Public Health: The Bigger Picture
It is important to examine the big picture of health outcomes in Detroit, since most available data does not focus on women's health. Historically, women have been left out of medical research, because society assumes that being male is the norm. Looking at data that relates to the population as a whole gives a larger picture about the intersection of race and class on health issues, which can help to reveal truths about women's health more specifically.
Regardless of gender, it is clear that race plays a defining role in determining health outcomes for everyone. Across the country, African-Americans have much higher risks of morbidity and mortality than the national average; it was found that after controlling for age and cause of death, African-Americans had a mortality rate that was 1.5 times higher than that of whites. In Detroit specifically, African-Americans had significantly higher mortality rates than whites in Detroit and whites elsewhere in the United States. Research shows that tackling socioeconomic inequality among racial groups in the United States would significantly help address racial health disparities (Schulz et al, 2002).
Across socioeconomic categories, African-Americans live in inferior neighborhoods to whites, which is a major determinant in health. In Detroit, race and socioeconomic status tend to go hand-in-hand, and African-Americans have been forced to live in areas of concentrated poverty. Research shows that living in areas of concentrated poverty has been associated with higher rates of mortality, cardiovascular disease, infant mortality, low birth weight, and poorer mental health. Living in poorer areas restricts African-Americans from resources that are necessary in improving health and preventing disease. While socioeconomic status is certainly an important influence, studies of Detroit show that when socioeconomic status is controlled for, African-Americans still experience poorer health outcomes than whites at all income levels, making race the determinant factor in health outcomes (Schulz et al, 2002).
Racial segregation has impacts on the quality of a neighborhood, in terms of physical characteristics like air quality and excessive noise as well as the social environment, including street maintenance, police, public schools, medical services like hospitals and pharmacies, and establishments like grocery stores (Schulz et al, 2002).
Evidence shows that living in high concentrations of poverty results in a physical environment that puts residents at higher risk for several diseases from factors such as airborne pollutants, traffic and proximity to highways, and industrial contaminants. In terms of simply eating healthily, African-Americans in Detroit often lack access to grocery stores, as white-owned establishments like these closed due to white flight. Additionally, health service providers are affected by increasing concentrations of poverty; health care facilities in poor neighborhoods are more likely to close than health care facilities in wealthier neighborhoods. The cost of medications in Detroit's poorer neighborhoods is higher than in suburban metro Detroit, and some pharmacies in poor, minority neighborhoods may even lack access to certain medications compared to other areas (Schulz et al, 2002).
Although issues relating to health and neighborhood safety are not directly correlating to female-specific health issues such as pregnancy and childbirth, these issues can still translate into women's health issues. Living in poor neighborhoods can contribute to negative physical and mental health outcomes for women. Additioanlly, living among pollutants and industrial contaminants will certainly have negative effects on one's physical wellbeing, and the safety of these neighborhoods contributes to women's agoraphobic tendencies. They may likely want to shelter their children from the dangers of the neighborhoods they live in, leading to a lack in healthy social relationships for adults and children alike.
One transparent way to understand that public health is a problem in Detroit for everyone — regardless of gender — is by looking at average life expectancy. On average, citizens of Detroit live to be 70 years old, which is starkly different than the 81-year-old life expectancy in Grosse Pointe, the wealthy, white neighboring city. (Detroit News) Examining Detroit as a poor, majority African-American city as compared to Grosse Pointe, a wealthy, white city is a simple way to conceptualize how race and class play into health outcomes.
Health disparities in Detroit as compared to other cities are extremely discouraging. Poor men and women alike will not live as long as the average life expectancy for poor men and women in the United States (New York Times). This indicates that holding socioeconomic status constant, Detroit still faces poorer health than other cities. Recognizing that Detroit faces public health issues for the overall public helps provide an explanation for the specific health issues that women face.
While data regarding life expectancies does not pertain to specific women's health issues, it is clear that the public health concerns that all Detroiters face will have impacts on women's health issues. The data are consistent in showing that as a poor, majority African-American city, Detroit has severe public health issues that are likely the root cause of issues relating to women's health.
Sources:
Aisch, G., Bui, Q., Cox, A., & Quealy, K. (2016, April 11). Where the Poor Live Longer: How Your Area Compares. Retrieved December 10, 2017, from https://www.nytimes.com/interactive/2016/04/11/upshot/where-the-poor-live-longer-how-your-area-compares.html?_r=0
MacDonald, C., & Ramirez, C. E. (2016, June 03). Life span for Detroit's poor among shortest in nation. Retrieved December 10, 2017, from http://www.detroitnews.com/story/news/local/detroit-city/2016/06/02/life-span-detroits-poor-among-shortest-nation/85325864/
Schulz, A. J., Williams, D. R., Israel, B. A., & Lempert, L. B. (2002). Racial and spatial relations as fundamental determinants of health in Detroit. The Milbank Quarterly, 80(4), 677-707.
