403 annotated bibliography final

Download 403 annotated bibliography final

Post on 16-Jan-2017




3 download

Embed Size (px)




The Effects of Material and Psychosocial Factors on Health in Segregated CommunitiesMarta ChmielowiczBryn Mawr College

The Effects of Material and Psychosocial Factors on Health in Segregated CommunitiesRace as a social construct is a powerful organizing feature of American society that reflects and reinforces group differences through access to power and social resources. One prominent way that this is accomplished is through residential segregation, referring to segregation in regard to the racial/ethnic composition and distribution of the population in city neighborhoods. By determining access to educational and employment opportunities for minority groups and creating residential environments that are unfavorable to good health, residential segregation halts socioeconomic mobility and is a central device by which racial inequality has been created and enforced in the United States (Collins & Williams, 1999). The mechanisms of institutionalized racism associated with residential segregation have been widely shown to adversely affect the health outcomes of minority racial groups (Collins & Williams, 1999; Fang, Madhavan, Bosworth, & Alderman, 1998; Williams & Collins, 2001). This is especially true of African Americans, who historically face an unprecedented level of segregation in the United States (Bcares, Nazroo, & Jackson, 2014) and are significantly more likely than Caucasians to live in deprived and economically segregated areas (Williams & Collins, 2001). These areas are in turn associated with higher rates of mortality, morbidity, and health risk factors compared with white neighborhoods (Gee and Payne-Sturges, 2004). Disparities such as these in health outcomes across neighborhoods are not only the result of individual factors (although negative exposures and a lack of resources held by individuals are essential aspects of segregation), but also from factors operating at the community level arising from systematic underinvestment in minority community infrastructure.Research has revealed two possible explanations linking health outcomes and residential segregation. The first focuses on the availability of material resources in the community, and the second focuses on individual psychosocial factors. This debate is important because understanding the root cause of health disparities in segregated neighborhoods could have significant policy implications. Proponents of the materialist perspective argue that racial health discrepancies result from differential community access to various material resources. Since segregation is generally linked to systematic underinvestment in the infrastructure of ethnic minority communities, these resources can include things like education (schools), employment opportunities, health services, housing quality, environmental pollution, malnutrition, transportation, amenities, and state services (Collins & Williams, 1999; Williams and Collins, 2001; Gee & Payne-Sturges, 2004). On the other hand, some researchers believe that psychosocial factors, or factors associated with individual psychological functioning such as trust, social support, social control, and sense of community, better explain the relationship between racial segregation and health (Gee & Payne-Sturges, 2004). This view has emerged from research suggesting that increased exposure to psychosocial stressors adversely affects the bodys physiological stress-response system, such as the regulation of cortisol, leading to negative health outcomes (Gee & Payne-Sturges, 2004). Because racial minorities residing in highly segregated communities tend to be disadvantaged economically and socially, they encounter greater levels of psychosocial stressors, which therefore results in health disparities among groups. One of these stressors may be the experience of racist stigma and discrimination (Gee & Payne-Sturges, 2004). Stigma is a combination of individual experiences of unfair treatment resulting from negative stereotypes of minority groups (Collins & Williams, 1999) and the more general social exclusion associated with social segregation. Another possibility is the sense of relative deprivation, or belief that one is at a disadvantage in relation to others. Evidence for the effect of relative deprivation can be seen in the higher mortality rates of African Americans living in white neighborhoods compared to those living in black neighborhoods, despite the fact that their socioeconomic status is more favorable (Fang et al., 1998).The importance of psychosocial factors on health is also demonstrated through the existence of ethnic density effects that lead to improved health outcomes among minority groups by increasing social cohesion, mutual social support, a stronger sense of a community and belongingness, and reducing exposure to interpersonal racism (Bcares et al, 2014). Ethnic density effects are thought to provide a buffering effect from the consequences of discrimination and the detrimental effects of low status stigma. However, research has shown that these positive effects cease to exist in communities that are extremely segregated (more than 85% black) as well as in higher SES African American populations (Bcares et al, 2014). This first finding suggests that the harmful individual and community material factors resulting from residential segregation overshadow potential benefits of ethnic density in areas where segregation is most profound. This means that the underlying cause of health disparities resulting from segregation is not due to the ethnic population density of a community, but due to the negative effects of some element of the segregated environment. The second suggests the potential importance of status inconsistency, or a mismatch between an individuals social status positions, as a mechanism linking stress and overall health with segregation. While I do not deny the existence of negative psychosocial consequences of residential segregation, I believe that the materialist interpretation is a more compelling explanation of health inequalities in that it addresses the structural causes of inequality rather than just individual perceptions of that inequality. One of the major problems that I see with psychosocial theories is that they have such a tight focus on the individual-level effects of larger scale processes that generate inequality that they fail to reference the societal conditions that create those inequalities in the first place. Since psychosocial theories focus on aspects of personal psychological functioning and interpersonal relations, it is hard to see how they could serve as a basis for an actual public policy agenda to reduce health discrepancies. In contrast, material interpretations recognize that health inequality is caused by economic and political processes that generate residential segregation and influence both individual resources as well as community resources. They have greater potential to inform strategic interventions in the distribution of resources that would have the greatest impact on improving public health.

Annotated ReferencesBcares, L., Nazroo, J., & Jackson, J. (2014). Ethnic density and depressive symptoms among African Americans: Threshold and differential effects across social and demographic subgroups. American Journal of Public Health, 104 (12), 2334-2341.This study aimed to determine the differential effects of ethnic density among African Americans, the thresholds at which ethnic density moves from being protective to detrimental to health outcomes, and the extent to which this is affected by area deprivation. It assessed depressive symptoms in a sample of African American respondents from the National Survey of American Life and the 2000 US Census in order to obtain information about area deprivation, ethnic density, and the social circumstances and mental health of the US black population. Results showed that the protective effects of ethnic density became detrimental when black ethnic density reached 85%. Black ethnic density was protective for people of lower socioeconomic status and detrimental to those of higher socioeconomic status, and increased ethnic density was associated with improved mental health only among people with less than a college education. These results suggests that the factors associated with residential segregation like economic deprivation and racial discrimination rather than ethnic density are responsible for greater depressive symptoms among African Americans. Although these results show the importance of psychosocial factors on mental health due to the protective effects of ethnic density below the 85% threshold, they also show that material factors are ultimately more responsible for negative health outcomes in the most highly segregated neighborhoods, and that any policy changes would have to address these material factors in order to produce meaningful change.Collins, C. A., & Williams, D. R. (1999). Segregation and morality: The deadly effects of racism? Sociological Forum, 14, 495-523.This study analyzed national demographic and health data from the 1990 United States Mortality Detail Files and the 1990 US Census to assess the extent to which racial residential segregation is linked to multiple indicators of mortality for blacks and whites, including deaths from all causes, deaths from heart disease and cancer, and homicide. It used social isolation, or isolation of blacks from non-blacks, rather than the typically used index of dissimilarity, or the degree of spatial distribution of blacks and non-blacks, as the primary measure of racial segregation. Results showed that mortality rates for all indicators were higher for African Americans compared to whites. The degree of social isolation was positively related to