African-American health: the role of the social environment.

Cooper and colleagues have noted that the forces affecting the health of minority populations are the same forces, on a less intensive scale, that affect the health of the overall population. That is, we can view the health of the African-American population as the visible tip of an iceberg. This tip of the iceberg is a function of the average health of the entire population. Thus, an effective strategy must address not only the tip, but also should attack the entire iceberg and reduce the risk that it is creating throughout the population. Similarly, Wallace and Wallace have shown how the mechanisms of hierarchical diffusion, spatial contagion, and network diffusion lead to the spread of health and social problems initially confined in inner cities to suburban areas and smaller cities. That is, because of the economic links typing various communities together, there are mechanisms that will ensure the diffusion of disease and disorder from one area to another. If unaddressed, the problems of stigmatized and marginalized urban populations will have adverse impacts on the health, well-being, and quality of life of the more affluent. Thus, investments that will improve the social conditions of a marginalized population can have long-term positive health and social consequences for the entire society. In summary, there are large and pervasive racial differences in health. Their causes are not obscure and unknown. The roots of black-white differences in health are not due primarily to differences in beliefs and biology. Instead, they are driven by fundamental societal inequalities. Today, we can make a new commitment to liberty, justice, and equality for all by mustering the political will to eliminate some of the fundamental inequities in society that lie at the foundation of health disparities.