Role of Partnerships: Second Annual Meeting of Child Health Services Researchers

Social Stratification: Implications for Understanding Racial, Ethnic and Class Disparities in Child Health and Development

Gontran Lamberty, Ph.D.
Chief, Research Branch, Health Resources and Services Administration

Lee Pachter, D.O.
Associate Professor, Pediatrics and Anthropology, University of Connecticut School of Medicine

Keith Crnic, Ph.D.
Head, Department of Psychology, Pennsylvania State University

Contents

Introduction
Overview of the Concept of Social Stratification
Influences on Health Disparities
Context and Developmental Issues for Minority Children

Introduction

This session provided a framework for examining health disparities within social contexts. Speakers explored the influence of social mechanisms (e.g., racial, ethnic, economic) on unequal distributions in health status.

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Overview of the Concept of Social Stratification

Dr. Lamberty cited the fact that racial, ethnic, and social class disparities exist in morbidity and mortality rates in the U.S., and noted that many causal explanations have been offered to account for these disparities. Among them are: biological pre-disposition, group position in the social structure, or a combination of biological and social factors. This presentation focused on the explanation of social stratification as a contributor to health disparities in this country.

Dr. Lamberty reviewed seven propositions that make up the theory of social stratification:

• Ascription to social class, ethnicity, and race is overlapping with resultant additive and multiplicative effects depending on the degree to which an individual occupies specific combinations of these social positions. Gender further complicates the situation.
• A social position such as social class, ethnicity and race carries with it varying degrees of segregation in the spatial, social and psychological environments.
• There are physical, social, and psychological environments that go along with the social position an individual is born into. Being born white or black, or being a working or upper class family entails a set of givens such as who one can marry, what neighborhood one can live in, the quality of the home, etc.
• Occupancy of social positions for a sizeable portion of the U.S. population is fixed at birth. This greatly magnifies the significance of the environments into which an individual is born and to which he/she may be exposed for an entire lifetime.
• Social positions such as social class, ethnicity and race are ascribed statuses- individuals are born into them.
• The effects of social stratification are shaped practically unimpeded over the life course of individuals.
• In socially stratified societies, individuals develop a hierarchical attribution system that consists of attitudes and beliefs about the self, as well as the person both above and below the social ladder. These stereotypes are quick to be activated and are likely to influence lay as well as professional judgement and decision-making.

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Influences on Health Disparities

Lee Pachter, D.O. explained a social mechanism to account for health disparities, and reviewed the social stratification theory: that society is arranged into a hierarchy of positions that are unequal with regard to:

• Power (ability to secure one's ends in life).
• Property (rights over goods and services).
• Status (judgement that one's position has prestige).
• Psychic gratification (other sources of pleasure and contentment).

Dr. Pachter noted that purely economic indicators (e.g., household income, wealth, deprivation) do not account for the unequal distribution of child health status. He suggested that racial and ethnic differences play an important role, and proposed a model of social stratification/child health status which suggests that disparities occur through promotion of residential segregation. Dr. Pachter cited the following data to illustrate residential segregation: Between 1970 and 1990, the number of urban poor families living in non-poor neighborhoods decreased from 45 percent to 30 percent, and the number living in poor neighborhoods rose from 38 percent to 41 percent. Evidently, poverty is becoming more concentrated.

Dr. Pachter explained three mechanisms by which residential segregation magnifies child health disparities: unequal distribution of economic capital, social capital, and psychological capital:

• The economic effects of residential segregation include: redlining, poor housing stock, fewer businesses/retailers, higher prices, and limited employment. The resulting health effects are unintentional injury, chronic disease (e.g., asthma), poor nutrition, and dental caries.
• Social capital includes the features of a social organization that facilitate cooperation for mutual benefits include: interpersonal trust, community participation, reciprocity, and availability of civic organizations.
• Effects of low psychological capital can be social (e.g., school, employment) or biological (e.g., stress). Environmental conditions such as racism, discrimination, chronic poverty, and violence can give rise to psychological attributes such as low self-esteem, low self-efficacy, and loss of control to an external locus.

Dr. Pachter suggested that given the effect of social stratification on health care disparities, a future research focus could be on what is different about children and families who thrive despite living in high-risk environments. The interconnectivity of social capital and child health is a multidisciplinary approach that speaks the language of policymakers.

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Context and Developmental Issues for Minority Children

Keith Crnic, Ph.D. presented an integrative model for developmental competencies in minority children. He emphasized the importance of context, because it coerces behavior differently in different settings. A context could be a school, neighborhood, or health care system, and each context contributes to the developmental process and outcomes in children. Contexts vary as a function of cultural influences, values and goals. Dr. Crnic noted that any particular context can be both inhibiting and promoting.

There are specific goals, values, attitudes, and behaviors that set minority children and their families apart from the dominant culture, and contribute to children's development. A family's structure, roles, values, beliefs, and goals form the primary developmental contexts for children, and may be influenced by traditional/cultural legacies, economic/political histories, migration/acculturation, or current contextual demands.

Children also actively contribute to their own development. This depends on their age, temperament, degree of self-regulation, health status and biological factors, as well as physical characteristics. Dr. Crnic noted that the influences of social stratification and culture on children's development are not simply additive or linear in function. Rather, the effects are mediational (i.e., indirect or attenuating), moderational (i.e., buffering or intensifying), or organizational (i.e., different factors exert their influence on children at different developmental points in time).

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Current as of June 2000

Internet Citation:

Social Stratification: Implications for Understanding Racial, Ethnic, and Class Disparities in Child Health and Development. Role of Partnerships: Second Annual Meeting of Child Health Services Researchers. June 27, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/chsr2soc.htm

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