Race and Social Problems

, Volume 6, Issue 3, pp 262–279 | Cite as

Residential Segregation, Health, and Health Care: Answering the Latino Question

  • Kathryn Freeman AndersonEmail author
  • Andrew S. Fullerton


The literature on the relationship between residential segregation and health outcomes for African Americans is well developed, but less is known about this association for Latinos in the USA. The literature for Latinos is limited, demonstrates mixed results, and suffers from data limitations. Using geographic concentration of poverty theory, we analyze the impact of Latino segregation on a series of health and health-care outcomes in order to better establish this relationship. This study uses data from the 2011 to 2012 Behavioral Risk Factor Surveillance System nested within metropolitan area-level data in a set of partial proportional odds and binary logistic multilevel regression models. We examine the relationship between Latino segregation and three health and health-care outcomes for 164 metropolitan areas in the USA. Overall, we find that Latino segregation is negatively related to good self-rated health, having a personal physician, and having health insurance for Latino respondents. Furthermore, for White respondents, no such association exists. As a result, residential segregation for Latinos contributes to the Latino–White health gap.


Race/ethnicity Health disparities Latinos Segregation 



The authors would like to thank Ada Wilkinson-Lee, Louise Roth, Joseph Galaskiewicz, and the members of the Social Inequality Workshop at the University of Arizona for their helpful comments on earlier drafts of this paper. The authors presented this paper at the annual meeting of the American Sociological Association in 2012 in Denver, CO.


  1. Acevedo-Garcia, D. (2000). Residential segregation and the epidemiology of infectious diseases. Social Science and Medicine, 51, 1143–1161.CrossRefGoogle Scholar
  2. Acevedo-Garcia, D. (2001). Zip code-level risk factors for tuberculosis: Neighborhood environment and residential segregation in New Jersey, 1985–1992. American Journal of Public Health, 91(5), 734–741.CrossRefGoogle Scholar
  3. Acevedo-Garcia, D., Lochner, K. A., Osypuk, T. L., & Subramanian, S. V. (2003). Future directions in residential segregation and health research: A multilevel approach. American Journal of Public Health, 93(2), 215–221.CrossRefGoogle Scholar
  4. Aguirre-Molina, M., Molina, C. W., & Zambrana, R. E. (2001). Health issues in the Latino community. San Francisco, CA: Jossey-Bass.Google Scholar
  5. Anderson, K. F., & Fullerton, A. S. (2012). Racial residential segregation and access to health-care coverage: A multilevel analysis. In J. J. Kronenfeld (Ed.), Issues in health and health care related to  race/ethnicity, immigration, SES and gender (Research in the Sociology of Health Care, Vol. 30, pp. 133–158). Emerald Group Publishing Limited.Google Scholar
  6. Bahr, P. R. (2007). Race and nutrition: An investigation of Black–White differences in health-related nutritional behaviors. Sociology of Health & Illness, 29(6), 831–856.CrossRefGoogle Scholar
  7. Borrell, L. N., & Crawford, N. D. (2009). All-cause mortality among Hispanics in the United States: Exploring heterogeneity by nativity status, country of origin, and race in the national health interview survey-linked mortality files. Annals of Epidemiology, 19(5), 336–343.CrossRefGoogle Scholar
  8. Borrell, L. N., & Lancet, E. A. (2012). Race/ethnicity and all-cause mortality in US adults: Revisiting the Hispanic paradox. American Journal of Public Health, 102(5), 836–843.CrossRefGoogle Scholar
  9. Borrell, L. N., Menendez, B. S., & Joseph, S. P. (2011). Racial/ethnic disparities on self-reported hypertension in New York City: Examining disparities among Hispanic subgroups. Ethnicity and Disease, 21(4), 429–436.Google Scholar
  10. Bullard, R. D. (2005). Environmental justice in the twenty-first century. In R. D. Bullard (Ed.), The quest for environmental justice: Human rights and the politics of pollution (pp. 19–42). San Francisco: Sierra Club Books.Google Scholar
  11. Chang, V. W. (2006). Racial residential segregation and weight status among U.S adults. Social Science and Medicine, 63, 1289–1303.CrossRefGoogle Scholar
  12. Chang, V. W., Hillier, A. E., & Mehta, N. K. (2009). Neighborhood isolation, disorder and obesity. Social Forces, 87(4), 2063–2092.CrossRefGoogle Scholar
  13. Collins, C. A. (1999). Racism and health: Segregation and causes of death amenable to medical intervention in major U.S. cities. Annals New York Academy of Sciences, 986, 396–398.CrossRefGoogle Scholar
  14. Collins, C. A., & Williams, D. R. (1999). Segregation and mortality: The deadly effects of racism? Sociological Forum, 14(3), 495–523.CrossRefGoogle Scholar
  15. Do, D. P., Finch, B. K., 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 and Medicine, 67, 1258–1268.CrossRefGoogle Scholar
  16. Dubowitz, T., Subramanian, S. V., Acevedo-Garcia, D., Osypuk, T. L., & Peterson, K. E. (2008). Individual and neighborhood differences in diet among low-income Foreign and U.S.-born women. Women’s Health Issues, 18, 181–190.CrossRefGoogle Scholar
  17. Ellen, I.G., Cutler, D.M., & Dickens, W. (2000) Is segregation bad for your health? The case of low birth weight. Brookings-Wharton Papers on Urban Affairs, 203–238.Google Scholar
  18. Enchautegui, M. E. (1997). Latino neighborhoods and Latino neighborhood poverty. Journal of Urban Affairs, 19(4), 445–467.CrossRefGoogle Scholar
  19. Eschbach, K., Ostir, G. V., Patel, K. V., Markides, K. S., & Goodwin, J. S. (2004). Neighborhood context and mortality among older Mexican Americans: Is there a barrio advantage? American Journal of Public Health, 94(10), 1807–1812.CrossRefGoogle Scholar
  20. Ferraro, K. F., & Yu, Y. (1995). Body weight and self-ratings of health. Journal of Health and Social Behavior, 36, 274–284.CrossRefGoogle Scholar
  21. Frank, R., Akresh, I. R., & Lu, B. (2010). Latino immigrants and the U.S. racial order: How and where do they fit in? American Sociological Review, 75(3), 378–401.CrossRefGoogle Scholar
  22. Fullerton, A. S. (2009). A conceptual framework for ordered logistic regression models. Sociological Methods and Research, 38, 306–347.Google Scholar
  23. Gaskin, D. J., Price, A., Brandon, D. T., & LaVeist, T. A. (2009). Segregation and disparities in health services use. Medical Care Research and Review, 66, 578–589.CrossRefGoogle Scholar
  24. Grady, S. C. (2006). Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis. Social Science and Medicine, 63, 3013–3029.CrossRefGoogle Scholar
  25. Greenberg, M., & Schneider, D. (1994). Violence in American cities: Young Black males is the answer, but what was the question? Social Science and Medicine, 39(3), 179–187.CrossRefGoogle Scholar
  26. Grier, S. A., & Kumanyika, S. K. (2008). The context for choice: Health implications of targeted food and beverage marketing to African Americans. American Journal of Public Health, 98(9), 1616–1629.CrossRefGoogle Scholar
  27. Haas, J. S., Phillips, K. A., Sonneborn, D., McCulloch, C. E., Baker, L. C., Kaplan, C. P., et al. (2004). Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual’s county of residence. Medical Care, 42(7), 707–714.CrossRefGoogle Scholar
  28. Harris, A. L., & Tienda, M. (2012). Hispanics in higher education and the Texas top 10% law. Race and Social Problems, 4(1), 57–67.CrossRefGoogle Scholar
  29. Hart, K. D., Kunitz, S. J., Sell, R. R., & Mukamel, D. B. (1998). Metropolitan governance, residential segregation, and mortality among African Americans. American Journal of Public Health, 88(3), 434–438.CrossRefGoogle Scholar
  30. Hayanga, A. J., Kaiser, H. E., Sinha, R., Berenholtz, S. M., Makary, M., & Chang, D. (2009). Residential segregation and access to surgical care by minority populations in US Counties. Journal of the American College of Surgeons, 208, 1017–1022.CrossRefGoogle Scholar
  31. Hearst, M. O., Oakes, J. M., & Johnson, P. J. (2008). The effect of racial residential segregation on Black infant mortality. American Journal of Epidemiology, 168(11), 1247–1254.CrossRefGoogle Scholar
  32. Hedeker, D., & Mermelstein, R. J. (1998). A multilevel thresholds of change model for analysis of stages of change data. Multivariate Behavioral Research, 33, 427–455.CrossRefGoogle Scholar
  33. Hummer, R. A., & Chinn, J. J. (2011). Race/ethnicity and U.S. adult mortality: Progress, prospects, and new analyses. Du Bois Review, 8(1), 5–24.CrossRefGoogle Scholar
  34. Iceland, J. (2004). Beyond Black and White: Metropolitan residential segregation in multi-ethnic America. Social Science Research, 33, 248–271.CrossRefGoogle Scholar
  35. Iceland, J., & Wilkes, R. (2006). Does socioeconomic status matter? Race, class, and residential segregation. Social Problems, 53(2), 248–273.CrossRefGoogle Scholar
  36. Idler, E. L., & Kasl, S. (1995). Self-ratings of health: Do they also predict change in functional ability? Journal of Gerontology, 50B, S344–S353.Google Scholar
  37. Inagami, S., Borrell, L. N., Wong, M. D., Fang, J., Shapiro, M. F., & Asch, S. M. (2006). Residential segregation and Latino, Black and White mortality in New York City. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 83(3), 406–420.CrossRefGoogle Scholar
  38. Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science and Medicine, 69, 307–316.CrossRefGoogle Scholar
  39. Krivo, L. J., Peterson, R. D., Rizzo, H., & Reynolds, J. R. (1998). Race, segregation, and the concentration of disadvantage: 1980-1990. Social Problems, 45(1), 61–80.CrossRefGoogle Scholar
  40. Kwate, N. O. A. (2008). Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in Black neighborhoods. Health and Place, 14, 32–44.CrossRefGoogle Scholar
  41. Landale, N. S., & Oropesa, R. S. (2005). What does skin color have to do with infant health? An analysis of low birth weight among mainland and island Puerto Ricans. Social Science and Medicine, 61(2), 379–391.CrossRefGoogle Scholar
  42. Larson, N. I., Story, M. T., & Nelson, M. (2009). Neighborhood environments: Disparities in access to healthy foods in the U.S. American Journal of Preventative Medicine, 36(1), 74–81.CrossRefGoogle Scholar
  43. LaVeist, T. A., & Wallace, J. M. (2000). Health risk and inequitable distribution of liquor stores in African American neighborhood. Social Science and Medicine, 51, 613–617.CrossRefGoogle Scholar
  44. Layes, A., Asada, Y., & Kephart, G. (2012). Whiners and deniers—What does self-rated health measure? Social Science and Medicine, 75, 1–9.CrossRefGoogle Scholar
  45. LeClere, F. B., Rogers, R. G., & Peters, K. D. (1997). Ethnicity health and place and morality in the United States: Individual and community correlates. Social Forces, 76(1), 169–198.CrossRefGoogle Scholar
  46. Lee, M., & Ferraro, K. F. (2007). Neighborhood residential segregation and physical health among Hispanic Americans: Good, bad, or benign? Journal of Health and Social Behavior, 48, 131–148.CrossRefGoogle Scholar
  47. Logan, J. R., Alba, R. D., & Zhang, W. (2002). Immigrant enclaves and ethnic communities in New York and Los Angeles. American Sociological Review, 67, 299–322.CrossRefGoogle Scholar
  48. Massey, D. S. (1990). American apartheid: Segregation and the making of the underclass. The American Journal of Sociology, 96(2), 329–357.CrossRefGoogle Scholar
  49. Massey, D. S. (2009). Racial formation in theory and practice: The case of Mexicans in the United States. Race and Social Problems, 1(1), 12–26.CrossRefGoogle Scholar
  50. Massey, D. S., & Denton, N. A. (1988). The dimensions of residential segregation. Social Forces, 67(2), 281–315.CrossRefGoogle Scholar
  51. Massey, D. S., & Denton, N. A. (1989). Hypersegregation in U.S. metropolitan areas: Black and Hispanic segregation along five dimensions. Demography, 26(3), 373–391.CrossRefGoogle Scholar
  52. Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press.Google Scholar
  53. Massey, D. S., & Fischer, M. J. (2000). How segregation concentrates poverty. Ethnic and Racial Studies, 23(4), 670–691.CrossRefGoogle Scholar
  54. Massey, D. S., Gross, A. B., & Shibuya, K. (1994). Migration, segregation, and the geographic concentration of poverty. American Sociological Review, 59(3), 425–445.CrossRefGoogle Scholar
  55. Massey, D. S., & Pren, K. A. (2012). Origins of the new Latino underclass. Race and Social Problems, 4(1), 5–17.CrossRefGoogle Scholar
  56. Mellerson, J., Landrine, H., Hao, Y., Corral, I., Zhao, L., & Cooper, D. L. (2010). Residential segregation and exercise among a national sample of hispanic adults. Health and Place, 16, 613–615.CrossRefGoogle Scholar
  57. Ortiz, V., & Telles, E. (2012). Racial identity and racial treatment of Mexican Americans. Race and Social Problems, 4(1), 41–56.CrossRefGoogle Scholar
  58. Patel, K. V., Eschbach, K., Rudkin, L. L., Peek, M. K., & Markides, K. (2003). Neighborhood context and self-rated health in older Mexican Americans. Annals of Epidemiology, 13, 620–628.CrossRefGoogle Scholar
  59. Peterson, B., & Harrell, F. E. (1990). Partial proportional odds models for ordinal response models. Applied Statistics, 39, 205–217.CrossRefGoogle Scholar
  60. Polednak, A. P. (1997). Segregation, poverty, and mortality in urban African Americans. New York, NY: Oxford University Press.Google Scholar
  61. Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and longitudinal modeling using Stata (2nd ed.). College Station, TX: Stata Press.Google Scholar
  62. Rabe-Hesketh, S., Skrondal, A. & Pickles, A. (2004) GLLAMM Manual. U.C. Berkeley Division of Biostatistics Working Paper Series. Working Paper 160.
  63. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage Publications.Google Scholar
  64. Rodriguez, R. A., Sen, S., Mehta, K., Moody-Ayers, S., Bacchetti, P., & O’Hare, A. M. (2007). Geography matters: Relationships among urban residential segregation, dialysis facilities, and patient outcomes. Annals of Internal Medicine, 146, 493–501.CrossRefGoogle Scholar
  65. Saenz, R., & Siordia, C. (2012). The inter-cohort reproduction of Mexican American dropouts. Race and Social Problems, 4(1), 68–81.CrossRefGoogle Scholar
  66. Santiago, A. M., & Wilder, M. G. (1991). Residential Segregation and Links to Minority Poverty: The Case of Latinos in the United States. Social Problems, 38(4), 492–515.CrossRefGoogle Scholar
  67. Shaw, R. J., & Pickett, K. E. (2011). The association between ethnic density and poor self-rated health among US Black and Hispanic people. Ethnicity and Health, 16(3), 225–244.CrossRefGoogle Scholar
  68. Shihadeh, E. S., & Flynn, N. (1996). Segregation and crime: The effect of Black social isolation on the rates of Black urban violence. Social Forces, 74(4), 1325–1352.CrossRefGoogle Scholar
  69. Subramanian, S. V., Acevedo-Garcia, D., & Osypuk, T. L. (2004). Racial residential segregation and geographic heterogeneity in Black/White disparity in poor self-rated health in the US: A multilevel statistical analysis. Social Science and Medicine, 60, 1667–1679.CrossRefGoogle Scholar
  70. Testa, M., Astone, N. M., Krogh, M., & Neckerman, K. M. (1993). Employment and marriage among inner-city fathers. In W. J. Wilson (Ed.), The ghetto underclass (pp. 96–108). Newberry Park, CA: Sage.CrossRefGoogle Scholar
  71. Viruell-Fuentes, E. A., Morenoff, J. D., Williams, D. R., & House, J. S. (2011). Language of interview, self-rated health, and the other Latino health puzzle. American Journal of Public Health, 101(7), 1306–1313.CrossRefGoogle Scholar
  72. Walton, E. (2009). Residential segregation and birth weight among racial and ethnic minorities in the United States. Journal of Health and Social Behavior, 50, 427–442.CrossRefGoogle Scholar
  73. White, K., Haas, J. S., & Williams, D. R. (2012). Elucidating the role of place in health care disparities: The example of racial/ethnic residential segregation. Health Services Research, 43(3), 1278–1299.CrossRefGoogle Scholar
  74. Williams, D. R. (1999). Race, socioeconomic status, and health: The added effects of racism and discrimination. Annals New York Academy of Sciences, 896, 173–188.CrossRefGoogle Scholar
  75. Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116, 404–416.CrossRefGoogle Scholar
  76. Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior, 51, S15–S27.CrossRefGoogle Scholar
  77. Wilson, W. J. (1987). The truly disadvantaged: The inner city, the underclass, and public policy. Chicago, IL: University of Chicago.Google Scholar
  78. Wilson, W. J. (1996). When work disappears: The world of the new urban poor. New York, NY: Random House.Google Scholar
  79. Zsembik, B. A., & Fennell, D. (2005). Ethnic variation in health and the determinants of health among Latinos. Social Science and Medicine, 61(1), 53–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kathryn Freeman Anderson
    • 1
    Email author
  • Andrew S. Fullerton
    • 2
  1. 1.Department of SociologyUniversity of ArizonaTucsonUSA
  2. 2.Department of SociologyOklahoma State UniversityStillwaterUSA

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