403 annotated bibliography final
TRANSCRIPT
Running head: EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 1
The Effects of Material and Psychosocial Factors on
Health in Segregated Communities
Marta Chmielowicz
Bryn Mawr College
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 2
The Effects of Material and Psychosocial Factors on
Health in Segregated Communities
Race 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 (Bécares, 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.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 3
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 body’s 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
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 4
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 (Bécares 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 (Bécares 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 individual’s 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
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 5
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.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 6
Annotated References
Bécares, 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.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 7
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 all of the indicators of mortality for black males and all
indicators except for homicide for black females, but only to cancer for white males. In
general, poverty was positively associated with mortality for both white males and
females compared to blacks, with the association being weakest for black females. This
implies that the adverse conditions linked to highly segregated neighborhoods may
negatively affect the health of all people who reside there regardless of race. The
demonstrated variation in the rates of mortality among blacks and whites, particularly
from cancer and heart disease, could also reflect the underlying mechanisms by which
segregation affects health. There are multiple material characteristics of low SES and
segregated environments, such as levels of carcinogens in the environment and
differences in access to medical care, that are likely to be related to these variations in
health outcomes.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 8
Fang, J., Madhavan, S., Bosworth, W., & Alderman M. H. (1998). Residential segregation and
mortality in New York City. Social Science & Medicine, 47 (4), 469-476.
This study examined all-cause and cardiovascular mortality in relation to residential
segregation in New York City. Researchers used 1990 US census data and New York
Mortality records for a seven-year period in order to examine segregation using the index
of dissimilarity across zip codes. Results showed variations in mortality across groups
that was independent of socioeconomic and demographic factors known to influence
health outcomes, suggesting the direct influence of aspects of residential segregation on
health. Both blacks and whites living in predominantly white areas had higher
socioeconomic status than their counterparts living in predominantly black areas.
However, whites of all ages and both sexes who lived in predominantly black areas had
higher mortality than those living in predominantly white areas, whereas mortality rates
for older blacks were higher in predominantly white areas. For young blacks, death rates
didn’t differ much by the racial composition of the area that they lived in after adjustment
for socioeconomic status. These findings suggest the importance of psychosocial factors
such as social support and social cohesion. Older black people living in white areas could
have greater rates of mortality due to the isolation and lack of social support network that
results from their existence as a demographic minority in a white area. This effect may
also be due to perceived status inconsistency, wherein black people living in white
neighborhoods may perceive an imbalance between their race and their social position,
creating resentment and discrimination that negatively affects health outcomes.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 9
Gee, G. C., & Payne-Sturges, D. C. (2004). Environmental health disparities: A framework
integrating psychosocial and environmental concepts. Environmental Health
Perspectives, 112(17), 1645-1653.
This article is a review of the literature examining the vulnerability of racial and ethnic
minorities to environmental and structural hazards associated with segregated
communities. The authors argue that since ethnicity is correlated with residential
location, residential location is a primary vehicle through which people of various ethnic
groups experience differential exposure to health risks. As a result of the institutionalized
racism which affects segregated and disadvantaged communities, those communities
encounter a greater number of physical and psychosocial stressors and environmental
pollutants which cause adverse health conditions among their residents. These stressors
could be counterbalanced by neighborhood social resources such as social cohesion,
community empowerment, social capital, and social control. However, the levels of stress
and pollution in segregated communities often outweighs neighborhood sources, leading
to increased levels of community stress, which in turn lead to increased individual stress
and increased vulnerability of individuals to illness. This research suggests that policies
to reduce health disparities among communities should focus on eliminating
environmental pollutants and community stressors by investing in the economic,
structural, and material resources of the community. This would decrease community and
individual stressors, reducing negative health outcomes among people in segregated
residential areas and closing the gap between advantaged and disadvantaged groups.
Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of
racial disparities in health. Public Health Reports, 116, 404-416.
EFFECT OF MATERIAL AND PSYCHOSOCIAL FACTORS 10
This article reviews evidence that suggests that segregation is a fundamental cause of
health disparities between African Americans and whites because it limits the access of
minority groups to education and employment, preventing socioeconomic mobility.
These structural conditions cause African Americans to be isolated in segregated
residential communities that face various social and physical risk factors, thereby creating
racial disparities in health. Some of these risk factors include community-level effects
such as state disinvestment of economic resources and infrastructure, increased exposure
to crime, decreased amenities, pollution, poor housing quality, and decreased access to
high quality medical care and nutritious food. In order to reverse these health disparities,
the authors suggest that attention be paid to eliminating racial disparities in
socioeconomic status by targeting interventions at entire communities as well as
individuals.