Tracing the roots of difference: A blog series

“We are not makers of history. We are made by history.”

Martin Luther King, Jr.

In addressing questions about equity, analysts often present results that differ significantly by race or gender or sexual orientation.  But however dramatic the differences – even for life-and-death indicators like life expectancy and infant mortality – they rarely explore the contexts in which disparities occur.

The contexts, of course, are broad; and they differ, at least somewhat, for every group.  Events that occurred decades or even centuries ago (such as the horrors of slavery – experienced by both African American and Native American populations – or the forcible removal of Indigenous children from their families for assimilation to white European culture) can be crucially relevant to health, wealth, and overall wellbeing among people today. Just as the effects of traumatic experiences can pass from generation to generation, the effects of historically racist policies (unfair lending and hiring practices, restrictive real estate covenants, unequal access to GI Bill benefits, unequal access to quality education) have impaired the ability of multiple generations to acquire wealth and build a buffer against hard times.

This is the first in a series of EQUITY BLOGS that looks at the root causes – historical and contemporary – of longstanding disparities in the health and wellbeing of King County residents. The blogs will investigate the notion, supported by many public health leaders, that “health is a function of social inequality.” They will also describe biological mechanisms that have been proposed to mediate the close relationship between social inequality and health outcomes.

Over the next few months, blogs will explore the following topics:

  • Discrimination: An equal opportunity experience? Results of the national Discrimination in America survey.
  • Historical trauma: What is it? Why is it important now? The lasting effects of major, sanctioned oppressions that deny or ignore a group’s humanity.
  • Intersectionality in action. Effects of trauma can be compounded by intersecting identities. Illustrated with recent data from King County communities.
  • Economic policy maintains the hierarchy. How policy has been shaped to preserve power, with enduring impacts.
  • Housing policies and practices in King County. How past and present housing policies influence opportunities for residents of King County.
  • Unequal education. A look at differences in educational opportunity and the differential benefits of education.
  • Unequal justice under the law. How do we explain growing disparities in our justice system? What are we doing about it?
  • Where is environmental justice? Introducing a mapping tool to see where demography intersects with pollution and how that relates to health in King County.
  • The R word: Racism. What does it mean? Why are we so hesitant to use it? A look at changing norms and attitudes.
  • The high cost of “making it.” The stresses of having to be 10 times as good to succeed, often in a hostile environment, are reflected in a host of health outcomes.
  • Birth outcome disparities, part II. Biological explanations of persistent disparities in infant and maternal mortality. “We carry our histories in our bodies. How would we not?” (Nancy Krieger)
  • Disparities tool debuts on Communities Count. Introduction to an interactive tool that highlights disparities – and patterns of disparities – across a range of indicators.
  • Equity sources. An organized, evolving list of curated sources – national and regional – related to the above blog topics will be available on the Data Resources page.

In addition to helping us understand disparities in local data, blogs in the series are meant to show how tightly our history weaves itself into our lives and our children’s futures. In looking at trauma, we acknowledge the rich variability of responses within and across groups and generations, from strength and resilience to ongoing harm embedded in policy and culture. Our goal is not to exacerbate existing divisions, but to reaffirm the shared values, identified by King County residents, that guide the work of Communities Count.  Whenever possible, the blogs focus on the lives of King County residents, calling out local heroes as well as promising regional programs and practices.


Data sources about King County communities include …

  • Communities Count offers interactive charts and maps on indicators across the following topics: education, family & community support, food, health, housing & transportation, income, population, and public safety.
  • Community Health Indicators: For 168 health and determinants-of-health indicators offers interactive charts and maps showing trends and demographics; data for King County regions, cities, and some neighborhoods.
  • City Health Profiles provides demographic and health data for 26 cities / geographic areas in King County.


Gun-related homicides: How does U.S. compare?

Shock and anger were not the only reactions to Wednesday’s massacre of nine worshippers at an African American church in Charleston, South Carolina.  Although racism was surely a factor in the tragedy, President Obama called out another salient feature, one that distinguishes our country from every other developed nation in the world:  “Once again innocent people were killed because someone who wanted to inflict harm had no trouble getting their hands on a gun…. This type of mass violence does not happen in other advanced nations.”

Was the President telling the truth?  Unfortunately, yes.  In fact-checking an assertion by former U.S. Representative from Virginia Jim Moran, compared the U.S. gun-homicide rate to the rates of 22 other nations defined as “high-income” by the World Health Organization: Australia, Austria, Canada, Czech Republic, Finland, France, Germany, Hungary, Iceland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Slovakia, Spain, Sweden, United Kingdom (England and Wales), United Kingdom (Northern Ireland), and United Kingdom (Scotland).  Using data mostly from 2009, they concluded that the gun homicide rate in the USA (3.0 per 100,000 people) was 15 times the combined rate of the 22 other nations (0.2 per 100,000).

And homicides are just the tip of the iceberg.  According to, an international database comparing armed violence and gun laws across 350 jurisdictions (hosted by the Sydney School of Public Health, University of Sydney), the 2013 rate of gun deaths in the USA from all causes – intentional and unintentional – was 10.64 per 100,000.  The rate in Washington state was slightly lower (9.07 per 100,000), but substantially higher than rates in other developed countries.

The 2012 rate of firearm-related deaths in King County was 7.9 per 100,000 — low, perhaps, by U.S. standards, but almost 4 times the rate in Israel and 36 times the rate in England and Wales. Rates were even higher among King County males, Blacks, the poor, residents of South Region, and both younger (18-24 years) and older (>65 years) adults.

What about access to guns? reports that the United States has the highest rate of civilian firearm possession in the world –101.05 firearms per 100 people.  Yemen, at 54.8 per 100, is a distant second.

According to King County’s Community Health Indicators, firearms are kept in or around 1 in 4 King County homes. It shouldn’t be surprising, then, that more people in King County die from gun violence than motor vehicle crashes.  For more information on regional gun violence and firearm access and policies, see two recent reports, Gun Violence in King County, and The Impact of Firearms on King County’s Children: 1999-2012.  For information on King County homicide and hate-crime trends, see Communities Count crime data.


Unconscious racist attitudes undermine best intentions

New York Times columnist Nicholas Kristof reviews research showing implicit biases of doctors, school principals, police, recruiters, and – yes – everyday citizens who “deplore discrimination” and would be appalled at the suggestion that they might harbor racist attitudes. Kristof links to an online test of unconscious attitudes, and offers hope that training, policies, and increased accountability can mitigate some of these unintentional acts of discrimination. Since its inception, Communities Count has focused on equity, and whenever possible analyzes community data by race, ethnicity, country of birth, first language, and sexual orientation. In the most recent Communities Count survey, King County residents reported significant disparities in experiences of discrimination.