What’s Race Got to Do With It? The Relationship Between Race and Health Outcomes in Segregated Neighborhoods

Health researchers have long believed that individual health outcomes are negatively affected by neighborhood segregation. In a joint report from the Joint Center for Political and Economic Studies and the Center on Human Needs at Virginia Commonwealth University published in 2012, researchers found that racial segregation drives the enormous variation in life expectancies in Chicago—as much as 33 years—depending on census tract. Their research suggests that the most segregated minority neighborhoods also tend to be the ones with the lowest educational attainment, the highest concentrations of poverty, and the poorest health outcomes.

Recent research on the impact of neighborhood segregation on health outcomes, however, reveals mixed results. Whereas some argue that racial segregation leads to poor health outcomes, others find that it may lead to improved health for some minority communities. A new study in the Journal of Urban Health suggests that this disparity may be due in part to a lack of understanding of the mechanisms through which segregation affects health outcomes. The findings suggest that race and ethnicity are important mechanisms through which neighborhood segregation affects self-rated health (SRH), an important predictor of mortality.

Joseph Gibbons and Tse-Chuan Yang, in their recent paper “Self-Rated Health and Residential Segregation: How does Race/Ethnicity Matter?,” explore the impact of neighborhood segregation on SRH. The authors find that black and other non-Hispanic minorities living in predominantly white neighborhoods are more likely to report poor or fair health than they would in segregated minority neighborhoods. These findings are consistent with past research that concludes that minorities in predominantly white areas may suffer from poorer health due to social isolation. Gibbons and Yang do not find conclusive evidence to support the hypothesis that residents of any racial or ethnic background will have poorer health when living in a neighborhood predominated by a certain racial or ethnic group than living in a mixed neighborhood.

In a regression of SRH on individual-level variables, the authors find that, in contrast to non-Hispanic white residents, non-Hispanic black residents are 50 percent more likely to report poor or fair health, and the likelihood is more than double for Hispanic residents. When neighborhood typology and socioeconomic conditions are added to the second model, the SRH disparities between non-Hispanic white and other minorities are reduced. While neighborhood typology is not significantly correlated with SRH, socioeconomic conditions are negatively associated with SRH, suggesting that neighborhood socioeconomic conditions can be used in part to explain the gap in odds of reporting poor or fair SRH between non-Hispanic whites and other minorities.

A third model delves deeper into the interactions between race and ethnicity and the predominantly white neighborhood. Non-Hispanic black residents living in a predominantly white neighborhood are 90 percent more likely to report poor or fair SRH than their peers in other types of neighborhoods. Similarly, other non-Hispanic minorities who live in predominantly white neighborhoods are twice as likely to report poor or fair SRH than their counterparts in other neighborhoods. These findings are consistent with earlier research that showed that living within predominantly white neighborhoods does not improve health for minorities, and also bolster evidence that racial segregation has negative effects on health. More information on methodology can be found at the end of the article.

While much attention has been paid to the role of segregation on health outcomes, the authors argue that race and ethnicity are important mechanisms through which neighborhood segregation affects self-rated health. Gibbons and Yang point to several policy conclusions that can be drawn from their findings, which include adopting health policies that target minority populations within segregated neighborhoods to reduce social isolation and improve health outcomes and integrating health and housing policies to ensure that health providers are available to properly serve residents’ needs. While this paper holds important implications for policymakers, its findings are limited to the Philadelphia metropolitan area. Additional research should expand the analysis to other regions in order to fully understand the impact of segregation in areas with varied racial and ethnic compositions.

Methodology

The authors draw individual level demographic data from the 2010 Southeastern Pennsylvania Household health survey of five counties in the Philadelphia metropolitan area conducted by the Public Health Management Corporation (PHMC). The dependent variable is SRH. Survey respondents were asked to assess their health on a scale from poor to excellent, and the answers were grouped into two categories: “poor/fair” and “good/very good/excellent.” The individual level variables obtained from the PHMC data include age, gender, poverty, race/ethnicity, martial status, education status, and educational attainment. Gibbons and Yang also use census data to obtain neighborhood level variables such as racial typology (predominantly white, predominantly black, predominantly other, and mixed) and socioeconomic conditions.

Article Source: Joseph Gibbons and Tse-Chuan Yang, “Self-Rated Health and Residential Segregation: How does Race/Ethnicity Matter?,” Journal of Urban Health, February 2014.

Feature Photo: cc/(Kris Scott)