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Poverty, Race, and Health: Does Place Matter?

Kevin M. Fitzpatrick, Ph.D. Professor and Jones Chair in Community

✤ Built environment studies show clear relationships between the physical environment and mental health outcomes.

✤ Chronic stress increases the risk of obesity, hypertension, diabetes, pre-term birth, and depression.

✤ Mortality rates among Blacks and Latinos living in high-risk neighborhoods are 50% higher compared to low-risk neighborhoods.

✤ Children living in poverty in the United States are more likely to develop physical and mental health problems at a rate of 5-6 times that of their out-of-poverty counterparts.

A Model for Understanding the Health, Race, and Place

Relationship

A. Diez Roux and C. Mair, 2010. Annals of NY Academy of Science 1186:125-45

✤ Structural factors like residential segregation continue to reinforce significant racial and ethnic inequalities in the United States.

✤ Racial and ethnic inequality tied to both social and physical environments often creating hazards and risks for all residents but tend to be greatest among the least mobile (youth, elderly, disabled).

✤ Some residents are better equipped at coping with these place-based stressors than others; money (financial capital) and friends (social capital) matter.

✤ Chronic disease and mental health outcomes are significantly impacted by these neighborhood place-based “effects”.

Place-Based Health Assumptions

How Segregated Can We Get?

Detroit MSA D = 67.8

Red =White; Blue = Black; Orange = Latino

✤ 98% African-American

✤ 33% of households living below the poverty level

✤ 14% of housing units are vacant

✤ Infant mortality rates three times greater than Jefferson county

✤ Chronic disease and violent death rates 25% higher than Jefferson county

✤ Lead paint exposure (< 5 years old) 123% higher than Jefferson county

Village Creek Context and Health

Are We Doing Anything About It?

✤ Removal Strategies

✤ Community Development Strategies

✤ Neighborhood Health Promotion

✤ Building a Healthier America Program