Economic Instability and the Social Determinants of Black Health

What does the economic justice message in Martin Luther King Jr.’s March 14, 1966, essay in The Nation have to do with this year’s Black History Month theme of Black Health and Wellness? Based on King’s assertion that “jobs are harder to create than voting rolls,” one might initially conclude, “very little,” but in fact his economic message has strong connections to health and wellness.

This blog first discusses how the pre-pandemic employment instability of Black Americans continues to reflect fragility. Second, the blog discusses how the persistent lack of economic security manifests itself in lower health and wellness outcomes. Third, the blog offers several ideas on how to make jobs more secure and thus improve the health and wellness of all, but especially Black Americans.

“Jobs Are Harder to Create Than Voting Rolls”

King cited the following 1960s points to support his claim about the difficulty of creating jobs with security for Black workers.

• Often undercut by layoffs, Black people were hit hardest, especially during tough economic times.
• Black workers were the first fired and the last hired: Declining unemployment rates for the overall population often masked slow gains for Black workers.
• Discrimination made it difficult to achieve job progression and career development, which in turn made it hard to gain seniority.
• Black workers lacked full-time and full-year employment, making income more volatile.
• Black Americans needed employment that feeds, clothes, educates and stabilizes a family.
• Even at low levels of unemployment, Black workers often lacked quality jobs.

Based on these points, King concluded that Black Americans faced an intense level of employment instability, and it reflected the fragility of Black “ambitions and economic foundations.”

King is describing a lack of job security. That lack lessens health and wellness. His measures listed above are both key labor market indicators and important social determinants of health. These show the environments in which people are raised, and the broader set of structures that frame how people live.

King’s Findings in 1966 Are Still Relevant Today

Although economic gains were made during the 1960s and 1970s, it is discouraging how the experiences of Black people in 1966 remain relevant today. Starting in the 1980s, the absolute and relative economic position of Black Americans hit a wall. In the past five recessions, Black jobless rates started higher than white jobless rates and often grew faster. The source is the author’s calculations using data from the U.S. Bureau of Labor Statistics and the NBER Business Cycle Dating Committee. (See FRED graph below.) Today, Black men’s earnings relative to white men’s are at their 1979 level, and if the disproportionate incarceration of Blacks is accounted for, their status slips to that of 1950.

Regardless of which labor market measure is used, persistent and large racial differences in income, employment, unemployment, earnings and occupation can be seen and remain today.The source is the author’s analysis using BLS data, an analysis that was presented by the author in a Jan. 13, 2022, speech for the Bureau of Labor Statistics, “Honoring the Life and Work of Martin Luther King Jr.” Health analysts call these labor market outcomes “social determinants of health,” and their slight improvement helps to explain why racial disparities in health and wellness outcomes such as obesity, diabetes, hypertension and heart disease have narrowed, yet large gaps remain.“Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes,” published in the April 2016 issue of the American Journal of Medical Sciences and accessed on the National Institutes of Health website. For example, according to a 2016 Harvard School of Public Health article, the death rate of asthmatic Black children is 500% higher than the death rate of asthmatic white children. Black adults who have cancer have a lower likelihood of surviving prostate, breast and lung cancer than white adults.

Wealth Is Also an Important Social Determinant of Health

One determinant that King did not talk about was wealth. It is also considered an important social determinant of health, and the Black-white wealth gap has shown little improvement since the 1950s and 1960s and continues today. The typical Black family had about 12 cents per $1 of wealth of the typical white family in 2019. (See graph below.) Even wealthier Black families (in the 82nd percentile) fell short of white medians (the 50th percentile). These wealth differences translate into different health and wellness outcomes.

We Need a New Way Forward for Addressing Racial Inequities

Evidence shows that broad-based economic growth alone may not be effective for narrowing racial economic inequality. Improvement in the relative earnings of young (16 to 24 years of age) Black workers seems to have stalled. Many start their careers with wages lower than their white counterparts. The source is the author’s “Honoring the Life and Work of Martin Luther King Jr.” speech to the U.S. Bureau of Labor Statistics. Large and persistent racial wage gaps exist even among Black and white adults who hold a bachelor’s degree and higher, and occupational segregation between Black and white Americans persists.The source is the author’s calculations using BLS data.

Given these setbacks, it may be helpful to shift conversations about proposed solutions from an equality narrative to an equity narrative. The latter focuses on having the resources needed to succeed, as opposed to equal amounts of resources for everyone. Given the nature of today’s economic insecurity, many Black Americans and low-income individuals can benefit from additional resources to overcome the significant challenges that impede their success.

We may also be wise to utilize “structural” concepts of equity instead of “static” equity, that is, approaches and mindsets that not only address current inequity but also acknowledge past inequities, those built on the nation’s historical policies and practices. “Redlining,” which systematically excluded Black Americans from access to homes, credit and insurance, is a perfect example. These deeply-rooted causes of contemporary economic insecurity hinder efforts to achieve equitable outcomes today.

The pandemic increased awareness of opportunities to broaden infrastructure investments beyond bridges, roads and broadband to also include human priorities such as social capital, mental health and access to quality child care. Collectively, these too are social determinants of health, and they are often prerequisites for economic security, health and wellness. They can also be beneficial for the economy in that they raise worker productivity, a key ingredient of economic growth.

The familiar inequities caused by the pandemic highlight the opportunity for new thinking about how to foster an economy where all workers can have the skills to provide lifelong economic security, the flexibility to provide care for their families, opportunities to grow and develop in their work—and where they can be healthy.

Notes and References

1. The source is the author’s calculations using data from the U.S. Bureau of Labor Statistics and the NBER Business Cycle Dating Committee.
2. The source is the author’s analysis using BLS data, an analysis that was presented by the author in a Jan. 13, 2022, speech for the Bureau of Labor Statistics, “Honoring the Life and Work of Martin Luther King Jr.”
3. “Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes,” published in the April 2016 issue of the American Journal of Medical Sciences and accessed on the National Institutes of Health website.
4. The source is the author’s “Honoring the Life and Work of Martin Luther King Jr.” speech to the U.S. Bureau of Labor Statistics.
5. The source is the author’s calculations using BLS data.