Good healthcare decisions depend on good data – whether you’re making federal health policy or treating a single patient.
But the data is often incomplete – particularly when it comes to defining a group that still makes up the majority of the U.S. population — a ‘non-Hispanic White’ person. That’s the primary reference category used in health data.
“Nobody questions who’s white, but they should,” said Jen’nan Read, a Duke sociologist and lead author of new research recently published in the journal Demography. “The white category contains diverse ethnic subgroups, but because we lump them all together, we miss important health vulnerabilities for millions of Americans.”
Read and co-author Fatima Fairfax, a Duke doctoral student in sociology, analyzed data from the 2000 to 2018 waves of the National Health Interview Survey to compare the health of white adults born in the U.S., Europe, the Middle East, and the Former Soviet Union.
Duke sociology professor Jen’nan Read and PhD student Fatima Fairfax
Separating groups collapsed into the white category, they found that foreign-born Whites have a smaller health advantage over U.S.-born whites than is commonly assumed, and immigrants from the Former Soviet Union are particularly disadvantaged. Those immigrants report worse health, including higher rates of high blood pressure, compared to U.S.-born whites as well as people from Europe and the Middle East.
These findings illustrate how global events, such as the wars in the Ukraine and Syria, have contributed to changes in the composition of white immigrants over time.
Understanding these changes – and the distinct experiences of white immigrant subgroups – is vital to understanding long-term patterns in health disparities within the broad white category, the authors argue.
“If we truly care about reducing health disparities in this country, we need to know where the disparities are. And they get hidden when people are lumped into broad categories,” Read said. “Ukrainian immigrants, for example, we see in the news what they’re leaving. Death, destruction, their kids may have gone years now without education. This has lifelong impacts on their wellbeing. The physical consequences from stress are enormous–we know stress increases all sorts of physical health problems. High blood pressure, cholesterol, the list goes on.”
And the science is clear. The more accurate the information healthcare providers have on their patients, the better the outcomes.
“We’re missing health patterns here,” Read said. “Our country is extremely diverse, and not talking about diversity doesn’t change that fact. Health inequality costs us a lot–it costs the healthcare system and society as a whole.”
“Health is arguably the most important indicator of how a society is doing, and paying more attention to diversity within broad categories will allow us to do better.”
Post by Eric Ferreri, Duke Marketing & Communications
What happens when you give people money? Dr. Aisha Nyandoro and Natalie Foster know: through their research, they’ve seen the impacts of guaranteed income firsthand.
On November 9, as part of the Duke Center for Child and Family Policy’s Sulzberger Distinguished Lecture series, these experts discussed their work and what we can learn from it at “What Happens When You Give People Money: The Future of Economic Security for Children and Families.”
Natalie Foster
Foster, co-founder and co-chair of the Economic Security Project, began with the big idea of guaranteed income. Before the pandemic, wealth and income inequality were at all-time highs — disparities that “can be traced back to the origins of racialized capitalism.” But recently, things have gotten even harder. Wages have remained stagnant despite increases in productivity — and despite inflation, making it harder to afford things like rent. Foster denounced the “strong ideology that says that lack of security in this system is a personal failing. That if you can’t pull yourself up, there’s something wrong with you.” There’s something wrong with the system, Foster said. “People are working. The economy isn’t.”
Foster said that even though there didn’t appear to be room in these political conditions to do things differently, she had the “audacity to imagine something else: the ‘adjacent possible.’” She wanted to give cash to people directly, ensuring an income floor regardless of whatever crises that may abound.
Foster worked with the mayor of Stockton, California on the Stockton Economic Empowerment Demonstration (SEED), which provided 125 Stockton residents with $500 monthly payments for two years.
Dr. Aisha Nyandoro
Foster was connected by a mutual friend to Nyandoro, the CEO of Springboard to Opportunities. Nyandoro had launched The Magnolia Mother’s Trust, which provides low-income Black mothers in Jackson, Mississippi with $1,000 monthly payments for one year.
With The Magnolia Mother’s Trust, Nyandoro sought to shift away from economic policy “rooted in ‘what is,’ and toward ‘what could be.’” This concept has a rich history, she said, and includes the work of Martin Luther King Jr. and the Black Panthers. She had a specific ‘what if’ in mind: “What if when Black women told us what they needed, we believed them?” What if we sought to overturn the very structures that keep these people down, and subverted the “paternalistic nature of the social safety net”?
Nyandoro stated that as a researcher, when she has questions, she “goes back to the people.” When she did, she found that although people’s needs were individual, “cash was ubiquitous” — cash was a solution that could address every single one of the problems that she heard. Giving cash directly could help combat a system that “penalizes people for being poor, rather than trying to lift them out of poverty.”
Why low-income Black mothers? Nyandoro explained that in order to do the work of economic liberation, one must identify what’s wrong with the system. In this case, that meant identifying those who are the most negatively impacted by the system, and using what limited resources are available to help them specifically.
Nyandoro turned to her findings: giving people cash works. These mothers are often working tirelessly, holding down two or three jobs and struggling to make ends meet. After receiving the money, people continue to work and often do so at higher rates (a major fear of opponents of guaranteed income). As a result, their income is often doubled — with life-changing results.
Beyond the numbers, Nyandoro emphasized that “we are seeing joy. We don’t talk about joy enough as it relates to Black women.” This money allowed Black women to feel free, to be entrepreneurial: to “dare to dream for the first time — for themselves and for their families.”
She referenced Chimamanda Ngozi Adichie’s famous speech “The Danger of a Single Story,” explaining that in order to change the narrative, “we need to change the narrator.” It’s time to think about whose voices we center.
In Jackson, Mississippi and Stockton, California, the pair had carried out research about the ‘adjacent possible.’ They’d used cities and states as “laboratories in democracy.” Foster said that their work was paving the way for gradual advances in guaranteed income — slowly, but surely. Then, the pandemic hit.
Suddenly, ideas that had recently been dismissed as too radical were viewed as necessary. Often unable to work, people needed money fast in order to put food on the table and cover their most urgent needs. The federal government rose to the challenge with the American Rescue Plan, providing stimulus checks and pandemic unemployment insurance, plus expanding the Child Tax Credit. “The ‘adjacent possible’”, Foster said, “had become the possible.”
The country saw an “immediate drop in poverty.” The pandemic was revealing, said Foster. It revealed that cash provides time, stress reduction, and resilience. It revealed that cash serves as a tool to create economic security and “build back better.” Above all, it revealed that “poverty is a policy choice that we’re currently making. We could make a different policy choice in order to eliminate it.”
The pandemic also revealed that stimulus checks and the Child Tax Credit were “very popular policies.” Nyandoro has observed support in the form of petitions for monthly cash transfers, the founding of organizations like Mayors for a Guaranteed Income and Guaranteed Income Community of Practice, and the launch of over a hundred guaranteed income pilots of some sort. All these efforts, Nyandoro said, are pushing toward “the same North Star”: centering the needs of families and achieving economic liberation through federal policy.
Foster turned the discussion toward next steps: “these victories have been immense, but could disappear” if the Build Back Better Act does not pass. The Act includes a year-long extension of the expanded Child Tax Credit, a key instantiation of guaranteed income. The Child Tax Credit has bipartisansupport.
If the extension of the Child Tax Credit passes, then according to Foster, guaranteed income is one step closer to becoming a cornerstone of social policy. This would be a “nail in the coffin of the way we’ve done policy for the last fifty years — that you’re only worth what you do in the world. Every human has dignity and worth, and we have the opportunity to build a policy that says just that.”
Nyandoro agreed with Foster. As an anti-poverty advocate, she believes in a world without poverty: a world where “everyone can have a life of dignity for themselves and their families.” She believes that the ‘adjacent possible’ is achievable if “we can move beyond our own individual needs in order to view life as a collective, where prosperity is shared rather than hoarded.” She ended by quoting Toni Morrison: “if you have some power, then your job is to empower someone else.”
Last Friday, the House voted to pass the Build Back Better Act, which now heads to the Senate.
Are prisoners who go back to their old neighborhoods upon release more or less likely to get arrested again than those who move? That’s the question University of Oxford sociology professor David Kirk posed in a seminar he gave at Duke March 28. Recidivism is the tendency of a convicted criminal to re-offend, and Kirk wondered if the risk of recidivism might be lower when former prisoners reside in a geographic area different from where they lived prior to incarceration.
To test his hypothesis, Kirk first designed a study in New Orleans following Hurricane Katrina. A full 72 percent of dwellings in New Orleans were damaged in some manner following the hurricane, but the neighborhoods that were hit the hardest tended to be areas that were socioeconomically disadvantaged and home to ethnic minorities. These also tended to be areas to which released prisoners would have returned. Realizing they would not be able to return because of the damage, Kirk designed a study to compare the likelihood of recidivism in people who moved to a different parish pre vs. post-Katrina. The results of the study showed that 50 percent of people were induced to move post-Katrina, compared to 25 percent before Katrina. Parolees who moved to a new neighborhood were less likely to be rearrested.
Based on the Moving to Opportunity (MTO) project, a government-funded housing mobility program in the 1990’s for poor families in five cities, Kirk decided to build on his Katrina results to launch a pilot program in Maryland called MOVE, or Maryland Opportunity through Vouchers Experiment. In the first design, the treatment group received a six-month housing subsidy upon release, but it had to be used in a new jurisdiction. The control group received a six-month subsidy in their home jurisdiction. In the results for this experiment, no one in either group that received free housing was rearrested. However, in the control group where released prisoners received no free housing and returned to their old neighborhoods, 22 percent were rearrested.
The second design gave no subsidy for staying in the home jurisdiction, but incentivized moving to a new city with free housing. In the Maryland experiment, the ‘home’ jurisdiction was Baltimore, and the treatment group housing subsidy was in Prince George’s County, about forty-five minutes away in neighboring Washington, D.C. The pilot implemented four prisons in the state of Maryland and male prisoners hailing from Baltimore were eligible, with the exception of sex offenders.
Graph courtesy of David Kirk, University of Oxford
In the second design where the treatment group got free housing in a new environment and the control group moved to their old communities with no free housing, 22 percent of the treatment group was rearrested compared to 57 percent of the control group. Kirk explained that this second design is more practical than the first because only one group has to receive subsidized housing, thus it is half the cost of the first design. However, since the treatment group gets free housing and moves in the second design, it is harder to tease out the exact reason for lower rearrest rates. Other general trends Kirk has found through his research are that younger individuals who have been imprisoned tend to benefit more from district changes than older individuals. There is also a much larger gap between ‘movers’ and ‘stayers’ in rearrest rates for women, so Kirk hopes to conduct future studies involving female released prisoners.
