Residential segregation is a fundamental cause of health disparities. We need to take steps that will reduce health risks caused by segregation and lead to more equitable, healthier communities.
For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.
In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.
The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health.
Segregated Opportunities
The effects of residential segregation are often stark: blacks and Hispanics who live in highly segregated and isolated neighborhoods have lower housing quality, higher concentrations of poverty, and less access to good jobs and education. As a consequence, they experience greater stress and have a higher risk of illness and death.
Although there are pockets of high residential segregation scattered across the country, residential segregation of blacks and whites appears highest in the Northeast and Great Lakes region and lowest along the Southeastern seaboard. It should be noted that, for 35 percent of U.S. counties, the black population was too small to calculate the residential segregation measure.
It’s important to note that for some population groups, living among others who share their cultural beliefs and practices can help build social connections that can lessen the health risks of hardship and neighborhood disadvantage.
Complex Solutions
We think every community should be paying attention to the ways that residential patterns may be a barrier to good health. There are approaches that can help reduce the health risks caused by segregation and lead to more equitable, healthier communities:
- Identifying the most pressing health needs in every community, and prioritizing those areas for investment.
- Access to safe, affordable housing and financing for everyone, and eliminating housing discrimination.
- Safe, reliable public transportation accessible to all.
- Jobs with wages that enable people to take care of themselves and their families.
- Improving access to healthy food in every community.
Getting to these and other solutions requires creativity, collaboration and authentic engagement of all people in a community—a top-down approach just won’t do.
We've seen this approach used successfully in Culture of Health Prize-winning communities such as Everett, Massachusetts, and Kansas City, Missouri, where residents tackled these tough issues head on.
In Everett, institutional racism and racial profiling were creating unhealthy conditions. The city set up forums where residents could discuss the hiring practices and diversity of the police department and suggest ways to build better community-police relations. The city also took steps to help immigrants who didn’t speak English navigate the health care system and to assist people of color in finding living-wage jobs and health care services.
Community organizers across Kansas City—after reviewing shocking data about the life expectancy gap between white and black residents, began frank and difficult discussions about systemic racism and its health implications. Armed with what they discovered, one of the city’s first actions was passing the Community Health Improvement Plan in 2001 as a direct response to the life expectancy gap. By examining disparities systematically and crafting solutions, the city has closed the life expectancy gap from 6.5 to 5 years.
The conversations and approaches will be different in every community. But we can start by learning from what’s working in places like Kansas City and Everett and many more. These communities are leading the way by creating a shared value for good health, where everyone has the opportunity to thrive, regardless of who they are and where they live.
About the Author
Donald Schwarz, MD, MPH, MBA, former vice president, Program, guided the Foundation's strategies and worked closely with colleagues, external partners and community leaders to build a Culture of Health in America.