The Poor Made Visible
reprinted from Michigan Today, Winter 2003
An interview with Professor Kristine A. Siefert
University of Michigan School of Social Work
I'm particularly interested in social and environmental factors associated with depression in low-income women. Material hardship is an important predictor of depression that is too often overlooked. It is important because many risk factors for depression are global or difficult to change.
One of the most significant findings to come out of my work is that women who report in our studies that they sometimes or often run out of food are much more likely to meet the diagnostic criteria for major depression.
My epidemiological study of household food insufficiency is part of the Women's Employment Study, which involves 753 women in an urban Michigan county who were welfare recipients in February 1997. Interviewers from our Institute for Social Research (ISR) interviewed a random sample of the women, and we have been following them for several years.
In the first year, we found that 25 percent met the diagnostic criteria for major depression. After we controlled for many other factors known to increase risk of depression, food insufficiency remained substantially and significantly associated with depression. This relationship has persisted over time.
The policy implications seem pretty clear: Give people enough to eat! This is a really rich country; we shouldn't have large numbers of poor mothers running out of food. Interesting enough, but not surprising, when mothers can't secure enough food for their household, they feed their children before themselves.
I'm planning another study with Prof. David Williams at ISR, a much larger study using the National Survey of American Life to look at the relationship between household food insufficiency and major depression in African Americans and in Afro-Caribbean Americans.
Some years ago I studied racial disparities in maternal and infant mortality, and I'm sorry to say that the conditions I found are still a national disgrace. Black maternal mortality rates in Chicago and Detroit were three to four times higher than they were for White women. At the national level, those sorry statistics have not improved. The gap has even widened.
One thing that really appalls me about our country's performance in this area is that it is an issue in which the risk factors are modifiable: adequate nutrition, access to good, quality care, a decent standard of living. The same holds true for food insufficiency, which is far higher among African- and Hispanic-American families than among White families and associated with a host of serious diseases for children and adults.
I see two explanations, both of which require policy remedies. One is institutional racism, the other is individual racism.
At the institutional level we need to take steps to eradicate racism, and affirmative action is one effective approach. It's certainly worked well for White women because of their more privileged history and experience in this country, but it will take more time for African Americans and other people of color to make similar gains.
At the individual level, the National Academy of Science's Institute of Medicine recently published a major book documenting case after case of racism on the part of health care providers. It's the thing no one wants to talk about. Whether health care providers are conscious of it or not, it still has the same deadly effect. We've had disgraceful health disparities in this country for decades. It's time that we faced the reasons and did something about it.
I've been working since 1977 on maternal and child health and women's health. What has become crystal clear to me over the course of many years, especially looking at history as well as the present, is the role of racism in health disparities. It's something that we as a society are only beginning to acknowledge. There's so much denial and refusal to acknowledge what's just so glaringly there.
We need more African Americans and more Hispanics in policy-making positions, as deans and faculty of health professional schools, as providers. Affirmative action is so important. We need anti-racist curricula in all of the helping professions. It needs to start in elementary school. And we must have legislative remedies, because unless the law backs up corrective efforts, the corrections are not going to be enough.
What's really important to my heart is eliminating health disparities. All mothers and children, all people in this country, should have a good start in life - the same chance to be healthy and happy. Poor White women experience health-damaging stresses, but they don't experience the pervasive, everyday racism as well as the larger more institutional forms of it that women of color experience. It's two different worlds.
Actually, despite their greater exposure to stressors and risk factors, African-American women have lower rates of major depression than White women. That's one of the really interesting things that I'm hoping to look at with David Williams. One of the things David and others have speculated is that religion may play a protective role. It’s important to look at belief systems as well as other protective factors and strengths because they have implications for health policy, too.
Next: Sheldon H. Danziger
