African Americans living below poverty are two to three times more likely to report serious psychological distress than those living above poverty, leading some to be resistant to pharmacological therapies. In the United States, not only do we live in a culture that does not support mental health and well-being, it is the only industrialized nation with no national paid maternity leave and no federally required vacation. And for African Americans, the never-ending onslaught of the stress of systemic and personal racism and discrimination — both at the macro and micro levels — exacerbates what regular life in America brings.
There’s a strong relationship between socioeconomic status and health such that people at the lower end, people in poverty tend to have poorer health and tend to have fewer resources for dealing with the stressors of life. Poverty, parenting, racial and gender discrimination put Black women — particularly low- income Black women — are at a greater risk of having poor health. The term “Black” encompasses both African Americans and more recent African and Caribbean immigrants. African American communities across the US are culturally diverse, with immigrants from African nations, the Caribbean, Central America, and other countries. Access is a central point of contention since often times low income communities are not equipped with adequate facilities and services. Having to seek treatment outside of the place where you live is an added barrier and provides for another layer of issues related to time, work, and transportation.4 In addition, regional differences are significant in help-seeking behavior for African Americans according to Taylor, Hardison, and Chatters (1996).5 Since black women are compensated disproportionately lower than their white counterparts, they are also least likely to have adequate insurance.
To expand the awareness on how the U.S’s gender pay gap disproportionately affects African American women and their health, creating a community based intervention led by a social justice support group that targets working African American women that is both valid and culturally relevant, would fortify social norms and enhance structural norms that advocate compliance to equal pay protocols in the work force.
Although wage disparities are an example of structural racism (as the standard current pay advantages Caucasian men who are the dominant group while disadvantaging Black women who are the non-dominant group), the federal government just recognized that health disparities are caused by social determinants of health in 2010.1 Other examples of structural racism include segregated neighborhoods, standards used for pay advantages, difference in hours worked and disparities of bonuses/referral policies.
Economic stability (employment and wages) is a social determinant of health that accounts for 40% of health factors that contribute to health outcomes. Studies have shown that experiencing discrimination results in biological effects that cause increased rates of disease, disability and increased stress for African-Americans which impairs their health status (ex: hypertension, neonatal deaths, delivering preterm infants of very low birth weight).
The wage gap in the US diminishes the amount of income Black women have to spend on healthcare services which explains why many Black women have previously reported delaying or foregoing healthcare due to costs, including not filling a prescription, lack of adequate health care, cutting prescription dosages and skipping a test or treatment. More than 20 percent of Black Americans are uninsured compared to fewer than 12 percent of Whites, according to the Department of Health Human Services.
Making healthcare accessible and affordable for African Americans requires coordinated efforts across healthcare systems, and advocacy and activism in the policy arena. By including mental health assessments in primary care, there will be a reduced need for expensive specialized care; especially if the assessments are used to do early intervention, such as lifestyle changes and medications, before there is need or acute care. To address the employment and wage gap, the local and state governments along with community-led social support groups/organizations must to track hiring and wage data based on race and gender including data concerning minority women.
All companies should be required to publicly report hiring and wage data based on race and gender including data concerning minority women, along with providing health insurance for low wage and minority women workers. Addressing these challenges entails educating working Black women and large companies/employers who employ a large number of black women, about social determinants of health. This objective also entails helping employed Black women grasp certain aspects of financial literacy, expand their health literacy, providing additional resources to expand their awareness of their own limitations and capabilities of accessing affordable and efficient health care based on their income and promoting partnerships with local/city/state staffing agencies (ex: Workforce One) that can further our efforts of advocating jobs offerings/openings that comply with equal pay protocols.
References:
1. The Impact of Structural Racism in Employment and Wages on Minority Women's Health. American Bar Association. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/minority-womens-health/. Accessed March 1, 2021.
2. Reducing inequality. Encyclopædia Britannica. https://www.britannica.com/topic/income-inequality/Reducing-inequality. Accessed February 17, 2021.
3. Hamm, N. (2018, October 8). African-American Women and Depression. Retrieved from https://psychcentral.com/lib/african-american-women-and-depression/
4. Best Practice Highlights African Americans/Blacks. (n.d.). Retrieved from https://www.psychiatry.org/File Library/Psychiatrists/Cultural-Competency/Treating-Diverse-Populations/Best-Practices-AfricanAmerican-Patients.pdf
5. (PDF) Postpartum Depression Among African-American Women. (n.d.). Retrieved from https://www.researchgate.net/publication/10867385_Postpartum_Depression_Among_African-American_Women