By Checkna Diawara Bagayoko

Introduction

In a time where the world is recovering from a global pandemic, opinions surrounding healthcare are more relevant than they have been many years. In December of 2020, the Center for Disease Control and Prevention (CDC) published an article reporting that racial minorities were disproportionately affected by the consequences of COVID-19. Interestingly enough, one of the factors affecting these populations included residential qualities such as “neighborhood and physical environment” (COVID-19). After gaining context on the effects of residential qualities on racial minority communities, one could argue that these characteristics are some of the most influential in creating health-related inequities.

While other social determinants of health, such as education and income, contribute to racial health disparities, the implications of residential barriers should not be overlooked. Residential barriers, barriers to quality health of certain communities, greatly impact populations who suffer from health-related disparities. Pharmacy and food deserts are two examples of residential barriers. These barriers further advance racial health inequities by exacerbating social determinants of health. Gaining an idea of what residential barriers are and what they look like are the first steps in thoroughly understanding how they influence the health outcomes of certain populations.

Pharmacy deserts can be defined as an area with inadequate access to pharmacies and prescription drugs. Food deserts can be defined as regions that lack grocery stores with affordable and healthy food options. As previously mentioned, pharmacy and food deserts contribute to residential barriers that cause health-related inequities (Cobaugh). The lack of access to these facilities and resources doesn’t necessarily act as barriers on their own. In reality geographic barriers affecting residents, like proximity from pharmacies or convenient stores, create the aforementioned phenomena. A closer focus on the impact of residence reveals more trends correlated between where someone lives and their quality of health.

Defining and Identifying Residential Segregation

Residential segregation involves the separation of social groups based on where they reside. Social groups can be categorized based on different factors such as age, sex, race, or ethnicity. Using these definitions, residential segregation could be identified and examined in municipal settings. Let’s use the city of Raleigh, North Carolina as an example. Figure 1 below presents a racial dot map. A racial dot map is a map that provides a visualization of the racial makeup and population density of a given region.

In this racial dot map of Raleigh, North Carolina, the concentration of colored dots represents the racial makeup of residents in certain areas. Green dots represent black residents, blue dots represent white residents, red dots represent Asian residents, orange dots represent Hispanic residents, and brown dots represent those of other racial and ethnic backgrounds.

After spending a few moments examining the dot map of Raleigh, noticeable patterns start to appear. The majority of the dots located on the southeastern portion of the map features mostly black residents, while white residents make up the majority of the dots on the northwestern part of the map. While the map above impeccably displays residential segregation, (based on racial identity), it doesn’t provide any information on how this phenomenon occurred. Although it’s an infamous topic, racial segregation is an effective example of the type of events that developed the residential trends seen in different racial demographics today.

Historical and Social Context of Residential Barriers

Segregation doesn’t have one sole cause. This kind of separation can occur because of various historical, social, and political circumstances (Williams). Jim Crow laws, legislation that legalized segregation by race, is an example of a political contributor to residential segregation. The discriminatory nature of Jim Crow laws restricted the rights of racial minorities in the United States by subjecting them to use separate, inferior facilities and institutions. “Under Jim Crow laws, states could authorize separate facilities not only for schools but for hospitals and clinics” (Britannica). These laws essentially restricted racial minorities to only access inferior quality healthcare institutions.

Other practices also produced similar conditions to those generated by Jim Crow Laws. Cultural institutions such as churches and economic associations, like housing and mortgage markets, further contributed to residential segregation by enforcing policies that discriminated against various minority groups (Williams 2). Understanding what contributes to residential segregation provides the context necessary to fully understand how those same factors influence outcomes of racial health disparities. In the context of African Americans’ experiences with segregation, these discriminatory policies limited the demographic to low-quality residential areas while also restricting their access to quality healthcare facilities (Williams).

Residential Barriers Influence on Social Determinants

Jeanie Franklin and Bill Kearney, two African Americans from Warren County North Carolina, witnessed the long-lasting effects of discriminatory practices against their community. In their interviews for the Southern Oral History Project (SOHP) both Franklin and Kearney reflect on the experiences they navigated through during racial segregation in Warrenton. In her SOHP interview, Franklin discusses how black communities in Warrenton primarily relied on the health department as a healthcare institution as a result of the discriminatory segregation laws in place:

“During that particular time, doctors’ offices were segregated as well, and that continued up to my time of having segregated doctors’ offices…. A lot of times, healthcare was home remedies. You know, whatever people knew or thought they knew that would help a particular medical condition, that’s what you were given. A lot of times, these were herbs or trees or other plants that just grew in the neighborhood nearby.” (Franklin 20.00)

As a result of the obstacles racial segregation posed in Warren County, home remedies were utilized as the primary form of healthcare for Franklin and others growing up. Based on Franklin’s experiences, it’s apparent that racial segregation had the unintended effect of making subjected communities more self-reliant. With limited exposure and access to adequate healthcare facilities, Franklin witnessed her community make use of the natural resources available to them. Equally affected by segregation, reverend Bill Kearney spoke about the support he witnessed occur in the community through his family’s garden. In his interview, Kearney shares his early childhood experiences, highlighting how support and comradery within the black community in Warrenton helped marginalized individuals during racial segregation:

“Growing up, we had a garden and mostly everything we ate was out of the garden. She [Kearney’s mother] would make things from scratch. Her employment helped her enhance what she was already doing around healthy eating and providing nutritious food for the children.” (Kearney 10:04)

Through both Kearney’s and Franklin’s interviews, people can gain a deeper understanding of how racial segregation influenced community relationships between individuals, as well as the relationships formed between communities and the healthcare institutions they used. Keep in mind that these experiences and relationships were formed in the 1950s, many decades before these interviews were conducted and released. So far, we’ve covered how racial segregation and other discriminatory practices produce the residential segregation patterns that contribute to racial health disparities. However, residential barriers to adequate healthcare don’t exist in a vacuum.

Similar to how geographical location can affect a person’s quality and access to healthcare, residential segregation also affects various factors that further influence healthcare disparities. Causal factors of healthcare outcomes include education, job occupations and conditions, income and wealth, and health-related behaviors. Because someone’s residence can influence these social determinants of health, learning how they perpetuate inequities in health will aid in identifying areas of needed intervention (Williams).

Potential Solutions

In a report based on racial segregation patterns, researchers found that “long-term exposure to conditions of concentrated poverty can undermine a strong work ethic, devalue academic success, and remove the social stigma of imprisonment as well as of educational and economic failure” (Williams). The consequences of racial segregation don’t end in these sectors of life. One reason why access to educational success is largely determined by the area of residence is because of local funding. Local governments and communities oversee funding for public education, meaning they largely determine the quality of education received by students at different schools (Williams 406). Residential segregation forces affected communities to make use of the resources around them, as told by Jeanie Franklin and Bill Kearney in their SOHP interviews. We’ve already discussed how the lack of healthy products in grocery stores, and even pharmaceutical enterprises can determine health outcomes. The correlation between the consequences of racial and residential segregation on important factors for community and individual health was well documented, and the aforementioned research confirms that causation is evident as well. Effectively reducing the effects of these trends involves implementing strategies to eliminate the source of these issues.

Increasing the knowledge and awareness of these issues is the first step in solving them, as it allows affected individuals to acquire a better perspective on the obstacles that prevent them from accessing proper health. Additionally, communities should be encouraged to participate in intervention efforts to reduce discriminatory practices against them, while also being supported in the advocacy of policies that seek to address their circumstances. In light of the attention racial health inequities received due to COVID-19, Bill Kearney wrote a blog post calling for people to act.

We should use our collective voices, political power, positions of privilege, media platforms, and other resources to challenge racist systems and elevate the voices of the oppressed who are demanding justice. This is our opportunity to advocate and work for racial equity. This is our opportunity to create a new reality by re-booting, re-imagining, and restructuring our racist systems/institutions. (Kearney)

Conclusion

Unsurprisingly, Kearney’s call for action was echoed in a scientific overview that proposed three intervention strategies to eliminate racial inequities in health. Of the three, the first suggested was “creating communities of opportunity”, which involves transforming marginalized communities into “places that provide opportunities in education, labor markets, housing markets, credit markets, health care and all other domains that drive well-being” (Williams). Practical steps to creating these changes involve: early childhood education interventions to positively impact the health of the youth, increasing awareness of issues like health inequity determinants such as residential segregation, and increasing political advocacy and relationships to demand policies that thoroughly address the factors that contribute to the disparities experienced by racial minority groups. Effectively implementing such strategies may very well lead to better health for communities affected by residential segregation and other racial health inequity factors.

References

Cobaugh, Daniel J. “Pharmacy access: Why are minorities’ options different?.” American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists vol. 74,10 (2017): 634-635. doi:10.2146/ajhp170191

“COVID-19 Racial and Ethnic Disparities.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Dec. 2020, www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html.

“Food Deserts*.” Food Empowerment Project, foodispower.org/access-health/food-deserts/.

Gebhart, Fred. “What Is a Pharmacy Desert?” Drug Topics, Drug Topics Journal, 24 Sept. 2019, www.drugtopics.com/view/what-pharmacy-desert.

Interview with Bill Kearney, 28 June 2018, Y-0034, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

Interview with Jennie Franklin, 14 November 2018, Y-0098, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

Kearney, Bill. “Surviving Racism and COVID-19 in Rural Warren County, N.C.” Center for Health Promotion and Disease Prevention, Food, Fitness & Opportunity Research Collaborative, 16 June 2020, hpdp.unc.edu/2020/06/surviving-racism-and-covid-19-in-rural-warren-county-n-c/.

“The Racial Dot Map.” Weldon Cooper Center for Public Service, University of Virginia, 2017, demographics.coopercenter.org/Racial-Dot-Map.

Williams, D R, and C Collins. “Racial residential segregation: a fundamental cause of racial disparities in health.” Public health reports (Washington, D.C. : 1974) vol. 116,5 (2001): 404-16. doi:10.1093/phr/116.5.404

Williams, David R, and Lisa A Cooper. “Reducing Racial Inequities in Health: Using What We Already Know to Take Action.” International journal of environmental research and public health vol. 16,4 606. 19 Feb. 2019, doi:10.3390/ijerph16040606