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

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Handbook of the Sociology of Health, Illness, and Healing

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

Abstract

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.

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Notes

  1. 1.

    The number of individuals who identify as Black may be decreasing as more Blacks adopt a biracial or immigrant identity (Korgen 1998; Rockquemore and Brunsma 2002; Waters 1996, 1999).

  2. 2.

    In another series of studies of overall birth weight, African-born Black women experienced lower rates of very low birth weight compared to African American women (Williams and Collins 1995), and Black Caribbean (75% from Jamaica, Haiti, Belize) women immigrants gave birth to heavier infants than African-American women (Pallotto et al. 2000).

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Author information

Authors and Affiliations

  1. Department of Sociology, Indiana University, Ballantine 744, Bloomington, IN, 47405, USA

    Pamela Braboy Jackson

Authors
  1. Pamela Braboy Jackson
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  2. Jason Cummings
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Corresponding author

Correspondence to Pamela Braboy Jackson .

Editor information

Editors and Affiliations

  1. Institute of Social Research, Indiana University, E. Third Street 1022, Bloomington, 47405, Indiana, USA

    Bernice A. Pescosolido

  2. Institute of Social Research, Indiana University, E. Third Street 1022, Bloomington, 47405, Indiana, USA

    Jack K. Martin

  3. Institute of Social Research, Indiana University, E. Third Street 1022, Bloomington, 47405, Indiana, USA

    Jane D. McLeod

  4. , National Primary Care Research and Devel, The University of Manchester, Oxford Street, Manchester, M13 9PL, United Kingdom

    Anne Rogers

Appendices

Appendix A. The dimensions of stratification identified by a select group of scholars to define the black middle class

Scholar

Occupation

 

Income

 

Education

 

Home ownership

 

Place of residence

 

Other

DuBois (1899)

X

and

X

  

and

X

  

and

Respectable; politically active

Drake and Cayton (1945)

  

X

and

X

    

and

Political power

Frazier (1957)

X

or

X

      

and

Moral values; Org. membership

Willie (1974)

X

and/or

X

and/or

X

    

and

Dual earner household

Wilson (1978)

X

          

Oliver and Shapiro (1995)

X

or

X

or

X

and/or

X

  

and/or

Wealth

Durant and Sparrow (1997)

  

X

and

X

      

Pattillo-McCoy (1999)

X

or

X

or

X

or

X

and

X

and

Voting

Willie and Reddick (2003)

X

and/or

X

and/or

X

      

Lacy (2007)

  

X

    

and

X

  

Appendix B. Percentage of Black adults who qualify as members of the middle class based on select criteria linked to the dimensions of stratification

Scholar

Occupation

Incomea

Education

Home ownership

Criteria

% MC

Criteria

% MC

Criteria

% MC

Criteria

% MC

Willie (1974)

b,c

39.9

Above Ntl. mediand

35.0

SC

44.7

  

Wilson (1978)

b,c,e

56.1

      

Landry (1987)

b,c,f

48.6

     

52.5

Oliver and Shapiro (1995)

b,c

39.9

$33,664

52.9

College

14.6

 

52.5

Hochschild (1995)

  

Upper one-third of income for Blacksg

30.3

SC

44.7

  

Durant and Sparrow (1997)

  

$16,608h

53.9

SC

44.7

  

Pattillo-McCoy (1999)

b,c

39.9

Income-to-needs ratio 2 or more

58.5

College

14.6

 

52.5

Lareau (2002, 2003)

b

19.9

      

Lacy (2007)

  

$30,000 and higherh

30.4

    
  1. a1999 Inflation adjusted values are presented for income in 1999 (Consumer Price Index)
  2. bProfessional/managerial
  3. cTechnical, sales, administrative
  4. d$53,000
  5. eCraftsmen, foremen
  6. fLimited service jobs (police, firemen, and kindred workers)
  7. gUpper one-third of income for $58,300
  8. hPersonal incomeSC refers to Some College

Appendix C. Description of measures used from the National Study of American Life

Variable name

Description

Social characteristics

Race/ethnicity

African-Americans; all Caribbeans (then subdivided into Haitians, English-speaking Caribbean Blacks, Spanish speaking Caribbean Blacks, French/Dutch speaking Caribbean Blacks), and non-Hispanic Whites

Social class

Education

Lower class

Less than high school, high school diploma, and some college  =  1

Middle class

College degree and higher  =  1

Income

Lower class

<$39,999  =  1

Middle class

$40,000–$80,000  =  1

Upper class

$80,001 and higher  =  1

Occupation

Lower class

Other profession  =  1

Middle class

Professional/managerial (white collar)  =  1

Physical health

Chronic health problems

Have you ever been diagnosed by a physician or health professional with any of the following (1) arthritis, (2) ulcers, (3) cancer, (4) hypertension, (5) diabetes, (6) liver problems, (7) kidney problems, (8) stroke, (9) asthma, (10) chronic lung disease, (11) blood circulation, (12) sickle cell disease, (13) heart trouble, (14) glaucoma, (15) fertility problems, and (16) osteoporosis. These items were summed to form a chronic health index.

Acute health problems

Have you had any of these in the past 12 months (1) migraines/bad headaches, (2) hearing problems, (3) visual problems, (4) allergies or infections, and (5) back problems? These items were summed to form an acute health index.

Perceived physical health

How would you rate your overall physical health? Response categories were: 1  =  excellent, 2  =  very good, 3  =  good, 4  =  fair, and 5  =  poor. Recoded such that high scores represent higher perceived health.

Mental health

Diagnostic assessments (lifetime DSM-IV) a

Mood

Lifetime rates of mood disorders (major depression, dysthymia, and bipolar)

Anxiety

Lifetime rates of anxiety disorders (panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder)

Substance

Lifetime rates of substance use disorders (alcohol abuse, alcohol dependence, drug abuse, drug dependence)

Any disorder

Lifetime rates of any disorder (a combination of the DSM-IV disorder groups listed below)

Symptoms

 

Non-specific

Non-specific distress (NSD) is a 30-day symptoms checklist consisting of ten items. “In the past 30 days, how often did you feel (1) you had crying spells; (2) restless; (3) depressed; (4) you could not get going; (5) you enjoyed life; (6) hopeful about the future; (7) everything you did was an effort; (8) you had trouble focusing; (9) happy; (10) people were unfriendly?” Response categories for both subscales were (1) most or all of the time; (2) occasionally; (3) some of the time; (4) rarely or never. All items were reverse coded and summed so that a high score represents high NSD (alpha  =  0.76)

Quality of life

Perceived mental health (PMH)

“How would you rate your overall mental health at the present time?” Responses included 1  =  excellent; 2  =  very good; 3  =  good; and 4  =  poor. Recoded such that high scores represent high perceived mental health

Life satisfaction (LS)

“In general, how satisfied are you with your life as a whole these days?” Responses ranged from 1  =  very dissatisfied to 4  =  very satisfied

Happiness

“Taking all things together, how would you say things are these days?” Responses ranged from 1  =  very happy these days, to 4  =  not happy at all these days. Recoded such that high scores represent much happiness

  1. n  =  6,082
  2. aAssessed using the Composite International Diagnostic Interview (CIDI)

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Jackson, P.B., Cummings, J. (2011). Health Disparities and the Black Middle Class: Overview, Empirical Findings, and Research Agenda. In: Pescosolido, B., Martin, J., McLeod, J., Rogers, A. (eds) Handbook of the Sociology of Health, Illness, and Healing. Handbooks of Sociology and Social Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7261-3_20

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