Race – and Place – Matters for Health

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A child is born in the United States. How much information do you need to predict her future health? To predict if she will enjoy a healthy life? If she will die an early death?

One important piece of information is where she lives. And more specifically, if she lives in an area of racial residential segregation. In 2001, David R. Williams and Chiquita Collins called racial residential segregation “a fundamental cause” of health disparities. For some time researchers had known socioeconomic status (SES) was linked to health inequalities. But what they had not asked, Williams and Collins point out, was what causes racial disparities in SES. Building on a literature that began in 1950, when Alfred Yankauer found a link between infant mortality and segregation, Williams and Collins show how segregation limits socioeconomic mobility – and, thus, access to education and employment and, ultimately, health.

One way sociologists measure group success is by the ability to pass advantage on to the next generation. This is called an “accumulation of advantages.” But when we consider how segregation, and structural racism, bears on health outcomes, we see something else. Racism creates an accumulation of disadvantages. While the majority of poor people in this country are white, William Julius Wilson has shown that most of those poor whites live in areas of economic integration. Most poor black Americans, on the other hand, live in poor neighborhoods. Concentrated poverty has profound consequences. In When Work Disappears: The World of the New Urban Poor, Wilson demonstrates how concentrated poverty increases joblessness, which threatens social organization, which, in turn, deepens poverty.

The impact on health of racial residential segregation is devastating. A 2011 study attributed 176,000 deaths to segregation in 2000. Michael R. Kramer and Carol R. Hogue provide a comprehensive review of the negative health effects of segregation in their 2009 Epidemiologic Reviews piece. They cite studies on the association of segregation with fewer healthy food options, obesity, low birth weight, cardiovascular disease, tuberculosis, HIV, gonorrhea, and how racism “weathers” the immune and neuroendocrine systems.

“Freedom Marchers.” Keoni Cabral. CC BY 2.0, 2009.

There’s probably no better place in the United States to study the negative health effects of racial residential segregation than Chicago. And the Joint Center for Political and Economic Study did just that. Though segregation has decreased in Chicago since the middle of last century, it remains the most segregated city in the United States, according to the Manhattan Institute for Policy Research. In July 2012, the Joint Center for Political and Economic Study released a study on Cook County, which has a black-white Index of Dissimilarity of 80.8%. (Index of Dissimilarity is a measure of segregation, which is somewhat problematic because it focuses on only two groups. It means that 80.8% of black residents would have to move elsewhere in order to evenly distribute the population.)

The Joint Center’s report – “Place Matters for Health in Cook County: Ensuring Opportunities for Good Health for All” – is chilling. In 2007, the premature death rate for black residents was 445.9 per 100,000 – for whites, it was 179.5. In six of the seven Chicago neighborhoods with the lowest life expectancy, the African American population was greater than 93%. In six of the eight neighborhoods with the highest life expectancy, the African American population was less than 10%. Not only does the Joint Center report show the tremendous moral cost of racial disparities, but they also calculate a staggering financial loss: $1.24 trillion from lost tax revenue and productivity. What does the Joint Center recommend? They say we must track health inequalities, understand food retail access, stimulate health food retail, ensure workplace justice, and address persistent poverty through partnership with governmental agencies.

Racial residential segregation impacts socioeconomic status, which impacts what social systems a person enters or exits (such as the school system, the labor market, and the criminal justice system). These life chances, when limited or constrained, deeply affect health. As poverty increases, joblessness increases, social organization decreases, and negative health outcomes increase. Poor health further removes residents of segregated neighborhoods from the labor market and, thus, adds to an accumulating amount of disadvantages. As the Joint Center writes, understanding racial residential segregation – and the neighborhood conditions that burden its residents – allows us to “powerfully predict who is healthy, who is sick, and who lives longer.” It hopefully will also push us away from the Daniel Moynihan model of “black pathology,” which wrongly suggests that something at the core of black residents is responsible for the negative effects of segregation. Rather, we need to hone our interventions at structural pathologies. Because we shouldn’t be able to predict how soon a child will die based on where she lives, but, as it stands now, we too often can.

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