Health and healthcare perspectives of African American residents of an unincorporated community: A qualitative assessment

Abstract

Residential perspectives about health in unincorporated communities are virtually unexplored. In this study, we conducted focus groups to assess individual and community health status, environmental health mediators, and systematic barriers to healthcare among African American residents of the unincorporated town, Fresno, Texas. Residents described their individual health status as excellent, but depicted the community's health status as fair. Unaffordable healthcare, limited access to healthcare, and environmental mediators were perceived to impact the Fresno community's health status. Our findings suggest a need to begin to examine health outcomes for minority residents in other unincorporated communities.

“A Community with Diversity of Culture, Wealth, Resources, and Living Experiences”: Defining Neighborhood in an Unincorporated Community

“…From an ecological perspective-which considers the physical infrastructure and demographic characteristics of an area-the neighborhood is conceptualized as a place where the use of land is a commodity in the spatial composition of the region (Galster 2001;Hunter 1979;Keller 1968). This framework defines the neighborhood as geographic units consisting of spatially defined boundaries often characterized by census tracts, zip codes, tertiary streets, a .25 mile radius around the home, landmarks, and/or infrastructure (Coulton et al 2001;Grannis 1998;Guo and Bhat 2007;King et al 2009;Kruger 2007;Nicotera 2007;Stoneall 1983). Most studies rely on census tracts, block groups, or zip codes to define neighborhoods (Coulton et al 2004;DeMarco and DeMarco 2010).…”

“…In sum, the dearth of research exploring the neighborhood experience in unincorporated regions is problematic because, for structural reasons, people residing in these regions often lack the physical, social, and economic resources necessary for community well-being (King et al 2009). Hence, because neighborhoods are mediating structures for creating community (Nowell et al 2006), research describing how people living in unincorporated areas define their neighborhood is an important step toward building community.…”

“…Arbitrariness can lead to neighborhoods with low legibility; in these areas, people experience lower levels of place identity and attachment, which is, in turn, related to lower levels of civic engagement (Brown et al 2003;Lewicka 2005Lewicka , 2011. Low legibility can occur anywhere, but is perhaps more likely in unincorporated communities (King et al 2009;Sokolow 2000). Unincorporated areas are not part of a city, and land use is administered as a part of a larger territorial division (e.g., a county).…”

“…The number of people who live in unincorporated areas in the US is growing (King et al 2009). For example, 20 % of Californians live in unincorporated areas (Sokolow 2000).…”

“…Sometimes, these areas have high population densities but little infrastructure and few social resources. When overlaid with the fact that housing in unincorporated areas is often less expensive than in surrounding cities because property taxes are not paid to run a local municipal government (King et al 2009;Sokolow 2000), the lack of resources becomes a social justice issue. Indeed, in places where housing is expensive, unincorporated areas can become the most viable option for low-wage earners.…”