Race-based neighborhood segregation is a "fundamental cause of racial disparities in health, one that influences access to social and material resources that promote health and avoid disease and influences many health outcomes," say Amy J. Schulz, Ph.D., of the University of Michigan and colleagues.
The findings may help explain why blacks, in particular, have higher rates of sickness and death than the national average, say the researchers, who explored the links between segregation, concentrated poverty and health in the Detroit metropolitan area.
Racial neighborhood segregation is particularly striking in Detroit, where the black population tends to cluster in the older urban area and whites live predominantly in outlying suburban communities. "Eighty-four percent of African-American residents would have to move in order to achieve an equal distribution of African-Americans in the area," Schulz notes.
Political, social and economic conditions in many metropolitan regions across the country have helped cluster blacks and other racial minorities in older urban areas with high concentrations of poverty as economic opportunities have moved out of city centers, according to the researchers.
In their Detroit case study, Schulz and colleagues documented several ways that segregation and the loss of economic resources in these "left-behind" communities can affect residents' health.
For instance, air and noise pollution may increase as commuter traffic winds its way out of these neighborhoods to better job opportunities in the suburbs. The dwindling tax base in these poorer communities can mean less support for municipal services like fire and police departments and trash collection, exposing residents to poor sanitation and reduced fire and crime protection.
Similarly, poor neighborhoods may lose hospitals, pharmacies and large grocery stores stocked with healthy foods. "The exodus of major grocery stores and other retail outlets from high-poverty areas in Detroit has forced residents to shop in small convenience or liquor stores in their communities, which have limited selections, often of poor quality and at high prices," the researchers say.
These environmental problems can contribute to "stressors" that increase the likelihood of developing chronic diseases like high blood pressure, according to the researchers.
Efforts to minimize neighborhood poverty on health and its impact on health, such as urban economic development, increased access to health care, and collaborations between local governments to improve metropolitan environments, "may help reduce pervasive racial disparities in health," Schulz and colleagues conclude.
The study is published in the December issue of the Milbank Quarterly, and was partially funded by the Centers for Disease Control and Prevention.
BY BECKY HAM, STAFF WRITER
HEALTH BEHAVIOR NEWS SERVICE
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Amy J. Schulz, Ph.D., at (734) 647-0221.
Milbank Quarterly: Contact Bradford H. Gray, Ph.D., at (212) 822-7287.
Journal
Milbank Quarterly