Relationship between residential segregation and health literacy among a multiethnic health center patient population

Introduction: The association between residential segregation and health disparities is well documented. Residential segregation has been referred to as the “structural lynchpin” that maintains structural inequality in America. Some researchers consider it a fundamental cause of racial/ethnic disparities in health. Few studies have identified mechanisms or pathways by which residential segregation influences health. We posit that health literacy is a pathway. This study tests whether there is an association between health literacy and residential segregation.

Methods: We conducted a cross-sectional survey with 962 patients of community health centers serving a diverse (29.0% white, 32.9% Black, and 38.2% Hispanic) medically underserved population in Long Island, NY. We examined bivariate associations between self-reported residential segregation experiences in five environments (i.e., junior high, high school, neighborhood growing up, current neighborhood, and current place of worship) and health literacy (as measured by the Newest Vital Sign) by race.

Results: For non-Hispanic whites and Hispanics there were significant differences in health literacy when comparing those who reported being in a mostly white environment compared to those who reported more diversity in their environments. There were no significant differences for non-Hispanic blacks likely due to the limited number of blacks reporting “mostly white” in any of the 5 environments.

Discussion: There are associations between self-reported residential segregation and health literacy in all five environmental domains but this relationship is nuanced. These findings suggest that future health promotion efforts that address limited health literacy may as a strategy reduce those effects of residential segregation on health.