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.

Essay

  • 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.  

Discussants

  • 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. 

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