In the first study of its kind, Cornell sociologists have found that people who have a medical emergency in a public place can't necessarily rely on the kindness of strangers. Only 2.5 percent of people, or 1 in 39, got help from strangers before emergency medical personnel arrived, in research published April 14 in the American Journal of Public Health.
For African-Americans, these dismal findings only get worse. African-Americans were less than half as likely as Caucasians to get help from a bystander, regardless of the type of symptoms or illness they were suffering - only 1.8 percent, or fewer than 1 in 55 African-Americans, received assistance. For Caucasians, the corresponding number was 4.2 percent, or 1 in 24.
People in lower-income and densely populated counties were also less likely to get help, the researchers said. Conversely, those in less-densely populated counties with average socioeconomic levels were most likely to get assistance.
"It's very surprising and disappointing to find such low rates of people helping each other and that African-American patients and those in poorer counties are left to wait longer for help," said lead author Erin York Cornwell, assistant professor of sociology and Sesquicentennial Faculty Fellow. York Cornwell wrote the study with Alex Currit, a doctoral student in the field of sociology at Cornell.
York Cornwell points out that the types of support bystanders could offer require little to no training, and could include offering a glass of water, covering someone with a blanket, putting pressure on a wound or assisting with medications.
"We find evidence that bystanders can provide help in a huge range of scenarios, but the rates of assistance are so incredibly low," she said.
In the paper, "Racial and Social Disparities in Bystander Support During Medical Emergencies in U.S. Streets," York Cornwell and Currit analyzed data on nearly 22,500 patients from the 2011 National Emergency Medical Services Information System (NEMSIS) data set, which they linked to characteristics of counties where the incidents occurred. The data came from emergency medical services providers, who fill out a form after each ambulance call. The form includes an indication of what type of help, if any, patients received from bystanders before medical staff arrived on the scene. Because of underrepresentation of Latinos in the data, the researchers focused on African-Americans and Caucasians.
York Cornwell thinks that disparities in receiving help could stem from differences in the social context of the neighborhoods where emergencies occurred. Sociological research suggests that socioeconomic disadvantage within an area shapes how people relate to each other. For example, neighborhoods that have a high degree of poverty and residential instability tend to have fewer social institutions like synagogues, churches and community organizations - and this can make it difficult for residents to get to know each other.
"When you have a neighborhood environment where people don't know each other, where people are wary of strangers on the street, and someone needs help right in that moment, people may be more likely to just look away or keep walking without lending a hand," she said.
Sociologists have used this theory to explain disparities in the development of stress-related illnesses over the long term. But York Cornwell is applying the theory to brief, urgent moments when people could use help but don't get it; over time those moments could add up and contribute to health disparities across racial groups, she said.
"Disparities in health across race are persistent and growing in many cases. We don't really have a good understanding of the reasons why we see such large disparities. These day-to-day processes could be an important contributor," York Cornwell said.
The study was supported in part by Cornell's Institute for the Social Sciences, where York Cornwell is a faculty fellow.
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