Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

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This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.

This chapter reviews recent studies of socioeconomic status (SES) and racial differences in health. It traces patterns of the social distribution of disease over time and describes the evidence for both a widening SES differential in health status and an increasing racial gap in health between blacks and whites due, in part, to the worsening health status of the African American population. We also describe variations in health status within and between other racial populations. The interactions between SES and race are examined, and we explore the link between health inequalities and socioeconomic inequality both by examining the nature of the SES gradient and by identifying the determinants of the magnitude of SES disparities over time. We consider the ways in which major social structures and processes such as racism, acculturation, work, migration, and childhood SES produce inequalities in health. We also attend to the ways in which other intervening factors and resources are constrained by social structure. Measurement issues are addressed, and implications for health policy and future research are described.

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