From Socioeconomic Epidemiology toward the Epidemiology of American Apartheid
The conceptual framework in Chapter 1 involves consideration of the effects of social class on the health of blacks and the possibility of a combined effect of black poverty and the segregation of blacks in urban areas ("concentration" or "neighborhood" effects). In this chapter, the results of a few studies of the relationship between poverty (or, more broadly, social class) and mortality are outlined, including the pioneering work of Kitagawa and Hauser ( 1973) on "socioeconomic epidemiology." The extension of this field to encompass segregation as a variable in predicting variation in mortality rates for blacks, and black/white ratios of mortality rates, is introduced, to be followed by detailed analyses in Chapter 5.
The relationship between social class and risk of illness and death has a long history, including the observations of R. Virchow ( 1821-1902) on epidemics in Upper Silesia, with his belief in the relevance of "liberty, education and prosperity" to health ( Silver, 1987; Susser, 1983, 1985). This topic is receiving increasing attention in epidemiology, sociology, and psychology (e.g., Adler et al., 1994; Liberatos et al., 1988; Marmot et al., 1987; Susser, 1985). Statistical studies started in Europe, due to the availability of data on occupational or other social-class indicators as well as better systems of registration of the population, and this tradition has continued ( Susser, 1983, 1985; Marmot et al., 1991; Vagero, 1991).
In Britain evidence indicates a widening gap in health and mortality between