The Dream Revisited
Discussion 25: Health and Segregation

Discussion 25: Health and Segregation

October 2017

The twenty-fifth discussion debates the significance of residential segregation as a social determinant of health and explores potential policy responses.


  • Health in the Segregated City

    by Mariana C. Arcaya , Alina Schnake-Mahl

    Residential segregation is linked to health in three ways: segregation contributes to neighborhood health disparities, segregation creates inequities in access to quality healthcare, and disparities in health may also heighten segregation. Individuals who live in poor, racially-isolated neighborhoods report worse outcomes on a variety of health measures. Residential segregation also creates a segregated system of health care delivery.  Finally, poor health may itself drive segregation by making it more difficult for people to leave poor neighborhoods.  


  • Segregated Health Systems

    by Jose F. Figueroa

    One of the means through which residential segregation intersects with healthcare is the (lack of) access to quality services. There is growing evidence that the focus on merely increasing access to services will not suffice because efforts to improve access do not always result in improving the quality of care dispensed.  With increased access, black and Hispanic individuals have been subject to unnecessary, economically inefficient, and at times harmful tests and treatments. While it is true that health care providers working with predominantly isolated and disadvantaged populations face more complex populations, these providers regularly underperform in implementing strategies that could improve the quality of care given to their populations. 

  • Why Aren’t Segregation’s Effects on Health Larger?

    by Sherry Glied

    While racial disparities in health are well-documented, and residential segregation is known to adversely affect educational and labor market outcomes among disadvantaged groups, there is less evidence that racial segregation widens racial disparities in health outcomes. While there are many plausible mechanisms to explain why segregation should widen health disparities, the evidence base is weak.  One possible explanation is that there are counteracting effects, such as the comforts of homogeneity, and that many of the policies that shape health outcomes do not vary across neighborhoods.

  • Residential Segregation and Health: A Hypothesis Still in Search of Convincing Evidence

    by Robert Kaestner

    There is mixed evidence regarding the connection between residential segregation and health. While race or ethnicity and poverty are strongly associated with health, and poverty status is linked to worse self-reported health, there are few credible and consistent studies that establish a causal relationship between isolation and health status. Even though the veracity of the link has not been disproven, it has also not been proven. This suggests that a need for empirical studies investigating the matter. 

Discussion 24: Policing and Segregation

July 2017

The twenty-fourth discussion examines the links between policing practices such as “stop and frisk” and race and class segregation and explores potential policy responses.  

Discussion 23: Race, Segregation, and Politics

March 2017

The twenty-third discussion explores the impact of persistent racial segregation on political discourse and electoral outcomes in the United States.

Discussion 22: The Stubborn Persistence of Racial Segregation

December 2016

The twenty-second discussion explores the role of residential choices in sustaining segregation within American cities.

Discussion 21: Suburban Poverty & Segregation

September 2016

The twenty-first discussion explores the increasing diversity of suburbs and increasing levels of suburban poverty and debates the challenges of supporting poor households’ economic self-sufficiency beyond the central city.

Discussion 20: Making Vouchers More Mobile

July 2016

The twentieth discussion examines the benefits of defining fair market rent by zip code, to make it easier for families to move to higher-opportunity neighborhoods, and weighs potential unintended costs.

Discussion 19: Public Housing and Deconcentrating Poverty

May 2016

The nineteenth discussion debates what we should do about high-poverty, distressed public housing developments in light of recent research from the Moving to Opportunity Program about the costs of concentrated poverty.

Discussion 18: Segregation & the Financial Crisis

February 2016

The eighteenth discussion debates the extent to which segregation exacerbated the unequal effects of the mortgage-driven financial collapse of 2007 and ways to address racial disparities in mortgage lending.

Discussion 17: Community Preferences and Fair Housing

November 2015

The seventeenth discussion debates the extent to which preferences in neighborhood residents in accessing new affordable housing promote or betray the goal of truly inclusionary communities. 

Discussion 16: A New Approach to Affirmatively Furthering Fair Housing

November 2015

The sixteenth discussion reacts to HUD’s renewed commitment to the new requirement of the Fair Housing Act to “affirmatively further fair housing.”

Discussion 15: Moving Up or Moving Out

July 2015

The fifteenth discussion explores the most effective ways to address concentrated poverty, focusing on policies that target both people and place.

Discussion 14: Housing Subsidies & Inclusive Communities

June 2015

The fourteenth discussion examines the policy issues underlying Texas vs. The Inclusive Communities Project: how government officials should balance the use of Low-Income Housing Tax Credit (LIHTC) allocations to create affordable homes in low-poverty neighborhoods with the use of LIHTC allocations to catalyze economic development in high-poverty neighborhoods.

Discussion 13: The Future of the Fair Housing Act

April 2015

The thirteenth discussion debates the significant of disparate impact liability under the Fair Housing Act, in light of the Supreme Court's deliberation in Texas Department of Housing and Community Affairs v. The Inclusive Communities Project.

Discussion 12: The Poor Door Debate

March 2015

The twelfth discussion weighs the controversy about "poor doors" in the context of a debate over the costs and benefits of mixed-income housing in high-cost markets.

Discussion 11: Explaining Ferguson Through Place and Race

January 2015

The eleventh discussion in The Dream Revisited explores how metropolitan development patterns shaped by race and class set the stage for the events in Ferguson, MO.

Discussion 10: Balancing Investments in People & Place

November 2014

The tenth discussion in the Dream Revisited debates the appropriate balance between investments to help low-income households move to neighborhoods that offer greater access to opportunity and investments to improve the quality of life in low-income neighborhoods.

Discussion 9: Residential Income Segregation

November 2014

The ninth discussion in The Dream Revisited analyzes segregation by income and debates the significance of the increasing isolation of the affluent.

Discussion 8: Neighborhoods, Opportunities, and the Housing Choice Voucher Program

October 2014

The eighth discussion in The Dream Revisited explores how the federal Housing Choice Voucher program can most effectively improve social, educational, and economic opportunities for voucher recipients. 

Discussion 7: Comparative Perspectives on Segregation

September 2014

The seventh discussion in The Dream Revisited explores what can be learned by looking at racial and economic segregation through a comparative lens. 

Discussion 6: Implicit Bias and Segregation

August 2014

The sixth discussion explores how implicit bias contributes to residential segregation and whether or not awareness of implicit biases can heighten a sense of moral urgency.

Discussion 5: Place-Based Affirmative Action

July 2014

The fifth discussion explores proposals to re-imagine affirmative action by focusing on neighborhood disadvantage instead of race.

Discussion 4: Neighborhood Gentrification

May 2014

The fourth discussion explores the relationship between gentrification, neighborhood integration, and public participation.

Discussion 2: Economic Segregation in Schools

March 2014

The second discussion on The Dream Revisited explores economic segregation in our schools and argues for its continued relevance today. 

Discussion 1: Why Integration?

January 2014

The frst discussion in The Dream Revisited asks what we mean by "integration" and why it may be a necessary strategy to acheive racial and economic equality.