Despite the 1954 Brown versus Board of Education Supreme Court decision, school segregation of U.S. blacks persists. Given the powerful role of education as a social determinant, health consequences of school segregation are likely to be substantial. This study indicates the causal link between school segregation and high school graduation and the association of graduation and life expectancy. It estimates the reduction in life expectancy associated with school segregation and characterizes the prevalence of school segregation of black students in states. Lack of high school completion is associated with a reduction in life expectancy of 9 years—similar to that of smoking. The prevalence of black school segregation (>50% minority) is greatest in the Northeast (81.1%), next highest in the South (78.1), next in the Midwest (68.4%), and lowest in the West (13.6%). Known remedies to school segregation must be implemented to eliminate this root of health inequity.
Objectives
The complex societal spread of COVID-19 in the U.S. indicates a need to recognize sociocultural forces to best understand and respond to the pandemic. This essay describes four principles of anthropology and sister disciplines that underlie the theory and practice of public health.
Methods
Research following anthropological and related approaches is reviewed to provide examples of the four principles from COVID-19 in the U.S.
Results
1. What counts as sickness, disease, injury, pathology, is fundamentally a matter of historically situated social ideas and values. 2. The ways in which societies are organized is a fundamental source of pathologies and their distributions within societies. 3. Conversely, health conditions can substantially alter the organization of societies. 4. Public health responses are social processes that affect intervention outcomes.
Conclusions
Anthropological approaches are recommended to address several facets of public health practice: problem analysis, intervention design, evaluation, and the public health enterprise itself.
The goal of this analysis is to estimate the proportion of COVID-19 deaths attributable to President Donald Trump’s early pronouncements about voluntary mask use and his intention not to use masks. Data from available research were used to estimate parameters for the calculation of population attributable risk for COVID-19 deaths reported to date. Assuming Trump’s pronouncement to have caused 25%, 50%, and 75% of the non-use of masks, estimates of Trump-attributable COVID-19 deaths to date would be, respectively, 4,244, 8,356, or 12,202. The effects of presidential pronouncements on health-related matters may have large public health consequences. Pronouncements of national leaders should be based on the best available science.
There is a widely held belief in a universal right to the highest attainable standard of health. This essay shows how this right is conceptually unclear, unattainable, and a distraction from a more concrete and attainable right: a right to equitable access to available resources for health (RARH), including equitable access to the social determinants of health. It clarifies conceptual and theoretical issues in the RARH: its underlying theory rooted in historical, economic, and axiological rationales; its concept of component resources and their availability, equity, sustainability; and the redistribution of wealth and power, metrics, and ethics. The advancement of global health equity requires explicit theorizing of what underlies a right to health. The right to the highest attainable standard of health fails in this regard. The RARH provides a desirable, actionable, and measurable foundation for global health equity.