Health, Racial Inequality, and Residential Segregation

By Jenny Enos, Sociology Doctoral Student at Rutgers University – New Brunswick

We often talk about health as a strictly biological concept. After all, poor health outcomes such as heart disease and cancer are heavily dependent on biological factors such as our genetic makeup and our age. Public discourse is also rife with notions that viruses, such as COVID-19, “do not discriminate” and affect all of us equally – regardless of the vastly different social circumstances under which people in the U.S. are living.

Sociologists, however, have long emphasized that health outcomes are far from strictly biological. In fact, the subfield of medical sociology – one of the American Sociological Association’s largest sections – is entirely devoted to the study of how social contexts and structures influence health, illness, and healthcare. Although certain poor health outcomes are indeed influenced by factors outside of the social world, medical sociologists stress the importance of social influence in examining e.g. who gets sick and why.

How sociologists are addressing the COVID-19 pandemic is a stellar example of what this framework looks like in action. Rather than being a disease that “does not discriminate,” data show that people of color are significantly more vulnerable to COVID-19 – both in terms of contracting the virus and dying from it.

Taking a closer look at the social contexts surrounding these statistics, it is clear that this disparity is largely a result of the socioeconomic inequality along ethnic and racial lines that persists in the U.S., whereby people of color are significantly more likely to be working low-wage “essential” jobs than their white counterparts and are also less likely to have adequate access to healthcare. Considering these social facts, it is no surprise that a public health crisis like COVID-19 impacts marginalized communities harder than privileged ones.

Racial and ethnic inequality is particularly important to consider within medical sociology precisely because they have such a strong impact on health outcomes. While the COVID-19 pandemic is bringing this into the public consciousness, racial and ethnic inequality affects health well beyond the scope of this virus.

The CDC lists multiple factors contributing to health disparities along ethnic and racial lines: discrimination, healthcare access and utilization, occupation, educational/income/wealth gaps, and housing. Research shows that these factors all contribute to the increased likelihood of a myriad of poor health outcomes in Black and Brown communities, including all-cause mortality, infant mortality, obesity, and mental health issues.

The impact of racial and ethnic residential housing segregation on health outcomes is a particularly severe problem facing many U.S. cities. Racial and ethnic residential segregation is the product of decades of systematic disinvestment in low-income and Black and Brown neighborhoods, leading to city neighborhoods or even specific blocks where nearly all residents are people of color, while White people have moved to wealthier neighborhoods or into the suburbs.

In Philadelphia, Pennsylvania – one of the most segregated cities in the U.S. – the high levels of racial and ethnic segregation have “resulted in the clustering of a wide array of adverse exposures that predispose residents to structural, behavioral, and psychosocial factors that lead to poor health outcomes.”

While plenty of research shows that racial and ethnic residential segregation is a contributing factor to poor health outcomes in Black and Brown communities, little is yet known about the specific mechanisms driving this relationship. In other words, how exactly does segregation lead to poor health outcomes, and are there any mediating variables?

In an article recently published in Sociological Forum, Kathryn Freeman Anderson and Lindsay Oncken address these questions by examining racial residential segregation and self-rated health in Houston, Texas. They propose that one way in which segregation leads to poor health outcomes is through how residents perceive their neighborhood conditions (both in terms of neighborhood disorder and environmental quality).

Using multilevel modeling and both individual survey and census-level data, Freeman Anderson and Oncken find that while perceived environmental quality does not mediate the relationship between racial residential segregation and poor self-rated health, perceived neighborhood disorder does in fact act as a linking mechanism between these two variables. Importantly, this suggests that one of the ways in which segregation leads to poor health outcomes is through making residents perceive their environment as disorderly (i.e. high crime rates, poorly maintained buildings, etc.) – which in turn may produce a stress response, leading to long-term health damage.

This particular study offers significant empirical evidence of the damaging health effects of the disinvestment in segregated neighborhoods and makes a strong case for why it’s necessary to supply these neighborhoods with more resources. It is also an important reminder that our perceptions, and not just our material social conditions, matter. As such, resources clearly need to be invested in making perceivable improvements to neighborhoods – ideally with the input of the residents in those neighborhoods, who interact within them in their daily lives.

Of course, general desegregation policies (such as the Neighborhood Homes Investment Act, which has been introduced in the House of Representatives) are also essential since they would involve making perceivable improvements to and lead to re-investment in those neighborhoods.

While more research would need to be done to assess exactly how effective an investment of such resources would be at improving health outcomes, studies such as this one suggest that it could make a serious difference and improve the overall health of Black and Brown communities.

Comments

[charles j. jones]

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https://www.youtube.com/watch?v=34hJd2uagWY

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