Segregation is making black Americans sicker — here’s how

A new study shows that where you live has a huge impact on health

A lack of affordable housing is linked to child poverty, food insecurity and health problems, claims a report that ranks the health of American counties released last week.

Across all American communities there is a consistent link between poor health and costly housing, the report found. But for black Americans — particularly those in historically segregated communities — the struggle with bad health is especially burdensome.

The report, released by the County Health Rankings and Roadmaps program, designed to provide data and evidence for communities to create programs that improve health, underscores a new concern: where people live can have a huge impact on their wellbeing.

The program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, explores health factors within large and small metro counties.

These include social and economic factors, health behaviours, clinical care, and the physical environment of communities to assess how the impact of living location affects health. (Full disclosure: Apolitical partners with the Robert Wood Johnson Foundation on our coverage of Health and Wellbeing)

“More segregated counties have higher rates of severe cost burden, for both White and Black households. However, Black residents face greater barriers to opportunity and health than White residents,” the report stated.

Place and race

Philadelphia’s historical legacy of segregation has persisted since the 1970s, and it currently ranks as one of the most racially divided big cities in the United States. Despite an uptick in racial diversity over the years, discriminatory policies continue to split Philadelphia along racial lines.

The effects of segregation on black Americans are palpable: not only do they lack the same educational and career opportunities as white Americans, but they don’t have access to the same services, such as transportation, housing, and adequate health facilities.

Although some big cities have made progress on integrating all ethnic groups, particularly places like Houston, Texas and Atlanta, Georgia, cities such as Philadelphia, Pennsylvania are still heavily segregated.

Philadelphia county, the county where Philadelphia is located, is not only struggling with integrating residents, but was also ranked last out of 67 counties in overall health for Pennsylvania, according to the report.

Inclusive communities with affordable housing programs that limit discriminatory practices are more successful at integrating minority groups, which results in better health for all residents, the program concluded.

“Children of colour face a greater likelihood of growing up in poverty, and low-income families struggle to pay rent and get enough to eat,” wrote Sheri Johnson, acting director of the County Health Rankings and Roadmaps in a statement. “It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity.”

Stark divides

In US counties with residential segregation of white and black residents, nearly one out of every four black households spend more than half their income on rent. Just one out of 10 white households in the same areas spend half their income on rent.

Spending a considerable amount on rent leaves little room to spend on choices contributing to good health. It can be a struggle to afford nutritious food, medicine, and fees for doctors when residents have little economic means.

The top performing counties stated that 13% of adults reported being in poor health. Meanwhile, the bottom performing counties reported 19% of adults. Philadelphia county did worse than the bottom average with a reported 20% of adults.

Segregated communities also have troubling rates of unhealthy behaviour such as smoking and excessive alcoholism, which can contribute to chronic illnesses and a decrease in life expectancy.

For instance, Philadelphia county data revealed that 20% of adults were tobacco users and 22% of adults were heavy drinkers. Only 14% of adults in the top percentile for healthy counties used tobacco while 13% engaged in excessive drinking.

Communities in the top percentile all ranked highly for accessibility to green spaces that promote wellbeing and grocery stores that have healthy food options. Philadelphia county was below average in Pennsylvania and the US in lack of food accessibility and physical inactivity.

Philadelphia county residents were twice as likely to die a premature death, contract a sexually transmitted disease, and end up in the hospital for a preventable reason compared to the top performing counties.

Bridging the gaps

The report stated that the way forward is to require, “policies, programs, and systems changes that respond to the specific needs of each community, promote inclusive and connected neighbourhoods, reduce displacement, and enable opportunity for better health for all people.”

The authors recommend inclusionary zoning laws, fair housing laws, and housing mobility programs to create inclusive communities that support integration.

Access to living wage jobs, green spaces, quality healthcare services, and transportation were also some ways to promote healthy living while making communities accessible for all residents.

Restricting discriminatory practices such as predatory lending and zoning laws that make it difficult for lower income families to move to certain neighbourhoods is key to ending segregation in America, the report said.

Supporting programs that cater to low-income families’ housing needs, such as housing choice vouchers and housing trust funds, are an effective way to reduce the struggle of paying the high costs of rent and facilitating home ownership for residents who otherwise wouldn’t have the opportunity.

For example, a housing trust program developed by Beyond Housing addresses the issue in St. Louis County, Missouri by providing subsidies to lower income families. The trust provides a lease for the land, but the resident owns the home.

Creating more inclusive communities, where all residents have equal opportunities, is necessary for breaking down racial barriers and promoting health and well-being.

“We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the colour of their skin or how much money they make,” said Richard Besser, MD, RWJF president and CEO. — Amelia Axelsen

(Picture credit: Flickr / Paul McCarthy)

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