By A. G. Moore 1/18/2013
The 1906 Atlanta Race Riots as depicted in a Paris Journal
Source:Biblioteque Nationale de France
It is rarely disputed by evidence-dependent analysts that the U.S. is a nation of two healthcare realities: one for the advantaged and one for the disadvantaged. A January 2013 JAMA (Journal of the American Medical Association ) article emphasizes this fact. The article shows that lung cancer deaths in the U.S. are directly linked to segregation; the more densely African American a neighborhood is, the higher is the risk of death from lung cancer. This holds true for whites living in overwhelmingly black neighborhoods and blacks living in overwhelmingly white neighborhoods. This holds true regardless of patients’ socioeconomic status. According to the JAMA study, it isn’t poverty or race that kills blacks with lung cancer in higher numbers; it’s neighborhoods.
While we may be startled to learn the reality of neighborhood-induced lung cancer death, there is actually nothing in the JAMA report that’s surprising. Deaths from violence are more likely to occur in highly segregated neighborhoods than in integrated neighborhoods. The same holds true for infant mortality.
The thing about the lung cancer study that is so startling is this: we have not before had laid out for us the clear role that segregation, apart from race and socioeconomic status, plays in the life and death of Americans.
In 2009 there was another peer-reviewed article published about U. S. health outcome and the relationship to neighborhood. This article looked at disease progression in patients with systemic lupus. The article’s conclusion: In many cases, one’s individual behavior may be better explained by the characteristics of one’s neighbors than by individual factors.
Another study, (Socioeconomic Status and Incidence of Type 2 Diabetes: Results From the Black Women’s Health Study in The American Journal of Epidemiology) examined the incidence of type 2 diabetes in African American women. The authors of this article concluded that, “…the risk of type 2 diabetes for African-American women is influenced…by the characteristics of the neighborhoods in which they live. Even women with the highest levels of education appeared to be affected by their neighborhood environment.”
While neither the lupus nor the diabetes study specifically conclude that it is racial segregation which directly affects disease outcome, both studies state that the neighborhood in which one lives has a direct influence on one’s health status.
Sandra Day O’Connor asserted from the Bench, when she was a Supreme Court Justice, that the need for affirmative action would eventually evaporate. She wrote, in 2003, “The Court expects that 25 years from now, the use of racial preferences will no longer be necessary to further the interest approved today.” (See Grutter V. Bollinger). What he medical studies cited above indicate is that though well-intentioned, Justice O’Connor’s views on affirmative action were mistaken. While race as an absolute may not be as determinative as some believe, neighborhood, as defined by race, is a powerful force. Perhaps, in light of what we are learning about the role of segregation and neighborhood, we can change the affirmative action formula. Perhaps there can be a combination of zip code, income and family background figured into affirmative action decisions.
What cannot happen is that the U.S. ignores the influence social factors–specifically, segregated neighborhoods–have on health, education and employment. Affirmative action addresses the inequities imposed by segregation. However, it cannot erase those inequities. That will happen only with the elimination of segregation itself.