How linked are health disparities, racial segregation?

newsroom@tri-statedefender.com | 11/3/2010, 7 p.m.

America’s Wire

While most Americans are unaware of the nation’s health disparities, those who are may well think that racial and ethnic minorities become sicker and die more often because they lack medical insurance, tend to be poorer or have unhealthy lifestyles.

Or, as a few sophisticates may know, because minorities receive unequal treatment from the medical system, regardless of economic status and insurance coverage.

A growing number of researchers cite a different cause, one that some say actually reflects the others. It is a social fact that has faded from public concern, despite its obvious persistence in every major city: residential segregation.

These researchers say segregation’s negative impact on health is true particularly for African-Americans, who studies consistently show are most likely to live apart from other racial-ethnic groups. Blacks, according to the Centers for Disease Control and Prevention, have the highest overall death rate in the country. The rate of high blood pressure among African-Americans is highest not just in the nation, but also in the world, the American Heart Association reports, as is the percentage of black men who contract prostate cancer.

“I argue that residential segregation by race is the fundamental cause of racial disparities in health in the United States,” said David R. Williams, a professor of public health at Harvard University. “It is not my position – I don’t think the data are consistent – that segregation is the only cause of disparities in health. It’s a major cause. It’s a big one.”

Williams has been an early and leading voice for this perspective. In 1999, while at the University of Michigan, he helped to conduct a study concluding that the concentration of poverty and disadvantage in segregated neighborhoods contributed to the disparities.

“Segregation determines your economic status,” Williams said recently, summing up the finding of that and subsequent studies. “Segregation determines, on average, the quality of schools you go to, your access to employment opportunities, the quality of housing and neighborhoods, whether your environment promotes health or discourages health. And segregation dramatically affects access to medical care.”

Segregated black neighborhoods tend to be poor – poorer, in fact, than impoverished white neighborhoods. Recent research, however, has begun to show that race, not class, adversely affects the health of African Americans in racially isolated communities.

Hope Landrine, a researcher for the American Cancer Society, reviewed the latest studies on residential segregation and black health, and compiled the findings last year in the journal “Ethnicity & Health.” Among them:

• Two to three times as many fast food outlets are located in segregated black neighborhoods than in white neighborhoods of comparable socioeconomic status, contributing to higher black consumption of fatty, salty meals and in turn widening racial disparities in obesity and diabetes.

• Black neighborhoods contain two to three times fewer supermarkets than comparable white neighborhoods, creating the kind of “food deserts” that make it difficult for residents who depend on public transportation to purchase the fresh fruits and vegetables that make for a healthy diet.