Racial and Spatial Relations as Fundamental Determinants of Health in Detroit

Abstract

As a social construct, race has been and remains a powerful organizing feature of American social life. Racial categories both reflect and reinforce group differences in access to economic, political, and social resources. In the United States, racial ideologies operate politically, legally, and socially to limit African Americans' and other labeled racial groups' access to economic resources (Darden 1986; Farley et al. 1994; Hummer 1996; Krieger 1999; LaVeist 1992; Massey and Denton 1993; Williams 1996, 1999). For example, institutional or structural forms of systematic discrimination can limit educational, employment, and housing opportunities. In this article, we suggest that efforts to reduce or eliminate well‐established racial disparities in health must consider the complex relationships between race and socioeconomic status, including the political, social, and economic processes that create and maintain racial differences in access to social and economic resources. African Americans in the United States have a higher than average risk of morbidity and mortality, despite declining mortality rates for many causes of death for the general population. This article examines race‐based residential segregation as a fundamental cause of racial disparities, shaping differences in exposure to, and experiences of, diseases and risk factors. The spatial distribution of racial groups, specifically the residential segregation of African Americans in aging urban areas, contributes to disparities in health by influencing access to economic, social, and physical resources essential to health. Using the Detroit metropolitan area as a case study, this article looks at the influences of the distribution of African American and white residents on access to these resources and discusses the implications for urban policies to reduce racial disparities in health status.

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

“…One recent study by Starks et al found that OHCA patients living in majority‐black neighborhoods had lower survival rates to hospital discharge 28. Residential segregation between blacks and other groups is extremely high in Detroit, and this segregation is associated with racial health disparities and high black mortality 29, 30, 31, 32. However, our calculated survival rates did not indicate a statistically significant difference in OHCA survival for blacks compared with other groups.…”

Retail Redlining in New York City: Racialized Access to Day-to-Day Retail Resources

“…42 Three primary mechanisms through which segregation operates include: (1) the concentration of poverty, (2) constrained access to economic and educational opportunity structures, and (3) neighborhood social and physical environments, including housing quality and the distribution of amenities and retail resources. 16,24,34,35,41,42 These pathways create economic, social, and physical contexts that determine the likelihood of conditions that foster, support, or sustain health.One of the primary constituents of a healthy neighborhood is the provision of public or private services that support people in their daily lives. 21 Public or private services include education, transportation, health care, and retail services.…”

Association of Residential Segregation and Disability: A Multilevel Study Using Iranian Census Data

“…It also affects intergroup connections in society. 4 Many papers have explored the effects of living in more segregated communities on health disparities and the links between residential segregation and health outcomes, including the relation between racial residential segregation and overall death, 5,6 tuberculosis, 7 cardiovascular diseases, 8 high body mass index, 9 pre-term birth in black populations, 10 and also social outcomes such as early adolescent sexual activity, 11,12 black homicide rates, 13,14 poor self-rated health, 9,15 access to employment, educational inequalities, crime, and other aspects of social and economical well-being. 16 So far, our literature review has shown that the relation between segregation and disability has not yet been investigated.…”