Download - 403 annotated bibliography final

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.


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


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


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 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.


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.


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.


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.


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.

Download - 403 annotated bibliography final

Top Related