Won’t You Be My Neighbor?
It’s a beautiful day in the neighborhood…
Where you live can affect your health in ways you might not be aware of. So says a new study by Melody Goodman and her associates. Her research focuses on health literacy and how it is related to residential segregation.
What is residential segregation? In this case it refers to the ethnic or racial makeup of communities. Recently Reuters reported a new study that reviewed the moving habits of over 100,000 families in the last 30 years. According to Kyle Crowder author of the study from the University of Washington in Seattle, sixty percent of families leaving black neighborhoods moved to black neighborhoods and nearly seventy-five percent of whites moved from white neighborhoods to another white neighborhood. In fact, the majority of blacks, whites and Hispanics, regardless of income, continue to live in neighborhoods with residents of their own race.
Why is this important?
There seems to be a relationship between segregated neighborhoods and a variety of health risks ranging from infectious diseases to exposure to toxins (Osypuk and Acevedo‐Garcia, 2008). For example, according to the CDC, exposure to benzene, a well known carcinogen (cancer causing toxin) is more likely among children in poorer urban neighborhoods. Benzene is in gasoline, and is found in the air on highly trafficked streets. Since there are fewer playgrounds and sidewalks in poorer neighborhoods, children playing in the streets have increased exposure.
Access to health care is another problem. How do you decide which doctor or dentist to use in your community? You ask your family, coworkers, neighbors, trusted others and get a smattering of stories about their experiences. Then you choose among the recommendations and try to get an appointment with that health care professional.
Since more African Americans and Hispanics have lower incomes on average than Whites, they are more likely to either have no health insurance or to be covered by Medicaid. Additionally they are less able to pay out of pocket for services. A domino effect results…since providers don’t receive full reimbursement for their services they are less likely to locate their practice in minority communities. (Bronstein et al., 2004)
When physicians and nurses live and work in your community, there is more of a chance for informal connections with them. This increases the amount of health information available in the community just because there’s a nurse or doctor or dentist in the neighborhood answering questions, (Cornwell and Cornwell, 2008.) In poorer communities without health professionals there is less available health information. With less informal contact, trust may be impacted. Among African Americans and Hispanics studies find that there is lower rates of trust of health care providers.
Additionally with fewer health care resources, African-Americans and Hispanics are more likely to turn to community health centers or hospital outpatient departments and emergency rooms (Gaskin et al., 2007, Lillie‐Blanton et al., 2001).
So we come full circle. Goodman and her colleagues looked at health literacy, or the degree to which a person can obtain, process and understand health information and services to make decisions. Lower use of preventive services, poorer management of diabetes and other chronic diseases and more hospitalizations are associated with lower health literacy. When Moody and her associates looked at a diverse sample of patients at a community health center, they found that, no matter their race, ethnicity, age, education or even country of birth, those patients who said they had attended a mostly white junior high school or were living in a mostly white neighborhood were more likely to have adequate health literacy than those who did not report either of these factors: where they lived and where they went to junior high school impacted their health literacy.
Would reimbursement changes affect the living and working decisions of health care providers? Could health literacy, taught to all, from elementary through high school, make a difference?
Won’t you be my neighbor?
Something to think about, don’t you agree?
Melody S Goodman, Darrell J Gaskin, Xuemei Si, Jewel D Stafford, Christina Lachance and Kimberly A Kaphingst, Self-reported segregation experience throughout the life course and its association with adequate health literacy, Health & Place, http://dx.doi.org/10.1016/j.healthplace.2012.04.010
Other citations mentioned in Goodman, et.al.
BRONSTEIN, J. M., ADAMS, E. K. & FLORENCE, C. S. 2004. The Impact of S-CHIP Enrollment on Physician Participation in Medicaid in Alabama and Georgia. Health Services Research, 39, 301-318
CORNWELL, E. Y. & CORNWELL, B. 2008. Access to expertise as a form of social capital: An examination of race-and class-based disparities in network ties to experts. Sociological Perspectives, 853-876.
GASKIN, D., DINWIDDIE, GY, CHAN, K, AND MCCLEARY, RR 2012. Residential Segregation and the Use of Healthcare Services. Medical Care Research and Review, 69, 158-175
LILLIE-BLANTON, M., MARTINEZ, R. M. & SALGANICOFF, A. 2001. Site of medical care: do racial and ethnic differences persist? Yale J Health Policy Law Ethics, 1, 15-32