The field of behavioral sciences
has some of the key answers
to some of the major crises that the United States faces,
in terms of health.
My name is David Williams.
My work is looking at social factors that affect health.
I think most Americans, when we think about health,
we think about medical care.
We think about access to medical care,
the quality of care that we receive,
but the scientific research is very clear:
that where we live, learn, work, and play
have more to do with our health than going to a doctor.
So when we talk about health and what can be done
to promote health, we really need to think
about the factors and the places where we spend most of our time
and the opportunities or barriers in those places
to lead a healthy lifestyle.
Does your neighborhood have access
to a full-service grocery store
where you can get access to fruits and vegetables?
Is your neighborhood free of crime
and is it safe to walk outside in the day?
Does your neighborhood
have access to green spaces and to parks
and to safe places to walk?
Low-income Americans are 3 times more likely
to die before the age of 65 than high-income Americans.
My earliest work started out looking
at inequalities in health, in terms of
socioeconomic inequalities in health.
Why does health vary by income
and educational and occupational status?
And many people don't realize this,
but the gaps in health in the United States,
by income and education,
are larger than the gaps in health by race.
It's an interesting sociological question, why, as a society,
we've historically paid complete attention
just to racial gaps in health
and not to the gaps by socioeconomic status.
Let me give you a concrete example.
Where you live in the United States,
for most people, determines where you go to school,
the quality of elementary and high school education,
and the quality of education then determines your access
to quality higher education, which determines your access
to quality jobs, which determines your access
to residence and quality neighborhoods,
which determines the quality of resources you have in life
to deal with all the things you will encounter.
In some states, there's a 13-year difference
in how long people live,
just linked to which county they live in.
All of these
are powerful ways in which our health is affected
that is shaped by the context in which we live.
Race has been what sociologists like to call "master status":
a "factor that determines your access
to virtually every resource within society."
Generally, even when we look at blacks and whites or Latinos
at the same levels of income or education,
there still is a residual effect of race,
so race still matters, then,
at every level of education and income
and that led to the question "What else is it about race
that still matters so much for health?"
What does it mean to be African American
in the United States and how does the experience of race
shape exposures that have consequences for health?
The "Everyday Discrimination" scale
is a 9-item set of questions that assess the ways
in which people are treated or the ways in which
people are treated in their day-to-day lives.
What the "Everyday Discrimination" scale does:
it tries to measure
how the experience, the way others treat them
and others view them, is different.
So it just captures the little indignities
that occur on a day-to-day basis
and what we are finding is that these chronic, minor,
ongoing experiences of incivility and discrimination
have long-term negative consequences for health.
That's kind of a powerful way in which racism affects health
that we seldom think about.
The idea that racism has consequences for health
is not new; it has been around for a hundred years.
But the actual, hard, scientific evidence
linking racism to actual disease processes,
like processes of inflammation and processes of
the subclinical development of heart disease, is new.
I think one of the things that I'm doing is encouraging people
to look at the intersections of inequalities,
looking at race and socioeconomic status together,
looking at the joint effect of both of those variables
and empirically documenting
the ways in which racism affects health.
The key to improving the health of America
is not linked to more medical care.
It's linked to factors outside the health care system
and paying attention to improving the quality of life
in the places where Americans spend most of their time:
our homes, our workplaces,
our schools, our neighborhoods, our communities
and if we can develop a culture of health
where we can make the healthy choice
the easy choice, we can put the United States
on a path to better health now and for the future.