for People of African Descent — a group that is among those
most affected by racism and inequality.
Keynote speaker Brian Smedley, PhD, executive director of
the nonprofit National Collaborative on Health Equity, began
the session with a talk on the health consequences of racism
here in the United States.
“People of color face poorer health across the life cycle
— literally from the cradle to the grave,” he said. “And
these inequalities persist even when income, education and
socioeconomic status are controlled.”
For example, he cited research that found that babies
born to African-American women with a college degree had
higher infant mortality rates than those born to white mothers
without a high school degree. And he discussed a recent study
in Pediatrics of children’s health, which found that African-
American and Latino children were in worse health than their
white peers of comparable socioeconomic status, at every
These disparities continue across the life span. For example,
Smedley said, in the highest-poverty areas of New Orleans,
residents have an average life expectancy of 55 — comparable
to many developing nations. People who live in wealthier
neighborhoods across the city, in contrast, can expect to live to 80.
“When it comes to your health, often your ZIP code is more
important than your genetic code,” he said.
These disparities have their roots in historical and
institutional racism, internalized racism, and real estate and
lending discrimination that result in continuing segregation,
among other causes, Smedley explained.
He also offered several examples of programs that are
helping to address these persistent health inequalities. Investing
in high-quality early childhood education, for example, can
improve health, economic and other outcomes for African-American and other children living in poverty. Some research
shows that for every $1 invested in early childhood education,
society reaps $17 in savings through developing healthier, more
productive individuals, he said.
Programs that increase housing mobility and help people
move out of high-poverty areas can also have an effect. An
example of this was the Department of Housing and Urban
Development’s “Moving to Opportunities” study, in which
some people using subsidized housing vouchers were randomly
given assistance to move from high-poverty to lower-poverty
neighborhoods. The study found that people who moved had
lower levels of diabetes and obesity 15 years later compared
with a control group who didn’t move, Smedley said.
Following Smedley’s keynote talk, a panel of four
psychologists discussed their work in different areas of health
• George Ayala, PsyD, executive director of the Global
Forum on MSM & HIV, spoke about improving the access of
men who have sex with men (MSM) to HIV services. These
men shoulder a disproportionate burden of the global HIV
• Bonnie K. Nastasi, PhD, a professor at Tulane University,
discussed her work developing culturally appropriate
community programs to improve mental health among
children and families living through war, natural disaster and
other stresses in places as diverse as New Orleans and Sri Lanka.
Finding community partners and immersing oneself in the
local culture is key, she said, because “the ultimate goal is to
develop programs that are socially valid at the local level …
and likely to be sustained.” In Sri Lanka, for example, Nastasi
worked with a local educator to develop and test culturally
specific mental health measures and school-based interventions
to help students cope in the aftermath of the 2005 tsunami.
• Barbara C. Wallace, PhD, a professor of health education
at Teachers College, Columbia University, spoke about how the
roots of global inequality extend back to the 1493 papal bull
“doctrine of discovery” that authorized the mass appropriation
of lands, territories and resources from indigenous peoples.
The subsequent dominance of Western values is reflected in
how “most psychologists are trained in Western models of
service delivery,” she said, as well as low utilization of mental
health services and premature termination of therapy sessions
by minorities. What is needed now is a new “global paradigm
of non-hierarchical equality,” she said, and a new unified
health psychology that takes into account social determinants
of health, the stress of perceiving and coping with racism and
structural barriers to equitable access to opportunities, while
valuing African and global indigenous perspectives.
• Tahereh Ziaian, PhD, a professor in the Division of Health
Sciences at the University of South Australia, spoke about her
research on the mental health of young migrants and refugees
in Australia. She has found that these at-risk populations
underutilize mental health services due to stigma, distrust of
the services, poor mental health literacy and other factors. The
solution, she said, is for mental health service organizations to
build cultural competency and use alternative service delivery
models and approaches to reach out to and educate those who
could benefit from their help.
At the end of the session, U.N. Ambassador Caleb Otto of
Palau — a physician who worked with psychologists at the
U.N. to get “mental health” included in the new sustainable
development goals — put the discussion in perspective.
“The world today has more riches than ever before,” he said.
“But there is more inequality than at any time since World War
II. One percent of the world owns 40 percent of the world’s
assets ... in the midst of plenty, we still have disparities.” n