Beyond Discrimination: Racial Inequality in a Post-Racist Era

Chapter 10. Racial Segregation and the Marketing of Health Inequality

317 Chapter 10    Racial Segregation and the Marketing of Health Inequality Naa Oyo A. Kwate They drink it thinkin’ it’s good, but they don’t sell that shit in the White neighborhood. —Public Enemy, “1 Million Bottlebags,” 1991 Why is it that there is a gun shop on almost every corner in this community ? . . . For the same reason that there is a liquor store on almost every corner in the Black community. Why? They want us to kill ourselves. —Furious Styles, Boyz N The Hood, 1991 The dismantling of state-­ sanctioned discrimination substantiates in the American imagination the notion of a postracial world, particularly with the election of President Barack Obama. But anyone walking through a black neighborhood knows that the United States is not “postracial.” The persistence of de facto segregation in most U.S. cities reminds us that we have not moved beyond the strictures of race. African Americans stand alone in the level of segregation they have faced for several decades in many U.S. cities (Massey and Denton 1993), and though there have been declines in U.S. segregation over time, they are relatively small (Iceland, Sharpe, and Steinmetz 2005) and unequally distributed across race and income groups (Fischer 2003). Moreover, relatively recent policies such as exclusionary density zoning have further contributed to segregation (Rothwell and Massey 2009). If the modest declines in post–civil rights black-­ white segregation repudiate the notion of a postracial United States, so too do the sequelae of 318    Beyond Discrimination segregation. Racial residential segregation has been described as the cornerstone on which black-­ white health disparities rest, because segregation blocks access to socioeconomic resources that promote health and increases exposure to environmental insults that damage health (Williams and Collins 2001). For example, residential segregation constrains access to high-­ quality schooling, and education (and thereafter, occupation and income) is strongly and positively associated with health. Empirical studies showing negative associations between segregation and health (Chang 2006; Cooper et al. 2007; Subramanian, Acevedo-­ Garcia, and Osypuk 2005; White and Borrell 2006) give weight to theoretical elaborations about why segregation should be harmful to health. Compared with whites, black people in the United States experience disproportionate morbidity and mortality for many diseases and chronic conditions (for example, cardiovascular disease, obesity, diabetes, and cancer). Other aspects of the social geography of black neighborhoods that might appear to be much more trivial—for example, how many fast food restaurants and alcohol ads are around—also play a fundamental role in understanding the persistence of racial inequality and the perpetuation of health disparities. Fast food and advertising are both as American as apple pie and seemingly prosaic in day-­ to-­ day living. Nonetheless, racialized marketing for these products has a profound influence directly and indirectly on how racial inequalities—in this case, health disparities—are sustained . A central theme throughout this volume is the notion that practices, processes, and institutions that appear to be racially neutral often have racially disparate consequences. This is certainly true for consumer marketing , a process typically constructed as merely a function of consumer demand and other objective market forces. It is true that marketers identify and target a variety of demographic segments, not all of which center on race; over-­ the-­ counter medicines may be marketed to seniors via television programs known to have older audiences. But when race is the demographic axis along which marketing is deployed, it necessarily relies on the marginalized position of black people in the United States; race is never neutral (Bonilla-­ Silva 1996). Marketing’s purpose is to create perceptions of nonmaterial value among consumers in order to prompt purchases (Grier and Kumanyika 2008), to effect top-­ of-­ mind preferences that often operate outside of awareness. In so doing, marketing is pernicious in shaping health-­ related behaviors. Clearly, marketing is just one of many factors that converge to shape what people consume; among others are individual taste preferences , cognitive factors including knowledge about how to shop for and cook healthy foods (Resnicow et al. 2000), social factors such as using food to project social position (Inness 2001; Mintz 2002), and contextual factors Racial Segregation and the Marketing of Health Inequality    319 such as the economic condition of the country (Neuhaus 1999). But herein lies the import of marketing: it exudes a subtle and pervasive influence on all of these factors. For example, Americans’ knowledge about and preferences for certain foods, shopping, and...