Race/Class Paradoxes: Residential Segregation Amplifies Disparities in Health Outcome

Background

Nassau County (NC), immediately to the east of New York City (NYC), with a history of residential race/class segregation and administrative decentralization, is one of the wealthiest counties in the country with excellent average health status based on Wisconsin criteria. Health outcomes show dramatic geographic variation within NC, pointing to effects of decentralized authority and/or to new links between juxta-urban disadvantage and poor health. We sought to develop testable hypotheses about community health in juxta-urban regions by studying NC and nearby counties. 

Methods

Using published data from NC, NYC, NY State, and federal agencies, we compared computed rates of specific health outcomes by race and location.

Results

For many outcomes, black/white rate ratios were similar or reduced in NC compared to neighboring counties within NYC, but were greater for infant mortality and certain cancers.  At neighborhood level, black infant mortality in relatively affluent NC zip codes was similar to extremely poor zip codes within NYC.

Conclusions

The findings suggest a complex relationship of race, class, and risk for specific outcomes most amenable to healthcare intervention. We propose several hypotheses, including special selective effects contingent on residential segregation, impacts of administrative decentralization on healthcare availability, differential awareness of access to care, and race and class effects of compromised public transportation systems. As more than half of US residents now live in nonrural settings outside the limits of major cities, issues of inequity and health disparity in regions like NC demand exploration.