Exclusive Commentary

Separate Spaces, Risky Places: A Price the Nation Can’t Afford

Brian D. Smedley, Joint Center for Political and Economic Studies - Posted October 15, 2013


As the nation commemorated the 50th anniversary of the 1963 March on Washington for Jobs and Freedom in August, many reflected on the United States’ progress toward racial equality. Without question, the nation has made significant strides toward expanding opportunity for all and reducing racial disparities across most measures. But many inequities persist, and few are more troubling than the persistent racial and ethnic health gap.

Many people of color face poorer health than white Americans from the cradle to the grave, in the form of higher rates of infant mortality, chronic disease and disability, and premature death. These health inequities carry a tremendous human toll, but also impose an enormous economic burden on the nation.

A study commissioned by the Joint Center for Political and Economic Studies found that the direct medical costs associated with health inequities – in other words, additional costs of health care incurred because of the higher burden of disease and illness experienced by minorities – was nearly $230 billion over the four year period studied, 2003 through 2006. Adding the indirect costs – such as lost wages and productivity and lost tax revenue – means that the total cost of health inequities for the nation was $1.24 trillion in the same time span.

The national discourse on health inequities tends to reduce these problems to merely issues of access to healthcare or the “bad behavior” of their victims, suggesting that if people only ate right, exercised, or saw a doctor regularly, health inequities could be eliminated.

Without question, access to high-quality healthcare is important, particularly for those who face health risks. And individuals should strive for active lifestyles and healthy diets.

But a large and growing body of research demonstrates that the spaces and places where people live, work, study, and play powerfully shape the opportunities that individuals have to achieve good health. As a result of persistent segregation, people of color disproportionately are situated in unhealthy spaces, a major factor that helps explain the poorer health of many minority groups.

Neighborhood conditions can overwhelm even the most persistent and determined efforts of individuals to take steps to improve their health. Neighborhoods characterized by high rates of poverty are disproportionately burdened by health risks, such as environmental degradation often brought about by a high density of polluting industries. It’s also harder to eat right in these communities because there are fewer grocery stores offering fresh fruits and vegetables.

These same communities typically have poorer-quality housing and transportation options, and were hit hardest by the home mortgage lending crisis, which crushed wealth opportunities and disproportionately affected communities of color. Many of these neighborhoods also experience high rates of crime and violence, which affect even those who are not directly victimized, as a result of stress and an inability to exercise or play outside. Even healthcare providers, hospitals, and clinics are harder to find in these neighborhoods.

African Americans, Hispanics, and American Indians are substantially more likely to live in high-poverty neighborhoods than white non-Hispanics. One in four African Americans, one in six Hispanics, and one in eight American Indians in metropolitan America live in a census tract where 30 percent or more of the population is in poverty. This contrasts starkly with the estimated 1 in 25 non-Hispanic whites in metro areas who live in one of these tracts.

But the high proportion of people of color in high-poverty communities isn’t solely the result of well-documented class differences:  even middle- and higher-income minorities are disproportionately in high poverty neighborhoods. That’s true because of a host of historic and contemporary factors that facilitate segregation, such as the ripple effects of Jim Crow segregation, “redlining” – the now-banned but persistent practice of disinvestment and economic discrimination against communities of color – as well as modern-day discrimination, such as steering of minority homebuyers or renters away from majority-white communities.

Segregation is unlikely to be completely eliminated in the U.S. but policymakers can make smart choices to help improve community conditions for health. Federal programs that stimulate investment in the nation’s hardest-hit communities are working to attract businesses, create jobs, and reduce the concentration of health risks. The Healthy Food Financing Initiative, for example, creates financial incentives for grocery stores or farmers’ markets to open in “food deserts” that lack access to healthy foods and the jobs that often accompany healthy food retail. And the Obama Administration’s “Promise Zones” initiative will streamline a host of federal “place-based” initiatives and offer technical assistance to jurisdictions that seek to stimulate economic activity and build ladders of opportunity.

Without question, policymakers are facing difficult budget decisions. But the substantial cost of the status quo makes investments in vulnerable communities one of the most cost-effective strategies to close the health gap and improve the overall health of the nation.

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Brian D. Smedley is the vice president and director of the Health Policy Institute of the Joint Center for Political and Economic Studies.

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