Ghettos, Barrios, and the Impact of Residential Segregation on Racial and Ethnic Differences in Self-Rated Health

Introduction: This paper uses the social determinants of health conceptual framework to examine the relationship between racial/ethnic residential segregation, neighborhood characteristics, and self-rated health. Compared to their white counterparts, black Americans live sicker and die younger. In an attempt to explain persistent and growing racial differences in health, Williams and Collins (2001) conclude that, “[s]egregation is a fundamental cause of differences in health …because it shapes socioeconomic conditions for blacks…at the neighborhood and community levels” (p. 405). Empirically, residential segregation explains 15% to 76% of the black/white disparities in self rated health (Do et al. 2008). Interestingly, Hispanics who live in low income neighborhoods with a higher proportion of Hispanics often report levels of self-rated health that are no worse, and in some instances, better than those of whites (Patel et al., 2003; Rios, Aiken & Zautra, 2012). One potential explanation for the differential impact of residential segregation on African Americans and Hispanics health is the way in which segregated black neighborhoods (i.e., ghettos) and segregated Hispanic neighborhoods (i.e., barrios) differ in their structure and process.

 

Method: To examine these relationships, we used data collected as part of Chicago Community Adult Health Study (N= 2949).  These data include surveys and Systematic Social Observations (SSOs), which took place in 99.5% (1664/1672) of blocks in which survey respondents were sampled. Following the social determinants framework, we measured fundamental causes including racial/ethnic composition and economic disadvantage, intermediate causes including institutions, services, hazards, participation, civic activities, and collective efficacy; proximate causes including disorder, violence, victimization and perceptions of police, intergenerational closure, exchange, and networks.  We conducted a latent class analysis (LCA) with neighborhood-cluster–level variables (N=343) to identify neighborhood typologies. Multi-level modeling was used to examine the relationship between living in each identified neighborhood types and self-rated health.

 

Results:  A four class solution was the best fitting model, with classes breaking down by racial and socioeconomic lines. The first class was identified as majority white (63%), the second class as black (90%) middle class (19% below poverty), the third class as Hispanic (65%) and the fourth class as black (94%) disadvantaged (41% below poverty).  These classes differed significantly in most indicators of intermediate and proximate social determinants of health. More specifically, relative to predominantly white neighborhoods, middle class black, Hispanic and low income black neighborhoods had fewer businesses, lower levels of collective efficacy, and higher levels of crime. Residence in these neighborhoods was also significantly related to self-rated health, with individuals living in black middle class (B(SE)=-.15(.05), Hispanic (B(SE)=-.17(.05) and black disadvantaged (B(SE)=-.25(.05)) neighborhoods having worse self-rated health than those living in primarily white neighborhoods.   

Implication:  This study demonstrates that racial/ethnic segregation continues to exist across Chicago’s neighborhoods, and that it is related to an unequal distribution of many of the social determinants of health. We also found that residence in these neighborhoods associated with worse self-rated health. The results indicate that the neighborhood is one way in which discrimination impacts health outcomes and suggests areas were social workers can address these inequalities.