'The numbers don't work for us': An alternate model of fundamental causality from the perspectives of African Americans in urban Atlanta.

摘要

Racial/ethnic disparities between African Americans and Whites in a number of health outcomes continue to exist despite decades of intervention research and social policy changes. Several perspectives have been proposed to explain the existence of these disparities, including the fundamental cause perspective. The fundamental cause perspective is promising because it suggests that focusing on distal factors that influence multiple risk factors and health outcomes may be the key to eliminating longstanding disparities in health. Proponents of this perspective suggest that low socioeconomic status is a fundamental cause of health disparities and that there are others yet to be determined and explicated. This study informs the development of an alternate model of fundamental causality rooted in the perspectives of those living in a neighborhood characterized by poor health and social outcomes.; Between April and August 2006 twenty residents (in two groups) from an urban Atlanta area used Photovoice to document their health and social realities. In total, they participated in seven rounds of picture-taking followed by seven small group dialogue sessions. Grounded theory analysis of the transcripts from these dialogues was used to develop an explanatory model of fundamental causes and their mechanisms. In contrast to the traditional framing of health in terms of physical health, residents defined community well-being and mental health as priority health concerns. Residents also identified the underlying factors and mechanisms that they believed contributed to poor community well-being and poor mental health. The most significant underlying factor was White and middle class Black indifference toward poor African Americans embedded in institutional practices and prevailing ideologies. This indifference contributes to neighborhood and housing disinvestment, speculative development, and displacement of families out of the neighborhood. The model also indicates that African Americans in this neighborhood use strategies such as help-seeking, resistance, cooperation, and organizing as strategies to mitigate the impact of these forces on community well-being and mental health.; Implications for research, policy, and practice are discussed with special attention to the need for greater integration of the fields of public health and urban planning to protect the public's health.