Race Disparities in Health among Older Adults: Examining the Role of Productive Engagement

Race differences in morbidity and mortality are visible across the life course and persist well into later life. Individuals who are members of some minority groups face the prospects of shorter life expectancies, poorer health outcomes at all ages, and longer periods of chronic disease and disability at the end of life. These disparities have given rise to intensive research seeking to determine their causal pathways and develop interventions. Health inequalities by race have been found to result from variations in socioeconomic status (SES) (Hayward, Crimmins, Milies, & Yang, 2000), social context (Waite & Hughes, 1999), community-level factors (Robert & Lee, 2003), social activity (Clark & Maddox, 1992), health behavior (Berrigan, Dodd, Troiano, Krebs-Smith, & Barbash, 2003), and the complex interactions among these factors (Williams, 2002). Productive engagement--that is, paid and unpaid involvement in activity producing goods or services--is likewise shaped by social and cultural forces that differentially act on individuals based on gender, age, and race (Hinterlong, Morrow-Howell, & Sherraden, 2001). It also exhibits a positive relationship to physical health and mortality (Glass, Mendes de Leon, Marottoli, & Berkman, 1999). Yet, its contribution to health disparities has been infrequently considered. This is the first study to explore how the functional status and self-rated health of older African American and white adults relate to productive engagement. RACE AND PRODUCTIVE ENGAGEMENT The relevance of race to productive engagement is best considered from a life course perspective. Productive activity occurs commonly in the context of social roles, such as that of paid worker, caregiver, or unpaid volunteer, which individuals manage as role sets. Late-life role sets are shaped by an array of social and cultural forces that influence individual behavior (Hill & Sandford, 1995). For example, caregiving displaces paid work more frequently for women than men throughout the life course. Similarly, cascading or cumulative disadvantages, such as racial discrimination and dominant norms, create increasingly unequal access to productive roles for African American and white individuals (Dannefer, 2003). For instance, evidence shows that race affects the range of volunteer and paid work opportunities available to individuals. From a life course perspective, health disparities research conducted among older adults heightens the salience of these forces because age is a proxy for exposure to social and material conditions that differentially affect individuals on the basis of race (Geronimus, 1992). This study was motivated by the assumption that these forces create racial differences in productive engagement that then act on pathways to health disparities such as power, SES, work conditions, and health care access (Williams & Collins, 1995). Racial differences in productive engagement are seen across types of roles, levels (hours) of performance, and activity patterns. Older African Americans are more likely to undertake formal paid employment (National Academy on an Aging Society, 2000), and less likely to volunteer (Independent Sector, 2000), but are equally likely to be caregivers compared with white adults (Alecxih, Zeruld, & Olearczyl, 2001). Irregular employment (Jackson, 2001) and informal social assistance (Navaie-Waliser et al., 2001) are more prevalent among older African Americans. Glass and colleagues (1995) found that elderly black people were more likely to increase their level of productive activity over time compared with white individuals. CONNECTING PRODUCTIVE ENGAGEMENT AND HEALTH Engagement is important to late-life well-being (Rowe & Kahn, 1998). Recent evidence shows that productive engagement specifically exhibits a significant, salutary connection to health (Everard, Lach, Fisher, & Baum, 2000; Rozario, Morrow-Howell, & Hinterlong, 2004) and mortality (Glass et al. …