Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Int J Health Policy Manag. 2018 Jan 1;7(1):1-9. doi: 10.15171/ijhpm.2017.90.
The health effects of economic resources (eg, education, employment, and living place) and psychological assets (eg, self-efficacy, perceived control over life, anger control, and emotions) are well-known. This article summarizes the results of a growing body of evidence documenting Blacks' diminished return, defined as a systematically smaller health gain from economic resources and psychological assets for Blacks in comparison to Whites. Due to structural barriers that Blacks face in their daily lives, the very same resources and assets generate smaller health gain for Blacks compared to Whites. Even in the presence of equal access to resources and assets, such unequal health gain constantly generates a racial health gap between Blacks and Whites in the United States. In this paper, a number of public policies are recommended based on these findings. First and foremost, public policies should not merely focus on equalizing access to resources and assets, but also reduce the societal and structural barriers that hinder Blacks. Policy solutions should aim to reduce various manifestations of structural racism including but not limited to differential pay, residential segregation, lower quality of education, and crime in Black and urban communities. As income was not found to follow the same pattern demonstrated for other resources and assets (ie, income generated similar decline in risk of mortality for Whites and Blacks), policies that enforce equal income and increase minimum wage for marginalized populations are essential. Improving quality of education of youth and employability of young adults will enable Blacks to compete for high paying jobs. Policies that reduce racism and discrimination in the labor market are also needed. Without such policies, it will be very difficult, if not impossible, to eliminate the sustained racial health gap in the United States.
经济资源（例如教育、就业和生活地点）和心理资产（例如自我效能感、对生活的感知控制、愤怒控制和情绪）对健康的影响是众所周知的。本文总结了越来越多证据的结果，这些证据记录了黑人的回报减少，即与白人相比，黑人从经济资源和心理资产中获得的健康收益系统地减少。由于黑人在日常生活中面临结构性障碍，与白人相比，同样的资源和资产为黑人带来的健康收益更小。即使在资源和资产享有平等机会的情况下，这种不平等的健康收益也会导致美国黑人和白人之间始终存在种族健康差距。在本文中，根据这些发现提出了一些公共政策建议。首先，公共政策不应仅仅侧重于平等获得资源和资产，还应减少阻碍黑人的社会和结构性障碍。政策解决方案应旨在减少各种形式的结构性种族主义，包括但不限于差异薪酬、居住隔离、教育质量较低和黑人社区和城市社区的犯罪。由于收入并没有表现出与其他资源和资产相同的模式（即收入对白人黑人和黑人的死亡率风险降低产生了类似的影响），因此强制执行平等收入和提高边缘化人群最低工资的政策至关重要。提高青年教育质量和青年就业能力将使黑人能够竞争高薪工作。还需要减少劳动力市场中的种族主义和歧视政策。如果没有这些政策，就很难甚至不可能消除美国持续存在的种族健康差距。
