Residential segregation & health Flashcards
Gaskin, Price, Brandon, & LaVeist. (2009). Segregation and disparities in health services use.
Gist: The authors compare racial disparities in health care use between two data sets (Exploring Health Disparities in Integrated Community project [Baltimore] and MEPS). Most national studies examine disparities using MSA or county level but the current authors argue that this doesn’t account for within-MSA differences. There were differences between the two samples regarding the impact of race & who gets care but not for average number of visits. Nationally, blacks were less likely to have a health care visit than whites, but this finding was reversed in the EHDIC site sample. They suggest there is a potential relationship between segregation and racial disparities in health care use.
Acevedo-Garcia & Lochner. (2003). Residential segregation and health.
Gist: The general definition of residential segregation is the differentiation of 2 or more population groups among subunits of a given social space. The social space can be geographic (e.g., school district) or economic (e.g., labor market). Racial residential segregation is a focus due to the stronger force it plays compared to social class because of U.S.’s history of racial discrimination & prejudice. However, Jargowsky & others have argued that segregation by class has increased, esp. for minority groups. Residential segregation can be measured with 5 outcomes: (1) evenness, (2) isolation, (3) clustering, (4) centralization, & (5) concentration. There is also hypersegregation (particular group suffers from segregation on more than 1 of 5 dimensions). Blacks tend to suffer from hypersegregation. Residential segregation also acts to concentrate poverty among neighborhoods. Regarding residential segregation & mortality, black mortality rates are generally higher in urban areas with high levels of segregation. Few studies have looked at white mortality rates & the results are inconsistent. Question remains regarding pathways between segregation & poor health. Some may include socioeconomic factors. Most studies use dimension of evenness. Some studies use racial composition as a proxy for segregation. Important points: (1) Segregation has different dimensions; (2) each dimension is conceptually associated with distinct pathways; (3) each dimension is empirically correlated differently with the outcome. More work needs to be done with multilevel models (most do metro-area levels). Most studies have focused on black-white segregation, so more work is needed with other minority groups. Also, there is some evidence that segregation may be positive on health (e.g., ethnic enclaves for immigrant groups).
Acevedo-Garcia, Lochner, Osypuk, & Subramanian. (2003). Future directions in residential segregation and health research: A multilevel approach.
Gist: The article reviews research on residential segregation using a multilevel approach & provides conceptualization of measurement selection & theorized pathways between segregation and health. Idea of segregation is multilevel (because it’s calculated using 2 geographic scales) and multidimensional.
Dissimilarity: Distribution of blacks and whites across neighborhoods in a given area
Isolation: Average probability of contact between blacks & whites at neighborhood level
Clustering: Degree to which black neighborhoods are continuous to each other
Centralization: Degree to which black neighborhoods are located near the metro area’s central city
Concentration: Population density of the segregated group across metro area relative to density of other group(s)
Hypersegregation: Patterns of segregation on multiple dimensions (blacks only group to experience this)
Dissimilarity is the most widely used but has the least clear conceptual relationship with health. Isolation may only affect certain outcomes that are related to contact with others (e.g., infectious diseases). Isolation could be related to social outcomes such as violence & intraracial homicide or environmental hazards. Clustering may affect access to resources near the neighborhood. Centralization may/may not be related to health; it could be related through the transmission or diffusion mechanism or through interaction between residents of central city & residents of suburbs.
Reardon. (2006). A conceptual framework for measuring segregation and its association with population outcomes.
Gist: Segregation doesn’t apply to individual neighborhoods but only to larger neighborhoods. For individual neighborhoods, it is more useful to describe the racial/SES composition. Segregation may be related to differential proximity of groups to a variety of environmental and/or social hazards. Conceptual & methodological issues include: (1) definition of “neighborhood”; (2) conceptual definition of segregation; (3) definition of population dimension along which we wish to measure segregation (e.g., 2+ distinct, unordered groups vs. ordered & continuous). Aspatial measures fail to account for spatial patterning & are sensitive to the “checkerboard problem” (ignoring spatial proximity of neighborhoods & only focus on racial composition of neighborhoods) and MAUP (“neighborhood” doesn’t have meaningful definition). Aspatial measures include evenness & exposure. Spatial measures include clustering, centralization, & concentration. There is also Reardon & Sullivan’s spatial exposure-isolation dimension & spatial evenness-clustering dimension. Population dimensions include: (1) 2 dichotomous groups; (2) >2 dichotomous groups; (3) no segregation have been developed to measure segregation among ordered categorical groups; (4) continuous.
Exposure: High segregation of region if members of one group inhabit local environments containing few members of another group (exposure index [aspatial] & spatial exposure index)
Evenness: High segregation of region if members of 1 group are distributed very differently throughout a region than members of another group (dissimilarity index [D], information theory or Theil index [H], Gini index [G], variance ratio index [V])
Dissimilarity index: % of all individuals who would have to transfer among units to equalize group proportions across units divided by % that would have to transfer if system started in state of complete segregation
Gini index: Related to but distinct from Gini Index of Inequality
Variance ratio index: Proportion of variance in group membership that is accounted for by between-subarea differences in group proportion
Information theory index: Entropy takes value of 0 if & only if population is made up of a single group & has its maximum if each of the groups are equally represented in population
Measures of multigroup segregation: Theil index is inherently multigroup while others have multigroup versions. Jargowsky came up with Neighborhood Sorting Index, a measure of income segregation (or segregation for any continuous variable).
Williams & Collins. (2013). Racial residential segregation: A fundamental cause of racial disparities in health.
Gist: Racial residential segregation is a fundamental cause. Physical separation of races is an institutional mechanism of racism designed to protect whites from social interaction with blacks. Despite absence of supportive legal statutes, degree of residential segregation remains high for most blacks in US. Evidence suggests that segregation is primary cause of racial differences in SES by determining access to opportunities. SES remains a fundamental cause of racial differences in health, & segregation creates conditions hostile to health in the social & physical environment.
Bell et al. (2006). Birth outcomes among urban African-American women: A multilevel analysis of the role of racial residential segregation.
Gist: This article showed that segregation can affect health outcomes (here, birth weight) differential depending on the dimension of segregation measured. They used measures of black-white isolation (probability that blacks will randomly encounter another black vs white) & clustering (extent to which black neighborhoods are contiguous to each other). The researchers investigated components related to LBW, prematurity (
Williams & Jackson. (2005). Social sources of racial disparities in health.
Gist: The authors outline social environment factors that initiate & sustain racial disparities in health; focused on 3 causes of death (homicide, heart disease, & cancer) that show black-white disparities & 2 causes of death (pneumonia & flu, suicide) with no black-white disparities. SES is a strong predictor of health variations & all indicators of SES are strongly patterned by race. Other links include health practices, stress, residential segregation & medical care.
Residential segregation: (1) central mechanism by which racial economic inequality created & reinforced in US; (2) neighborhood conditions encourage violence & create racial differences in homicide; (3) independent of individual SES, factors linked to poor residential environments.
Medical care: (1) black assault victims less likely than white peers to receive timely emergency transport & high-quality medical care; (2) blacks less likely to receive preventive, screening, diagnostic, treatment, & rehabilitation services for cancer ; (3) black Medicare patients more likely than white patients to reside in areas where medical procedure rates & quality of care are low; also pharmacies less likely to have adequate supplies & hospitals more likely to close.
Why no disparities: (1) Flu & pneumonia - population-wide benefits of widely diffused technology; (2) Suicide - Protective resources that may improve health & protect vulnerable populations from some of negative environmental exposures (e.g., self-esteem, religious involvement).
Policy implications: (1) addressing segregation as primary cause of racial inequality; (2) narrow the income gap (b/c black-white income gap parallels changes in black-white health gap); (3) improve medical care; (4) rethink health policy to be more encompassing (e.g., education policy is health policy, etc.).
Grady. (2006). Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis.
Gist: This study looked at racial disparities in LBW in New York City & focused on racial residential segregation & neighborhood-level poverty plus individual-level factors. They argue against the “ethnic density hypothesis”. They found that residential segregation (i.e., isolation) increased the risk of LBW at neighborhood scale while neighborhood-level poverty increased risk of LBW at individual scale. Racial differences disappeared with increasing poverty within segregated neighborhoods.
Northridge, Stover, Rosenthal, & Sherard. (2003). Environmental equity and health: Understanding complexity and moving forward.
Gist: The history of environmental equities includes: (1) publication of Silent Spring in 1962 against indiscriminate use of pesticides; (2) 1982 protests staged over PCB dump; (3) 1994 Clinton signed order requiring federal agencies to identify & address disproportionately high & adverse human health/environmental effects of programs, policies, & activities on people of color & impoverished communities. There has been a lack of health research on environmental inequity (with exception of lead poisoning).
Lead poisoning: Both SES & racial disparities in BLLs; exposure differences between urban & rural areas.
Air pollution: Racial/ethnic disparities in effects (esp. particulate matter); 3 primary pollutants associated with cardiovascular illnesses & effects increased for people with diabetes & older adults.
Blacks face greatest hostility in housing market; barriers to housing also higher for impoverished older adults, people with HIV/AIDS, & people with serious psychiatric disabilities. Methodological issues include: (1) ethnic groups may have different views on what environmental threats are important; (2) need to demonstrate association between unequal environmental burdens & disparities in health outcomes; (3) whether hazards came first or disadvantaged groups in an area; (4) Superfund sites (CERCLIS neighborhoods typically working class, lower % of black/Hispanic residents & higher % of Native Americans, less densely populated & more residents with industrial jobs; as % blacks or Hispanics & low SES households increased, fewer CERCLIS sites placed on NPL - evidence for inequity in prioritization process).
Eberhardt & Pamuk. (2004). The importance of place of residence: Examining health on rural and nonrural areas.
Gist: Authors looked at differences among health measures between rural, suburban, & urban residents. For many measures, rural & urban residents had lower health outcomes than suburban residents. Rural residence doesn’t always show a health disparity (e.g., urban areas are highest on indicators like homicide). Rural was worse than or the same as urban for mortality measures (e.g, premature, infant, adult, cause-specific), morbidity & chronic health conditions (e.g., diabetes, arthritis, hypertension), mental health (e.g., suicide, negative mood), & risk factors (e.g., cigarette smoking, obesity). Regarding demographic & socioeconomic factors, health insurance lower in most rural & urban counties & regionally worse in West & South for some measures.
