Health Disparities and the Black Middle Class: Overview, Empirical Findings, and Research Agenda

Part of the Handbooks of Sociology and Social Research book series (HSSR)


Health disparities may follow along a series of “…events signified by a difference in (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny” (Carter-Pokras and Baquet 2002: 427). This chapter focuses on three types of health disparities assessed by evaluating the gap in health status or a given health outcome. First, we describe Black–White differences across health and refer to these patterns as general health disparities. Second, we present some research demonstrating the standard SES-health gradient where those at the top of the economic hierarchy are in much better health than those at the bottom of the economic hierarchy. We focus specifically on the health of African Americans since our ultimate goal is to better understand differences within this population. Third, we emphasize a more recent disparity highlighted by some health scholars – that of a paradox among the Black middle class. These inequalities are surprising (and hence referred to as paradoxical) because the patterns are counter-intuitive to the SES-health gradient.


Life Satisfaction Social Capital Middle Class Health Disparity Lower Class 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alba RD, Logan JR, Bellair PE (1994) Living with crime: the implications of racial/ethnic differences in suburban location. Soc Forces 73:395–434Google Scholar
  2. Bahr H, Chadwick BA, Stauss JH (1979) American ethnicity. D.C. Heath and Company, Massachusetts, pp 128–129Google Scholar
  3. Battle J, Wright E (2002) W.E.B. Du Bois’s talented tenth: a quantitative assessment. J Black Stud 32:654–672Google Scholar
  4. Berkman LF, Glass T (2000) Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 137–173Google Scholar
  5. Blank RM, Dabady M, Citro CF (eds) (2004) Measuring racial discrimination. National Academies Press, Washington, DCGoogle Scholar
  6. Breslau J, Kendler KS, Maxwell Su, Gaxiola-Aguilar S, Kessler RC (2005) Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 35:317–327Google Scholar
  7. Broman CL, Neighbors HW, Delva J, Torres M, Jackson JS (2008) Prevalence of substance use disorders among African Americans and Caribbean Blacks in the national survey of American life. Am J Public Health 97:1–9Google Scholar
  8. Browning CR, Feinberg SL, Dietz RD (2004) The paradox of social organization: networks, collective efficacy, and violent crime in urban neighborhoods. Soc Forces 83:503–534Google Scholar
  9. Carter-Pokras O, Baquet C (2002) What is a ‘health disparity’? Public Health Rep 117:426–433Google Scholar
  10. Champion AG (1994) International migration and demographic change in the developed world. Urban Studies 31:653–678Google Scholar
  11. Chatters LM, Taylor RJ, Neighbors HW (1989) Size of informal helper network mobilized during a serious personal problem among Black Americans. J Marriage Fam 51:667–676Google Scholar
  12. Cockerham WC (1990) A test of the relationship between race, socioeconomic status, and psychological distress. Soc Sci Med 31:1321–1331Google Scholar
  13. Colen CG, Geronimus AT, Bound J, James S (2006) Maternal upward socioeconomic mobility and Black–White disparities in infant birth weight. Am J Public Health 96:2032–2039Google Scholar
  14. Collins JW Jr, David RJ, Symons R, Handler A, Wall S, Andes S (1998) African-American mothers’ perception of their residential environment, stressful life events, and very low birth weight. Epidemiology 9:286–289Google Scholar
  15. Crimmins EM, Saito Y (2001) Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences. J Soc Sci Med 52:1629–1641Google Scholar
  16. Cummings JL, Jackson PB (2008) Race, gender, and SES disparities in self-assessed health, 1974–2004. Res Aging 30:137–167Google Scholar
  17. Davis JF (1991) Who is Black? State University of Pennsylvania, University Park, PAGoogle Scholar
  18. Drake SC, Cayton HR (1945) Black metropolis: a study of Negro life in a northern city. Harper & Rowman, New YorkGoogle Scholar
  19. Drevenstedt GL (1998) Race and ethnic differences in the effects of religious attendance on subjective health. Rev Relig Res 39:245–263Google Scholar
  20. DuBois WEB (1899) The philadelphia negro. University of Pennsylvania Press, Philadelphia, PAGoogle Scholar
  21. Durant TJ, Sparrow KH (1997) Race and class consciousness among lower- and middle-class Blacks race and class consciousness among lower- and middle-class Blacks. J Black Stud 27:334–351Google Scholar
  22. Ellison CG (1990) Family ties, friendship, and subjective well-being among Black Americans. Journal of Marriage and the Family 52:298–310Google Scholar
  23. Farmer MM, Ferraro KF (1997) Distress and perceived health: mechanisms of health decline. J Health Soc Behav 38:298–311Google Scholar
  24. Forman T (2003) The social psychological costs of racial segmentation in the workplace: a study of African Americans’ well being. J Health Soc Behav 44:332–352Google Scholar
  25. Fouron G (1983) The Black dilemma in the US: the Haitian experience. J Caribb Stud 3:242–265Google Scholar
  26. Frazier EF (1957) Black bourgeoisie: the rise of a new middle class. Free, New YorkGoogle Scholar
  27. Gatewood WB (2000) Aristocrats of color: the Black elite, 1880–1920. University of Arkansas Press, FayettevilleGoogle Scholar
  28. Geronimus AT, Hicken M, Keene D, Bound J (2006) Weathering’ and age patterns of allostatic load scores among Blacks and Whites in the United States. Am J Public Health 96:826–833Google Scholar
  29. Giddens A (1973) The class structure of the advanced societies. Hutchinson University Library, LondonGoogle Scholar
  30. Gordon A (1998) The new diaspora – African immigration to the United States. J Third World Stud 15:79–103Google Scholar
  31. Grieco E (2004) U.S. in focus: the african foreign born in the United States. Migration Policy Institute, Washington, DCGoogle Scholar
  32. Grieco EM, Cassidy RC (2001) Overview of race and Hispanic origin: census 2000 brief. U.S. Census Bureau, Washington, DCGoogle Scholar
  33. Harrell JP, Hall S, Talliaferro J (2003) Physiological responses to racism and discrimination: an assessment of the evidence. Am J Public Health 93:243–248Google Scholar
  34. Hayward MD, Miles TP, Crimmins EM, Yang Yu (2000) The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Am Sociol Rev 65:910–930Google Scholar
  35. Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P (2004) Sample designs and sampling methods for the collaborative psychiatric epidemiology studies (CPES). Int J Methods Psychiatr Res 13:221–240Google Scholar
  36. Herzog AR, Rodgers WL, Woodworth J (1982) Subjective well-being among different age groups. The University of Michigan, Institute for Social Research, Survey Research Center, Ann Arbor, MIGoogle Scholar
  37. Hochschild J (1995) Facing up to the American dream: race, class, and the soul of the nation. Princeton University Press, Princeton, NJGoogle Scholar
  38. Hughes M, Thomas M (1998) Race, class, and quality of life in America. 1972–1996. Am Sociol Rev 63:785–795Google Scholar
  39. Hummer RA, Rogers RG, Nam CB, LeClere FB (1999) Race/ethnicity, nativity, and U.S. adult mortality. Soc Sci Q 80:136–153Google Scholar
  40. Hwang SS, Fitzpatrick KM, Helm D (1998) Class differences in racial attitudes: a divided Black America? Sociol Perspect 41:367–380Google Scholar
  41. Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37Google Scholar
  42. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, Trierweiler SJ, Williams DR (2004) The national survey of American life: a study of racial, ethnic, and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res 13:196–207Google Scholar
  43. Jackson PB (2005) Health inequalities among minority populations. J Gerontol 60B(Special issue II):63–67Google Scholar
  44. Jackson PB, Stewart Q (2003) A research agenda for the Black middle class: work stress, survival strategies, and mental health. J Health Soc Behav 44:442–455Google Scholar
  45. Jacobson E (2003) An introduction to haitian culture for rehabilitation service providers. Center for International Rehabilitation Research Information and Exchange (CIRRIE). University of Buffalo, State University of New York, New York.
  46. James S, Van Hoewyk J, Belli RF, Strogatz DS, Williams DR (2006) Life-course socioeconomic position and risk for hypertension in African American men: the pitt county study. Am J Public Health 96:812–817Google Scholar
  47. James W (2002) Explaining Afro-Caribbean social mobility in the United States: beyond the Sowell thesis. Comp Stud Soc Hist 44:218–262Google Scholar
  48. Kalmijn M (1996) The socioeconomic assimilation of Caribbean American Blacks. Soc Forces 74:911–930Google Scholar
  49. Kawachi I, Berkman LF (eds) (2003) Neighborhoods and health. Oxford University Press, New York, NYGoogle Scholar
  50. Keil JE, Tyroler HA, Sandifer SH et al (1977) Hypertension: effects of social class and racial admixture. The results of a cohort study in the Black population of Charleston, South Carolina. Am J Public Health 67:6234–6639Google Scholar
  51. Kennedy R (2004) Finding a proper name to call Black Americans. Journal of Blacks in Higher Education 46:72–83Google Scholar
  52. Kessler RC, Neighbors H (1986) A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav 27:107–115Google Scholar
  53. Kessler RC, Katherine A, McGonagle SZ, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM- III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51:8–19Google Scholar
  54. Kessler RC, Mickelson KD, Williams DR (1999) The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav 40:208–30Google Scholar
  55. Keyes C, Shmotkin D, Ryff CD (2002) Optimizing well-being: the empirical encounter of two traditions. J Pers Soc Psychol 82:1007–1022Google Scholar
  56. Kohn M (1977) Class and conformity: a study in values, with a reassessment. University of Chicago Press, ChicagoGoogle Scholar
  57. Korgen K (1998) From Black to biracial. Praeger, Westport, CTGoogle Scholar
  58. Krivo LJ, Peterson RD (2000) The structural context of homicide: accounting for racial differences in process. Am Sociol Rev 65:547–559Google Scholar
  59. Kronus S (1971) The Black middle class. Merrill, Columbus, OHGoogle Scholar
  60. Kubrin C, Weitzer R (2003) Retaliatory homicide: concentrated disadvantage and neighborhood culture. Soc Probl 50:157–180Google Scholar
  61. Lacy KR (2007) Blue-chip Black: race, class, and status in the new Black middle class. The University of California Press, BerkeleyGoogle Scholar
  62. Landry B (1987) The new Black middle class. University of California Press, BerkeleyGoogle Scholar
  63. Lareau A (2002) Invisible inequality: social class and child rearing in Black families and White families. Am Sociol Rev 67:747–776Google Scholar
  64. Levine R, Foster JE, Fullilove RE, Fullilove MT, Briggs NC, Hull PC, Hennekens CH (2001) Black–White inequalities in mortality and life expectancy, 1933–1999: implications for healthy people 2010. Public Health Rep 116:474–483Google Scholar
  65. Lin N (2000) Inequality in social capital. Contemp Sociol 29:785–795Google Scholar
  66. Logan JR, Deane G (2003) Black diversity of metropolitan America. University at Albany Lewis Mumford Center for Comparative Urban and Regional Research, Albany, NYGoogle Scholar
  67. Lu MC, Halfon N (2003) Racial and ethnic disparities in birth outcomes: a life-course perspective. Mater Child Health J 7:13–30Google Scholar
  68. Marmot MG, Ryff CD, Bumpass LL, Shipley MJ, Marks NF (1997) Social inequalities in health: next questions and converging evidence. Soc Sci Med 44:901–910Google Scholar
  69. Marsden PV (1988) Homogeneity in confiding networks. Soc Networks 10:57–76Google Scholar
  70. Marsh K, Darity WA Jr, Cohen P, Casper L, Salters D (2007) The emerging Black middle class: single and living alone. Soc Forces 86:735–762Google Scholar
  71. Marshall G, Roberts S, Burgoyne C (1996) Social class and underclass in Britain and the United States. Br J Sociol 47:22–44Google Scholar
  72. Martinez R Jr (2003) Moving beyond Black and White violence: African American, Haitian and Latino homicides in Miami. In: Hawkins DF (ed) Interpersonal violence: the ethnicity, race and class nexus. Cambridge University Press, New York City, pp 22–43Google Scholar
  73. Martineau WH (1977) Informal social ties among urban Black Americans: some new data and a review of the problem. J Black Stud 8:83–104Google Scholar
  74. Massey D, Condran GA, Denton NA (1987) The effect of residential segregation on Black social and economic well-being. Soc Forces 66:29–57Google Scholar
  75. McEwen BS, Seeman T (1999) Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Annu NY Acad Sci 896:30–47Google Scholar
  76. McNulty TL, Holloway SR (2000) Race, crime, and public housing in Atlanta: testing a conditional effect hypothesis. Soc Forces 79:707–729Google Scholar
  77. Morenoff J, Sampson RJ (1997) Violent crime and the spatial dynamics of neighborhood transition – Chicago, 1970–1990. Soc Forces 76:31–64Google Scholar
  78. Musick MA (2000) Theodicy and life satisfaction among Black and White Americans. Sociol Relig 61:267–287Google Scholar
  79. National Center for Health Statistics (NCHS) (2007) Health, United States with chartbook on trends in the health of Americans. U.S. Government Printing Office, Hyattsville, MarylandGoogle Scholar
  80. Neighbors HW (1987) Improving the mental health of Black Americans: lessons from the community mental health movement. Milbank Q 65:348–380Google Scholar
  81. Oliver ML (1988) The urban Black community as network: toward a social network perspective. Sociol Q 29:623–645Google Scholar
  82. Oliver ML, Shapiro T (1995) Black wealth, White wealth: a new perspective on racial inequality. Routledge, New YorkGoogle Scholar
  83. Owens ML (1997) Renewal in a working-class black neighborhood. J Urban Aff 19:183–205Google Scholar
  84. Pallotto EK, Collins JW Jr, David RJ (2000) Enigma of maternal race and infant birth weight: a population-based study of US-born Black and Caribbean-born black women. Am J Epidemiol 151:1080–1085Google Scholar
  85. Pamuk E, Makuc D, Heck K, Reuban C (1998) Socioeconomic status and health chartbook. National Center for Health Statistics, Health, United States, Hyattsville, MDGoogle Scholar
  86. Pattillo-McCoy M (1999) Black picket fences: privilege and peril among the Black middle class. University of Chicago Press, ChicagoGoogle Scholar
  87. Peterson R, Krivo L (1999) Racial segregation, the concentration of disadvantage, and Black and White homicide victimization. Sociol Forum 14:465–493Google Scholar
  88. Portes A (1998) Social capital: its origins and applications in modern sociology. Ann Rev Sociol 22:1–24Google Scholar
  89. Preston S, Elo IT (1995) Are educational differentials in adult mortality increasing in the United States. J Aging Health 74:476–496Google Scholar
  90. Read JG, Emerson MO (2005) Racial context, Black immigration and the U.S. Black/White health disparity. Soc Forces 84:181–199Google Scholar
  91. Riolo S, Nguyen TA, Greden JF, King CA (2005) Prevalence of depression by race/ethnicity: findings from the national health and nutrition examination survey III. Am J Public Health 95:998–1000Google Scholar
  92. Rockquemore KA, Brunsma DL (2002) Beyond Black: biracial identity in America. Sage Publications, Newbury Park, CAGoogle Scholar
  93. Rose F (1997) Toward a class-cultural theory of social movements: reinterpreting new social movements. Sociol Forum 12:461–494Google Scholar
  94. Ross CE, Mirowsky J (2002) Family relationships, social support and subjective life expectancy. J Health Social Behav 43:469–489Google Scholar
  95. Ruggles S, David Hacker J, Sobek M (1995) Overview of the integrated public use microdata series. Hist Methods 28:33–39Google Scholar
  96. Sampson RJ, Morenoff JD (1997) Ecological perspectives on the neighborhood context of urban poverty: past and present. In: Brooks-Gunn J, Duncan GJ, Aber JL (eds) Neighborhood poverty. Russell Sage Foundation, New York, NY, pp 1–22Google Scholar
  97. Schnittker J (2007) Working more and feeling better: women’s health, employment and family life, 1974–2004. Am Sociol Rev 72:221–238Google Scholar
  98. Schuessler RF (1982) Measuring social life feelings. Jossey-Bass, San Francisco.Google Scholar
  99. Schuessler RF, Freshnock L (1978) Measuring attitudes toward self and others in society: state of the art. Social Forces 56:1228–1244Google Scholar
  100. Schulz A, Williams D, Israel B, Becker A, Parker E, James SA, Jackson J (2000) Unfair treatment, neighborhood effects, and mental health in the detroit metropolitan area. J Health Social Behav 41:314–332Google Scholar
  101. Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS (1997) Price of adaptation – allostatic load and its health consequences. Arch Intern Med 157:2259–2268Google Scholar
  102. Singh GK, Miller BA (2004) Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health 95:114–121Google Scholar
  103. Singh GK, Yu SM (1996) Adverse pregnancy outcomes: differences between U.S. and foreign-born women in major U.S. racial and ethnic groups. Am J Public Health 86:837–843Google Scholar
  104. Somervell PD, Leaf PJ, Weissman MM, Blazer DG, Bruce ML (1989) The prevalence of major depression Black and White adults in five United States communities. Am J Epidemiol 130:725–735Google Scholar
  105. Smith KP, Christakis NA (2008) Social networks and health. Ann Rev Sociol 34:405–429Google Scholar
  106. Taylor J, Turner RJ (2002) Perceived discrimination, social stress, and depression in the transition to adulthood: racial contrasts. Soc Psychol Q 65:213–225Google Scholar
  107. Thoits PA (1995) Stress, coping and social support processes: where are we? What next? J Health Social Behav 35:53–79, Extra IssueGoogle Scholar
  108. Thomas ME, Holmes BJ (1992) Determinants of satisfaction for Blacks and Whites. Sociol Q 33:459–472Google Scholar
  109. Treiman DJ (1977) Occupational prestige in comparative perspective. Academic, New YorkGoogle Scholar
  110. Census Bureau US (2000) Statistical abstract of the United States: 2000. U.S. Government Printing Office, Washington, DCGoogle Scholar
  111. U.S. Department of State (2002) 1990 and 1992 statistical yearbook of the immigration and naturalization service. U.S. Department of Justice, 1991, and 1993, Washington, DCGoogle Scholar
  112. Vargas CM, Ingram DD, Gillum RF (2000) Incidence of hypertension and educational attainment the NHANES I epidemiologic follow-up study. Am J Epidemiol 152:272–278Google Scholar
  113. Waters MC (1996) Ethnic and racial groups in the USA: conflict and cooperation. In: Rupensinghe K, Tishkov V (eds) Ethnicity and power in the contemporary world. United Nations, Tokyo, pp 236–262Google Scholar
  114. Waters MC (1999) Black identities: West Indian immigrant dreams and American realities. Russell Sage Foundation, New York, NYGoogle Scholar
  115. Williams DR (1997) Race and health: basic questions, emerging directions. Ann Epidemiol 7:322–333Google Scholar
  116. Williams DR (2000) Race and health in Kansas: data, issues, directions. In: Tarlov AR, St Peter RF (eds) The society and population health reader. New, New York, pp 236–258Google Scholar
  117. Williams DR (2001) Racial variations in adult health status: patterns, paradoxes, and prospects. In: Smelser NJ, Wilson WJ, Mitchell F (eds) America becoming: racial trends and their consequences, vol II. National Academy Press, Washington, DC, pp 371–410Google Scholar
  118. Williams DR (2003) The health of men: structured inequalities and opportunities. Am J Public Health 93:724–731Google Scholar
  119. Williams DR (2004) Health and the quality of life among African Americans. In: Daniels LA (ed) The state of Black America. National Urban League, New York, NY, pp 115–138Google Scholar
  120. Williams DR, Collins C (1995) U.S. socioeconomic and racial differences in health. Annu Rev Sociol 21:349–386Google Scholar
  121. Williams DR, Jackson PB (2005) Social sources of health disparities. Health Aff 24:325–334Google Scholar
  122. Williams DR, Gonzalez HM, Neighbors H et al (2007) 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 64:305–315Google Scholar
  123. Williams, DR, Takeuchi, D, Adair, R (1992) Socioeconomic status and psychiatric disorder among Blacks and Whites. Social Forces 71:179–194Google Scholar
  124. Williamson J (1980) New people: miscegenation and mulattoes in the United States. Free, New YorkGoogle Scholar
  125. Willie CV (1974) The Black family and social class. Journal of Orthopsychiatry 44:50–60Google Scholar
  126. Wilson WJ (1978) The declining significance of race: Blacks and changing American institutions. University of Chicago Press, ChicagoGoogle Scholar
  127. Winn P (1992) Americas: the changing face of Latin America and the Caribbean. Pantheon, New YorkGoogle Scholar
  128. Wright EO (1979) Class structure and income determination. Academic, New YorkGoogle Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SociologyIndiana UniversityBloomingtonUSA

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