Neighborhood conditions: A common basis for multiple health disparities
RESEARCH SHOWS THAT neighborhood conditions and economic characteristics influence a variety of health outcomes and health behaviors. While the diversity of the causes and possible outcomes complicates research and study design, the close relationship between neighborhood conditions and health outcomes presents policymakers with a variety of ways to improve residents’ health.
Research findings of Diversity and Health Disparities cluster faculty Lonnie Snowden, UC Berkeley Public Health Professor, and Julian Chun-Chung Chow, Hutto-Patterson Charitable Foundation Professor at UC Berkeley School of Social Welfare, deepen our understanding of the complex relationship between neighborhood poverty, race/ethnicity, and mental health service use.12 Chow and Snowden compare the mental health service use of different racial/ethnic populations living in high- or low-poverty areas and find that disparities in emergency and inpatient service utilization and coercive referrals were more evident in low-poverty areas.
Their findings also reveal that racial/ethnic minorities who access mental health services are less likely than whites to have been referred by themselves, family members, or friends, as shown in Figure 2. Troublingly, Blacks and Hispanics are more likely than whites to be referred to mental health services by law enforcement. Snowden and Chow reason that the lack of tolerance for racial minorities in low-poverty areas makes these individuals stand out, which draws heightened attention from law enforcement, thus forcing racial/ ethnic minorities with mental illness into treatment services. These results imply the need to tailor mental health services to the unique needs of minority racial/ethnic groups in different settings, encourage appropriate pathways to mental health care in low-poverty areas, and prioritize programs in high-poverty areas that target racial/ethnic minority and immigrant children.
Neighborhood and social inequalities help explain high rates of asthma in racial/ethnic minority groups, as shown through research led by Jason Corburn, UC Berkeley Public Health and City & Regional Planning Professor and Haas Institute Diversity and Health Disparities research member. Corburn, Jeffrey Osleeb, and Michael Porter found that high rates of asthma hospitalization among New York City children can be predicted by having a low-income, being a minority, and living in substandard housing, as shown in Figure 3.13 Asthma rates in “hotspot” neighborhoods, where rates of asthma hospitalizations were statistically significant relative to the population, were nearly three times the national average, and hotspot residents were twice as likely to be African American and/or Latino.14
Research from UC Berkeley Public Policy Professor and Diversity and Health Disparities member Rucker Johnson describes a relationship between exposure to poor neighborhood conditions early in life and poor health later on. Johnson, Robert Schoeni, and Jeannette Rogowski followed the health trajectories of married couples and neighbors for 38 years and found that living in poor neighborhoods during young adulthood is strongly associated with negative health outcomes in later life.15 On average, the health status of Black people deteriorated 30 years faster than the health status of white people. This finding is consistent with the weathering hypothesis introduced by Arline T. Geronimus (1992), which posits that Blacks experience early health deterioration because of repeated exposure to social or economic adversity and political marginalization.16 Johnson’s findings build on his prior research that shows how neighborhood quality influences later-life health in ways that cannot be reduced to the characteristics of the individuals and families themselves, as illustrated in Figures 4 and 5.17
UC Berkeley Public Health Professor and Haas Institute Diversity and Health Disparities fauclty member Denise Herd, with Sylvia Guendelman, Paul Gruenewald, and Lillian Remer, produced research showing racial health disparities early in the life course. In a study examining the incidence of low birth weight among racial/ethnic groups living in the same area, Herd et al. found that rates of low birth weight among African Americans were lower if they lived in areas that were more densely populated, had greater income disparities, and had low rates of alcohol abuse or dependence.18 These relationships were different or absent for Hispanic and white women. The most surprising finding was that African American, but not white or Hispanic, women living in segregated areas had significantly lower rates of low birth weight infants. This finding builds on growing evidence of the benefits of high racial group density on African American health conditions.19 The results from Herd et al.’s study show us that the relationship between neighborhood conditions, race, and health outcomes is complex: conditions that may be beneficial for some groups are harmful or have no effect for others.
Research from the Haas Institute Diversity and Health Disparities research cluster demonstrates how the differences in racial/ethnic health outcomes are shaped by neighborhood-based factors such as concentration of poverty, population density, income disparities, and racial segregation. What’s interesting and complicated about these associations is that place and the people who compose a place are not mutually exclusive. Rather, they are part of a mutually reinforcing and reciprocal relationship.20 This is why reducing racial/ethnic health disparities will require cooperation and collaboration between many different stakeholders and decision-makers—city planners, physicians, lawmakers, community residents, and more.