Residential segregation results in the creation of “ghettos.” These neighborhoods exist in cities all across America and experience similar issues despite their geographic location. Segregation contributes to deferring the American Dream by denying the opportunity for homeownership, quality education, and economic stability.
Marginalized communities are characterized further by a high concentration of African-American residents, poor housing stock and high exposures to environmental toxins. They are also more likely to have fast food chains, liquor stores, convenience stores, and violent crime.These neighborhoods are less likely to have supermarkets, green space for recreation, banks, or other anchor institutions to support economic stability.
The deprivation that exists in these neighborhoods leads to a cycle of poverty that is hard to break.
Where a person lives affects their health in many ways. Segregation is one of the many causes of racial disparities in health. Research shows that segregation affects health literacy and access to health care services. Communities with high proportions of racial and ethnic minorities have less access to doctors and fewer doctors accept Medicaid in communities with higher percentages of minority residents.
Segregation in St. Louis was fueled by public policy, which is why St. Louis remains one of the most segregated cities in the U.S. Restrictive deed covenants made it illegal for African Americans to buy homes in some neighborhoods. Segregation was not limited to where people lived, but also occurred in other aspects of people’s lives, such as accessing health care services.
One example is the Homer G. Phillips Hospital, located in the Ville neighborhood. For years, this anchor institution was the only hospital that provided health care for African Americans and trained African-American physicians, dentists and nurses. The closing of Homer G. Philips is part of the history of race, class and health in St. Louis.
Segregation is one of many factors that influence social circumstances that have an impact on health, such as education and employment. Where you will live, work, and play is often a determinant of your health. Integration alone is not enough to improve health and not necessarily the only or right answer. Segregation did not just happen, it resulted from purposeful and strategic policies and practices and the development of solutions must have a sense of purpose. This will require a coordinated set of policy changes to improve the environment where people live, health and well-being.
We suggest a few policy strategies in our brief see www.forthesakeofall.org.
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor at Saint Louis University and Melody S. Goodman, MS, PhD, is an assistant professor at the Washington University School of Medicine.
