copyright 2004, gilbert c. gee, phd neighborhoods and health disparities 2004 summer public health...
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Copyright 2004, Gilbert C. Gee, PhD
Neighborhoods and Health Disparities
2004 Summer Public Health Research Institute and Videoconference on Minority Health
Gilbert C. Gee, PhDUniversity of Michigan
Copyright 2004, Gilbert C. Gee, PhD
U.S. Life Expectancy by Race, 1930-1999
0
10
20
30
40
50
60
70
80
90
Lif
e E
xpec
tan
cy f
rom
Bir
th (
year
s)
White
Black
White 61.4 64.2 69.1 70.6 71.7 74.4 76.1 77.3
Black 48.1 53.1 60.8 63.6 64.1 68.1 69.1 71.4
1930 1940 1950 1960 1970 1980 1990 1999
Copyright 2004, Gilbert C. Gee, PhD
Per Capita Expenditures on Health Care, Top Five Countries, 1999
$2,313
$2,424
$2,425
$2,794
$4,358
$0 $1,000 $2,000 $3,000 $4,000 $5,000
Canada
German
Norway
Switzerland
U.S.A.
Copyright 2004, Gilbert C. Gee, PhD
Health Care Expenditures, As Percent of Gross Domestic Product, 1999
9.5
9.6
10.6
10.4
13
0 2 4 6 8 10 12 14
Canada
France
Germany
Switzerland
U.S.A.
% GDP
Copyright 2004, Gilbert C. Gee, PhD
Life Expectancy at Birth
Women
1. Japan 82.9
2. France 82.6
3. Switzerland 81.9
19. U.S. 78.9
Men
1. Japan 76.4
2. Sweden 76.2
3. Israel 75.3
20.Cuba 75.0
25. U.S. 72.5
Copyright 2004, Gilbert C. Gee, PhD
• The greater disability burden to minorities is of grave concern to the public health, and it has very real consequences. Ethnic and racial minorities do not yet completely share in the hope afforded by remarkable scientific advances….
• David Satcher, M.D., Ph.D. (2001)
Copyright 2004, Gilbert C. Gee, PhD
Health Disparities
• Racial disparities are a marker of the health of race relations.
• Explanations– Genetics/Biology (?)– Social Class– Culture– Discrimination– Geography
Copyright 2004, Gilbert C. Gee, PhD
Political-Economic System
National & State Policies
Community and Occupations
Stratification
Social Networks
Health Behaviors
Genetics
HealthCare
Copyright 2004, Gilbert C. Gee, PhD
Convergent perspectives
• “Ecological model”– Bronfenbrenner
• Proximal-Distal– Amick
• Fundamental / root causes– Link & Phalen
• Ecosocial theory– Krieger
• Multi-level perspective– Diez-Roux
Copyright 2004, Gilbert C. Gee, PhD
Why look at neighborhoods as an explanation for health disparities?
1. Whites and ethnic minorities do not live in the same places.
2. Neighborhoods provide fundamental contexts that shape life experiences and exposures
• Environmental exposures may lead to illness• Neighborhoods set and reflect opportunity structures
3. Improving neighborhoods may be a way to eliminate health disparities.
Copyright 2004, Gilbert C. Gee, PhD
• Real-Estate Boards
– “A Realtor should never be instrumental in introducing into a neighborhood … members of any race or nationality … whose presence will clearly be detrimental to property values in that neighborhood.”
• National Association of Real Estate Brokers, 1924.
• Ended, 1950
Copyright 2004, Gilbert C. Gee, PhD
• Government
– “If a neighborhood is to retain stability, it is necessary that properties shall continue to be occupied by the same social and racial classes. A change in social or racial occupancy generally contributes to instability and a decline in values.”
• Federal Housing Administration, 1938
– Changes with Civil Rights• Equal Credit Opportunity Act• Fair Housing Act• Community Reinvestment Act• Home Mortgage Disclosure Act
Copyright 2004, Gilbert C. Gee, PhD
What about today?
• HUD’s Housing and Discrimination Study, 2000
• Audit Methodology
• “Asian and Pacific Islander homebuyers experience consistent adverse treatment 20.4% of the time, with systematic discrimination occurring in housing availability, inspections, financing assistance, and agent encouragement. This level of discrimination is comparable to the level experienced by African American homebuyers…”
Source: The Urban Institute, 2003
Copyright 2004, Gilbert C. Gee, PhD
Residential Patterns of Whites & African Americans, Detroit, MI, 1990
African AmericansWhites
D=89
Copyright 2004, Gilbert C. Gee, PhD
Table 1. Metropolitan Segregation* 1980-2000
1980 1990 2000
Black with Whites 73.8 68.8 65.0
Hispanic with Whites 50.7 50.6 51.5
Asian with Whites 41.2 42.0 42.1
Census, 2000 * Index of dissimilarity
Copyright 2004, Gilbert C. Gee, PhD
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
% Black
0.5
1
1.5
2
2.5
3
Lyn
chin
g R
ate
Standardized Lynching Rate for 7 Groups of Mississippi Counties by Percent Black -- JS Reed, 1972
Copyright 2004, Gilbert C. Gee, PhD
Age-adjusted CVD Mortality, by Birthplace and Gender, NYC, 1988-1992
Fang, et al., 1996
Copyright 2004, Gilbert C. Gee, PhD
Potential Mechanisms
• Environmental Justice
• Community stressors
• Concentration of poverty
• Clustering of resources
Copyright 2004, Gilbert C. Gee, PhD
Street noise or traffic present among homeowners, by social status
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Total Black Below poverty
%
Street noise or traffic present among renters, by social status
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
Total Black Below poverty%
Source: 1999 American Housing Survey
Copyright 2004, Gilbert C. Gee, PhD
Neighborhood Vehicular Burden & Health
Vehicular burden
Lower Upper
Median Median
Health Status ** 68.1 72.1
Depression ** 0.22 0.20
Traffic stress 3.91 4.13
** P < 0.01
Copyright 2004, Gilbert C. Gee, PhD
-1.56 -0.85 -0.14 0.58 1.29 2.00
TRAFFIC STRESS
65.0
65.8
66.6
67.4
68.2
69.0
69.8
70.6
71.4
72.2
73.0
General Health
LOW HIGH
Upper QuintileLower Quintile
Vehicular Burden
Figure 2. Interaction between Traffic Stress and Vehicular Burden on Health Status
Controlling for all covariates. Traffic stress is centered at its group mean. The lower quintile and upper quintile of vehicular burden refers to the bottom 25% and upper 25%, respectively, of car use density in census tracts. Traffic stress and health status are measured at the individual level. n=1,503
Source: Gee & Taekuchi, 2004
Copyright 2004, Gilbert C. Gee, PhD
Ethnic Composition of High Poverty Neighborhoods, 1990 Census (Adapted from Jargowski, 1997)
White23%
Black49%
Other4%
Hispanic24%
Copyright 2004, Gilbert C. Gee, PhD
White28%
Black12%
Asian12%
Hispanic48%
White52%
Black5%
Asian12%
Hispanic31%
High Job Growth Areas
Low Job Growth Areas
Ethnic composition of Low and High Job Growth Areas, Los Angeles, 1990(Adapted from Pastor, 2001)
Copyright 2004, Gilbert C. Gee, PhD
Source: Federal Reserve, 2001 Survey of Consumer Finances
• Median family net worth, 2001
– Homeowners $171,700– Renters 4,800
Copyright 2004, Gilbert C. Gee, PhD
Homeownerhip rates by Ethnicity of Householder, 2000 Census
0 10 20 30 40 50 60 70 80
Hispanic
Black
Two or more races
Asian and Pacific Islander
American Indian & Alaskan Native
White Non-Hispanic
%
Copyright 2004, Gilbert C. Gee, PhD
Housing Appreciation between1967-1988, by Race and Housing
Value
0
10000
20000
30000
40000
50000
60000
Less expensivehomes
More expensivehomes
Th
ou
san
ds
$
White
Black
Source: Oliver & Shapiro, 1997
Copyright 2004, Gilbert C. Gee, PhD
• Alcohol & tobacco advertising (USDHHS, 1998)
• Pharmaceuticals (Morrison, 2000)
• Food stores (Morland, et al., 2001)
Copyright 2004, Gilbert C. Gee, PhD
Segregation
Resource Depletion Resource Accumulation
EmploymentEducationNetworks
Municipal ServicesEnvironmental Toxins
EmploymentLanguage, Tutoring
Refuge from Overt RacismLegal Assistance
Foods
Negative Outcomes Positive Outcomes
Copyright 2004, Gilbert C. Gee, PhD
• “I don’t consider myself a minority when I am there [Little Saigon, California]. When I am in other malls such as South Coast Plaza, I am constantly aware that I am ‘different’ because of my physical traits. It is a belonging need that other places cannot fulfill.”
Quoted in Munzamar, et al., 2000
Copyright 2004, Gilbert C. Gee, PhD
• “The ethnic enclave is an attempt … to create social and cultural ecological conditions for ease in survival and adaptation.”
• Munzamar, et al., 2000
Copyright 2004, Gilbert C. Gee, PhD
• Black political power (Laveist, 1993)
• Social capital (Sampson, 1997; Kawachi, et al., 1998)
Copyright 2004, Gilbert C. Gee, PhD
Race/Ethnicity
Residential Location
Community Stressors
NeighborhoodResources
EnvironmentalToxins
Community Stress
IndividualStress
Exposure
InternalDose
HealthEffect
EnvironmentalLevel Vulnerability
IndividualLevel Vulnerability
Gee & Payne-Sturges
Environmental Racial Disparities Framework
Residential segregation
Copyright 2004, Gilbert C. Gee, PhD
A woman walks past a homeless person sleeping on the sidewalk on Mission Street in downtown San Francisco. New York Times
Copyright 2004, Gilbert C. Gee, PhDMonica Almeida/New York Times
Women sit in a coffee shop as a homeless man panhandles for money outside on Market Street in downtown San Francisco.
Copyright 2004, Gilbert C. Gee, PhD
Demonstrators from labor organizations and anti-World Trade Organization groups march in downtown Seattle to protest the World Trade Organization talks on Tuesdsay. New York Times. 12/1/99
Copyright 2004, Gilbert C. Gee, PhD
For further reading:
• Neighborhoods and Health. 2003. Eds: I Kawachi & L.F. Berkman. New York: Oxford University Press
• Building communities from the inside out. 1993. Kretzmann J.P. and McKnight J.L. Chicago: ACTA Publications
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