L, Aronson B. Beyond net worth: racial differences in wealth portfolios and Black-White health inequality across the life course. J Health Soc Behav. 2020;61(2):153–69. https://doi.org/10.1177/0022146520924811.
Boen C, Yang YC. The physiological impacts of wealth shocks in late life: evidence from the Great Recession. Soc Sci Med. 2016;150:221–30. https://doi.org/10.1016/j.socscimed.2015.12.029.
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S. Socioeconomic status in health research. J Am Med Assoc. 2005;294(22):2879. https://doi.org/10.1001/jama.294.22.2879.
Braveman P, Acker J, Arkin E. Wealth matters for health equity: executive summary. 2018;Robert Wood Johnson Foundation.
Brown TH. Diverging fortunes: racial/ethnic inequality in wealth trajectories in middle and late life. Race Soc Probl. 2016;8(1):29–41. https://doi.org/10.1007/s12552-016-9160-2.
Bureau of Labor Statistics. National longitudinal surveys: NLSY97 documentation 2018; https://www.nlsinfo.org/content/cohorts/nlsy97/using-and-understanding-the-data/nlsy97-documentation#supplemental
Burbidge JB, Magee L, Robb AL. Alternative transformations to handle extreme values of the dependent variable. J Am Stat Assoc. 1988;83(401):123. https://doi.org/10.2307/2288929.
Campbell JL. Neoliberalism in crisis: regulatory roots of the US financial meltdown. In Markets on trial: The economic sociology of the US financial crisis: Part B. Emerald Group Publishing Limited 2010;. https://econpapers.repec.org/paper/nbrnberwo/11330.htm
Campbell JR, Hercowitz Z. The role of collateralized household debt in macroeconomic stabilization (NBER Working Paper No. 11330). 2005; National Bureau of Economic Research.
Charron-Chénier R, Seamster L, Shapiro TM, Sullivan L. A pathway to racial equity: student debt cancellation policy designs. Soc Curr 2021;23294965211024670. https://doi.org/10.1177/23294965211024671
Chetty, Raj, Friedman JN, Hendren N, Jones MR, Porter SR. The Opportunity Atlas: mapping the childhood roots of social mobility. In NBER Working Paper Series 2018;(p. 25147). www.opportunityatlas.orgtract-leveldataisavailableathttps://opportunityinsights.org/data/
Clayton M, Liñares-Zegarra J, Wilson JO. Does debt affect health? Cross country evidence on the debt-health nexus. Soc Sci Med. 2015;130:51–8. https://doi.org/10.1016/j.socscimed.2015.02.002.
Darity W, Hamilton D. Bold policies for economic justice. Rev Black Polit Econ. 2012;39(1):79–85. https://doi.org/10.1007/s12114-011-9129-8.
Darity W Jr, Hamilton D, Paul M, Aja A, Price A, Moore A, et al. What we get wrong about closing the racial wealth gap. Samuel DuBois Cook Center on Social Equity and Insight Center for Community Economic Development. 2018;1(1):1–67.
Despard MR, Friedline T, Birkenmaier J. Policy recommendations for helping US households build emergency savings. 2018; https://openscholarship.wustl.edu/csd_research/783/
Dowd JB, Zajacova A. Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? Int J Epidemiol. 2007;36(6):1214–21. https://doi.org/10.1093/ije/dym214.
Drentea P, Reynolds JR. Where does debt fit in the stress process model? Soc Mental Health. 2015;5(1):16–32. https://doi.org/10.1177/2156869314554486.
Dwyer RE. Credit, debt, and inequality. Ann Rev Sociol. 2018;44:237–61. https://doi.org/10.1146/annurev-soc-060116-053420.
Eisenberg-Guyot J, Firth C, Klawitter M, Hajat A. From payday loans to pawnshops: fringe banking, the unbanked, and health. Health Aff. 2018;37(3):429–37. https://doi.org/10.1377/hlthaff.2017.1219.
Elder GH. Life course dynamics: trajectories and transitions, 1968–1980. Cornell University Press; 1985.
Ettman CK, Cohen GH, Abdalla SM, Galea S. Do assets explain the relation between race/ethnicity and probable depression in U.S. adults? PLoS One. 2020;15(10):e0239618. https://doi.org/10.1371/journal.pone.0239618.
Farmer MM, Ferraro KF. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005;60(1):191–204. https://doi.org/10.1016/j.socscimed.2004.04.026.
Fellowes M, Mabanta M. Banking on wealth: America’s new retail banking infrastructure and its wealth-building potential. Brookings Institution. 2008; https://www.brookings.edu/research/banking-on-wealth-americas-new-retail-banking-infrastructure-and-its-wealth-building-potential/
Finch BK, Hummer RA, Reindl M, Vega WA. Validity of self-rated health among Latino(a)s. Am J Epidemiol. 2002;155(8):755–9. https://doi.org/10.1093/aje/155.8.755.
Fitch C, Hamilton S, Bassett P, Davey R. The relationship between personal debt and mental health: a systematic review. Ment Health Rev J. 2011;16(4):153–66. https://doi.org/10.1108/13619321111202313.
Folkman S. Stress: appraisal and coping. Springer; 1984.
Ford CL, Airhihenbuwa CO. Critical race theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010;100(S1):S30–5. https://doi.org/10.2105/AJPH.2009.171058.
Frech A, Houle J, Tumin D. Trajectories of unsecured debt and health at midlife. SSM - Popul Health. 2021;15:100846. https://doi.org/10.1016/j.ssmph.2021.100846.
Friedline T, Despard MR, Birkenmaier J. Policy recommendations for expanding access to banking and financial services (Grand Challenges for Social Work initiative Policy Brief No. 11–4) 2018; https://openscholarship.wustl.edu/csd_research/781/
Friedline T, Freeman A. The potential for savings accounts to protect young-adult households from unsecured debt in periods of macroeconomic stability and decline. Social Service Review. 2016;90(1):83–129. https://doi.org/10.1086/685791.
Friedline T, Masa RD, Chowa GAN. Transforming wealth: using the inverse hyperbolic sine (IHS) and splines to predict youth’s math achievement. Soc Sci Res. 2015;49:264–87. https://doi.org/10.1016/j.ssresearch.2014.08.018.
Fong R, Lubben J, Barth RP (Eds.). Grand challenges for social work and society. Oxford University Press; 2017.
Hajat A, Kaufman JS, Rose KM, Siddiqi A, Thomas JC. Do the wealthy have a health advantage? Cardiovasc Dis risk Factors Wealth. 2010. https://doi.org/10.1016/j.socscimed.2010.09.027.
Hajat A, Kaufman JS, Rose KM, Siddiqi A, Thomas JC. Long-term effects of wealth on mortality and self-rated health status. Am J Epidemiol. 2011;173(2):192–200. https://doi.org/10.1093/aje/kwq348.
Hamilton D, Zewde N. Promote economic and racial justice: eliminate student loan debt and establish a right to higher education across the United States. Washington Centre for Equitable Growth. 2020. https://equitablegrowth.org/promote-economic-and-racial-justice-eliminate-student-loan-debt-and-establish-a-right-to-higher-education-across-the-united-states/
Hamilton D, Paul M, Aja A, Price A, Moore A, Chiopris C. What we get wrong about closing the racial wealth gap. Insight Center for Community Economic Development. 2018; https://socialequity.duke.edu/wp-content/uploads/2019/10/what-we-get-wrong.pdf
Hicken MT, Kravitz-Wirtz N, Durkee M, Jackson JS. Racial inequalities in health: framing future research. Soc Sci Med (1982). 2018;199:11. https://doi.org/10.1016/J.SOCSCIMED.2017.12.027.
Hodson R, Dwyer RE, Neilson LA. Credit card blues: the middle class and the hidden costs of easy credit. Sociol Q. 2014;55(2):315–40. https://doi.org/10.1111/tsq.12059.
Houle JN. A generation indebted: young adult debt across three cohorts. Soc Probl. 2014;61(3):448–65. https://doi.org/10.1525/sp.2014.12110.
Huang J, Sherraden MS, Clancy MM, Sherraden M, Birkenmaier J, Despard M, Frey J, Callahan C, Rothwell D. Policy recommendations for meeting the Grand Challenge to Build Financial Capability and Assets for All (Grand Challenges for Social Work Initiative Policy Brief No. 11). American Academy of Social Work & Social Welfare. 2016; https://doi.org/10.7936/K7057FG8
Huang J, Sherraden MS, Sherraden M. Toward finance as a public good. 2021; https://openscholarship.wustl.edu/csd_research/917/
Hudson D. Achieving health equity by addressing legacies of racial violence in public health practice. Ann Am Acad Pol Soc Sci. 2021;694(1):59–66. https://doi.org/10.1177/00027162211015932.
Hudson DL, Puterman E, Bibbins-Domingo K, Matthews KA, Adler NE. Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health. Soc Sci Med. 2013;97:7–14. https://doi.org/10.1016/j.socscimed.2013.07.031.
Hyman L. Debtor nation: the history of America in red Ink (Reprint ed.). Princeton University Press. 2012.
Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37. https://doi.org/10.2307/2955359.
Johnson NL. Systems of frequency curves generated by methods of translation. Biometrika. 1949;36(1/2):149. https://doi.org/10.2307/2332539.
Karger HJ. Scamming the poor. Soc Policy J. 2004;3(1):39–54. https://doi.org/10.1300/J185v03n01_04.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;80–94. https://doi.org/10.2307/2626958
Mossakowski KN. Dissecting the influence of race, ethnicity, and socioeconomic status on mental health in young adulthood. Res Aging. 2008;30(6):649–71. https://doi.org/10.1177/0164027508322693.
Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72(8):800–8. https://doi.org/10.2105/AJPH.72.8.800.
Muntaner C, Eaton WW, Miech R, O’campo P. Socioeconomic position and major mental disorders. Epidemiol Rev. 2004;26(1):53–62. https://doi.org/10.1093/epirev/mxh001.
Nam Y, Huang J, Sherraden M. Asset definitions. In: Sherraden MW, McKernan S-M, editors. Asset building and low-income families. Urban Institute Press; 2008. p. 1–31.
Oliver ML, Shapiro TM. Black wealth, white wealth: a new perspective on racial inequality. Routledge; 2006.
Pearson JA. Can’t buy me whiteness: New lessons from the Titanic on race, ethnicity, and health. Du Bois Review: Social Science Research on Race. 2008;5(1):27–47.
Peplinski B, McClelland R, Szklo M. Associations between socioeconomic status markers and depressive symptoms by race and gender: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Ann Epidemiol. 2018;28(8):535–42. https://doi.org/10.1016/j.annepidem.2018.05.005.
Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Ann Rev Sociol. 2015;41(1):311–30. https://doi.org/10.1146/annurev-soc-073014-112305.
Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51(S):28–40. https://doi.org/10.1177/0022146510383498.
Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P. Should health studies measure wealth? A systematic review. Am J Prev Med. 2007;33(3):250–64. https://doi.org/10.1016/j.amepre.2007.04.033.
Richardson T, Elliott P, Roberts R. The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis. Clin Psychol Rev. 2013;33(8):1148–62. https://doi.org/10.1016/J.CPR.2013.08.009.
Rubin DB. Multiple imputation for survey nonresponse. Wiley; 1987.
Rumpf H-J, Meyer C, Hapke U, John U. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res. 2001;105(3):243–53. https://doi.org/10.1016/S0165-1781(01)00329-8.
Sherraden M, Clancy MM, Beverly SG. Taking child development accounts to scale: ten key policy design elements (CSD policy brief 18–08). 2018; https://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1043&context=csd_research
Sherraden MS, Huang J, Frey JJ, Birkenmaier J, Callahan C, Clancy MM, Sherraden M. Financial capability and asset building for all. American Academy of Social Work and Social Welfare; 2015. p. 1–29.
Sherraden M, Wayne. Assets and the poor: a new American welfare policy. M.E. Sharpe. 1991.
Shuey KM, Willson AE. Cumulative disadvantage and Black-White disparities in life-course health trajectories. Res Aging. 2008;30(2):200–25. https://doi.org/10.1177/0164027507311151.
Spilerman S. Wealth and stratification processes. Ann Rev Sociol. 2000;26(1):497–524. https://doi.org/10.1146/annurev.soc.26.1.497.
Squires GD. Organizing access to capital: advocacy and the democratization of financial institutions. Temple University Press. 2003; https://www.bibliovault.org/BV.book.epl?ISBN=9781592130269
Sun AR, Houle JN. Trajectories of unsecured debt across the life course and mental health at midlife. Soc Mental Health. 2020;10(1):61–79. https://doi.org/10.1177/2156869318816742.
Sun S, Huang J, Hudson DL, Sherraden M. Cash transfers and health. Annu Rev Public Health. 2021;42(1):363–80. https://doi.org/10.1146/annurev-publhealth-090419-102442.
Rothstein R. The color of law: a forgotten history of how our government segregated America. Liveright Publishing. 2017.
Von Hippel PT. Regression with missing Ys: an improved strategy for analyzing multiply imputed data. Sociol Methodol. 2007;37(1):83–117. https://doi.org/10.1111/j.1467-9531.2007.00180.x.
Walsemann KM, Ailshire JA, Gee GC. Student loans and racial disparities in self-reported sleep duration: evidence from a nationally representative sample of US young adults. J Epidemiol Community Health. 2016;70(1):42–8. https://doi.org/10.1016/S1047-2797(97)00051-3.
Walsemann KM, Gee GC, Gentile D. Sick of our loans: student borrowing and the mental health of young adults in the United States. Soc Sci Med. 2015;124:85–93. https://doi.org/10.1016/j.socscimed.2014.11.027.
Wei L, Parrish L, Ernst K, Davis D. Predatory profiling: the role of race and ethnicity in the location of payday lenders in California. 2012; https://doi.org/10.2139/ssrn.1531333
Williams B. Debt for sale: a social history of the credit trap. Philadelphia: Univ. Pa. Press; 2004.
Williams DR. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997;7(5):322–33.
Williams DR, Collins C. US socioeconomic and racial differences in health: patterns and explanations. Ann Rev Sociol. 1995;21(1):349–86. https://doi.org/10.1146/annurev.so.21.080195.002025.
Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(3):305–15. https://doi.org/10.1146/annurev-publhealth-040218-043750.
Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–25.
Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x.
Wu S, Wang X, Wu Q, Harris KM. Household financial assets inequity and health disparities among young adults: evidence from the national longitudinal study of adolescent to adult health. J Health Disparities Res Pract. 2018;11(1):122–135. https://pubmed.ncbi.nlm.nih.gov/31236310/
Acknowledgements
I thank Michael Sherraden, Shenyang Guo, Margaret S. Sherraden, Darrell Hudson, Hedy Lee, and Jin Huang for their valuable suggestions at various stages of this project. I gratefully acknowledge partial funding support from the Jane B. Aron Doctoral Fellowship from The National Association of Social Workers Foundation.
Funding
This research receives partial funding support from the Jane B. Aron Doctoral Fellowship from The National Association of Social Workers Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Consent for Publication
The author has approved the manuscript and agree with its submission to the journal.
Research Involving Human Participants and/or Animals
Not applicable.
Informed Consent
Not applicable. This research utilizes secondary data.
Conflict of Interest
The author declares no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sun, S. Building Financial Capability and Assets to Reduce Poverty and Health Disparities: Race/Ethnicity Matters. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01648-9
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40615-023-01648-9