Abstract
Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.
Highlights
In the United States (U.S.), racial and ethnic minorities fare significantly worse than their white counterparts on most health outcomes, including cancer, cardiometabolic disease, infant mortality, and mental health
The area of measurement across studies was defined at multiple levels, including census tract (CT) (n = 11), followed by zip code (n = 4), county (n = 3), community district (CD) (n = 3), and city (n = 1)
We critically review the empirical evidence as it relates to the link between segregation–as defined by ICERace-Income−and population-level health disparities
Summary
In the United States (U.S.), racial and ethnic minorities fare significantly worse than their white counterparts on most health outcomes, including cancer, cardiometabolic disease, infant mortality, and mental health. Racialized residential segregation in the U.S is the result of a long history of explicit racist policies (e.g., Jim Crow laws) that continue to be perpetuated by local and federal housing policies (e.g., redlining) and economic practices (e.g., home lending) and enforced by aggressive and violent policing by law enforcement and citizens [2, 6, 7] These racist structures are designed, in part, to spatially concentrate and disenfranchise racial and ethnic minority populations from mainstream white society, restricting access to resources and opportunity for optimal physical and mental health and economic affluence and mobility [2, 8]. The underlying processes that underpin the observed association between segregation and health outcomes are understudied and unclear
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