摘要：Recent theoretical and empirical studies of the social determinants of health inequities have shown that economic deprivation, multiple levels of racism, and neighborhood context limit African American health chances and that African Americans' poor health status is predicated on unequal opportunity to achieve the American Dream. President Obama's election has been touted as a demonstration of American meritocracy—the belief that all may obtain the American Dream—and has instilled hope in African Americans. However, we argue that in the context of racism and other barriers to success, meritocratic ideology may act as a negative health determinant for African Americans. On July 16, 2009, President Barack Obama spoke at the NAACP at its centennial celebration, articulating a common goal for the association and his administration: “We want everyone to participate in the American Dream.” He argued that although poor and African American children face social challenges, these challenges need not stop their success: “No one has written your destiny for you. Your destiny is in your hands… . That's what we have to teach all our children. No excuses.” 1 This notion—that through striving, anyone can achieve and create his or her own destiny—is central to American ideology. This ideology asserts that the United States is a meritocracy and that its citizens—regardless of the social stratum from which they start—should aspire to, and in fact can attain, the height of social and economic success described as the American Dream. American meritocracy, the claim goes, has liberated its citizens from old-world confines of class and heritage. President Obama personifies the promise of American meritocracy—an African American man in a country with a long history of racism, rising from very modest means. His presidency seems to demonstrate that the American Dream is indeed within anyone's reach. But what if belief in the American Dream can lead to poor health among African Americans? Compared with Whites, African Americans experience more morbidity and mortality resulting from economic and other inequalities. 2 Moreover, upward socioeconomic mobility does not always lead to better health for African Americans. 3 We propose that in the context of strong social barriers to success, especially racism, belief in meritocratic ideology may be detrimental to African American health. We do not suggest that believing in the American Dream is ineluctably detrimental to all African Americans, nor do we suggest that such beliefs should be eradicated. Certainly, belief in meritocracy and the possibility of success through hard work and effort undergirds American optimism and attempts to achieve. Instead, we hope to problematize how public health researchers and policymakers understand meritocracy by looking at some of the less visible ways in which meritocratic ideology may jeopardize health and well-being. We introduce our ideas about the potential pathogenic effect of meritocracy and briefly discuss two mechanisms: individual, through the impact of stress and coping on health, and structural, through the impact of beliefs and values on policies. Figure 1 depicts some mechanisms through which meritocratic ideology may lead to poor health. Open in a separate window FIGURE 1 Structural and individual pathways through which meritocratic ideology may harm African American health.
