The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context - socio-demographic composition, social aspects, and built environment - has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the US National Health Interview Survey (NHIS) (1989-1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15 to 76 percent reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black /white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females.
Postprint version. Published in Social Science & Medicine, Volume 67, Issue 8, 2008, pages 1258-1268.
Finch, B. K., Do, D. P, Basurto-Davila, R., Bird, C., Escarce, J., & Lurie, N. (2008). Does place explain racial health disparities? Quantifying the contribution of residential context to the black/white health gap in the United States. Social Science & Medicine, 67(8), 1258-1268.
© Social Science & Medicine, 2008, Elsevier
NOTICE: This is the author's version of a work that was accepted for publication in Social Science & Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social Science & Medicine, [Volume #67, Issue #8, (2008)] DOI: 10.1016/j.socscimed.2008.06.018