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Neighborhood Disadvantage, Residential Segregation, and Beyond—Lessons for Studying Structural Racism and Health


A recent surge of interest in identifying the health effects of structural racism has coincided with the ongoing attention to neighborhood effects in both epidemiology and sociology. Mindful of these currents in the literature, it makes sense that we are seeing an emergent tendency in health disparities research to operationalize structural racism as either neighborhood disadvantage or racial residential segregation. This review essay synthesizes findings on the relevance of neighborhood disadvantage and residential segregation to the study of structural racism and health. It then draws on recent literature to propose four lessons for moving beyond traditional neighborhood effects approaches in the study of structural racism and health. These lessons are (1) to shift the focus of research from census tracts to theoretically meaningful units of analysis, (2) to leverage historic and geographic variation in race relations, (3) to combine data from multiple sources, and (4) to challenge normative framing that aims to explain away racial health disparities without discussing racism or racial hierarchy. The author concludes that research on the health effects of structural racism should go beyond traditional neighborhood effects approaches if it is to guide intervention to reduce racial and ethnic health disparities.

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  1. 1.

    Acosta D, Ackerman-Barger K. Breaking the silence: time to talk about race and racism. Acad Med. 2017 Mar;92(3):285–8.

    Article  PubMed  Google Scholar 

  2. 2.

    Hardeman RR, Medina EM, Kozhimannil KB. Structural racism and supporting black lives—the role of health professionals. N Engl J Med. 2016 Dec 1;375(22):2113–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Sule E, Sutton RM, Jones D, Moore R, Igbo I, Jones LA. The past does matter: a nursing perspective on post traumatic slave syndrome (PTSS). J Racial Ethn Health Disparities. 2017 Jan;11

  4. 4.

    Ramaswamy M, Kelly PJ. Institutional racism as a critical social determinant of health. Public Health Nurs. 2015 Jul 1;32(4):285–6.

    Article  PubMed  Google Scholar 

  5. 5.

    Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41(1):311–30.

    Article  Google Scholar 

  6. 6.

    Sewell AA. The racism-race reification process: a mesolevel political economic framework for understanding racial health disparities. Sociology of Race and Ethnicity. 2016 Oct 1;2(4):402–32.

    Article  Google Scholar 

  7. 7.

    Corburn J. Concepts for studying urban environmental justice. Curr Environ Health Rep. 2017 Mar;4(1):61–7.

    Article  PubMed  Google Scholar 

  8. 8.

    Diez Roux AV. Neighborhoods and health: what do we know? What should we do? Am J Public Health. 2016 Feb 17;106(3):430–1.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Sharkey P, Faber JW. Where, when, why, and for whom do residential contexts matter? Moving away from the dichotomous understanding of neighborhood effects. Annu Rev Sociol. 2014;40(1):559–79.

    Article  Google Scholar 

  10. 10.

    Gee GC, Ford CL. Structural racism and health inequities. Du Bois Rev. 2011 Apr;8(1):115–32.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Viruell-Fuentes EA, Miranda PY, Abdulrahim S. More than culture: structural racism, intersectionality theory, and immigrant health. Soc Sci Med. 2012 Dec;75(12):2099–106.

    Article  PubMed  Google Scholar 

  12. 12.

    Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000 Aug;90(8):1212–5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    LaVeist TA. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res. 1994 Apr;29(1):1–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Williams DR, Mohammed SA. Racism and health II a needed research agenda for effective interventions. Am Behav Sci. 2013 Aug 1;57(8):1200–26.

    Article  Google Scholar 

  15. 15.

    Feagin J, Bennefield Z. Systemic racism and U.S. health care. Soc Sci Med. 2014 Feb;103:7–14.

    Article  PubMed  Google Scholar 

  16. 16.

    Smedley BD, Myers HF. Conceptual and methodological challenges for health disparities research and their policy implications. J Soc Issues. 2014 Jun 1;70(2):382–91.

    Article  Google Scholar 

  17. 17.

    Ford CL, Airhihenbuwa CO. Critical race theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010 Apr 1;100(S1):S30–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Mason T. Informing the CCHHS Strategic Plan: Community Health Planning Initiatives [Internet]. Cook County Health and Hospital System; 2016. Available from:

  19. 19.

    Powell JA. Structural racism: building upon the insights of John Calmore. North Carolina Law Review. 2007;86:791.

    Google Scholar 

  20. 20.

    Bonilla-Silva E. Racism without racists: color-blind racism and the persistence of racial inequality in the United States. Lanham: Rowman & Littlefield Publishers; 2006. p. 596.

    Google Scholar 

  21. 21.

    Krieger N. Embodying inequality: epidemiologic perspectives. Amityville: Baywood Pub; 2005.

  22. 22.

    Sampson RJ. Great American City: Chicago and the enduring neighborhood effect. Chicago: University of Chicago Press; 2012. p. 553.

  23. 23.

    Logan JR, Molotch H. Urban fortunes: the political economy of place. Berkeley: University of California Press; 1987.

  24. 24.

    Wilson WJ. The truly disadvantaged: the inner city, the underclass, and public policy. Chicago: University of Chicago Press; 1987.

    Google Scholar 

  25. 25.

    Massey DS, Denton NA. American apartheid: segregation and the making of the underclass. Cambridge: Harvard University Press; 1993.

    Google Scholar 

  26. 26.

    Morenoff JD. Neighborhood mechanisms and the spatial dynamics of birth weight. Am J Sociol. 2003 Mar;108(5):976–1017.

    Article  PubMed  Google Scholar 

  27. 27.

    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: social processes and new directions in research. Annu Rev Sociol. 2002 Jan 1;28:443–78.

    Article  Google Scholar 

  28. 28.

    Tienda M. Poor people and poor places: deciphering neighborhood effects on poverty outcomes. Chicago - Population Research Center. 1991.

  29. 29.

    Yen IH, Syme SL. The social environment and health: a discussion of the epidemiologic literature. Annu Rev Public Health. 1999;20(1):287–308.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Collins JW, Shay DK. Prevalence of low birth weight among Hispanic infants with United States-born and foreign-born mothers: the effect of urban poverty. Am J Epidemiol. 1994 Jan 15;139(2):184–92.

    Article  PubMed  Google Scholar 

  31. 31.

    Gomez SL, Shariff-Marco S, DeRouen M, Keegan THM, Yen IH, Mujahid M, et al. The impact of neighborhood social and built environment factors across the cancer continuum: current research, methodological considerations, and future directions. Cancer. 2015 Jul 15;121(14):2314–30.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001 Jul 12;345(2):99–106.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    LeClere FB, Rogers RG, Peters K. Neighborhood social context and racial differences in women’s heart disease mortality. J Health Soc Behav. 1998 Jun;39(2):91–107.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Browning CR, Wallace D, Feinberg SL, Cagney KA. Neighborhood social processes, physical conditions, and disaster-related mortality: the case of the 1995 Chicago heat wave. Am Sociol Rev. 2006 Aug 1;71(4):661–78.

    Article  Google Scholar 

  35. 35.

    Osypuk TL, Acevedo-Garcia D. Beyond individual neighborhoods: a geography of opportunity perspective for understanding racial/ethnic health disparities. Health Place. 2010 Nov;16(6):1113–23.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31(1):178–94.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    White K, Borrell LN, Wong DW, Galea S, Ogedegbe G, Glymour MM. Racial/ethnic residential segregation and self-reported hypertension among US- and foreign-born blacks in New York City. Am J Hypertens. 2011 Aug 1;24(8):904–10.

    Article  PubMed  Google Scholar 

  38. 38.

    Greer S, Kramer MR, Cook-Smith JN, Casper ML. Metropolitan racial residential segregation and cardiovascular mortality: exploring pathways. J Urban Health. 2014 Jun;91(3):499–509.

    Article  PubMed  Google Scholar 

  39. 39.

    Kramer MR, Cooper HL, Drews-Botsch CD, Waller LA, Hogue CR. Metropolitan isolation segregation and black–white disparities in very preterm birth: a test of mediating pathways and variance explained. Soc Sci Med. 2010;71(12):2108–16.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Massey DS. Segregation and stratification: a biosocial perspective. Du Bois Review: Social Science Research on Race. 2004 Mar;1(1):7–25.

    Article  Google Scholar 

  41. 41.

    Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000 Oct 16;51(8):1143–61.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit. The Milbank Quarterly. 2002;80(4):677–707.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Kim Y, Bruckner TA. Political fragmentation and widening disparities in African-American and white mortality, 1972–1988. SSM - Population Health. 2016 Dec;2:399–406.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Grigoryeva A, Ruef M. The historical demography of racial segregation. American Sociological Review. 2015;80(4):814–42.

  45. 45.

    Sampson RJ. Moving and the neighborhood glass ceiling. Science. 2012 Sep 21;337(6101):1464–5.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Ludwig J, Liebman JB, Kling JR, Duncan GJ, Katz LF, Kessler RC, et al. What can we learn about neighborhood effects from the moving to opportunity experiment? Am J Sociol. 2008 Jul;114(1):144–88.

    Article  Google Scholar 

  47. 47.

    Oakes JM. The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc Sci Med. 2004 May;58(10):1929–52.

    Article  PubMed  Google Scholar 

  48. 48.

    Glymour MM, Rudolph KE. Causal inference challenges in social epidemiology: bias, specificity, and imagination. Soc Sci Med. 2016;166:258–65.

    Article  PubMed  Google Scholar 

  49. 49.

    Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology. 1997;8(6):621–8.

    CAS  PubMed  Google Scholar 

  50. 50.

    Mendez DD, Hogan VK, Culhane JF. Institutional racism, neighborhood factors, stress, and preterm birth. Ethn Health. 2014;19(5):479–99.

    Article  PubMed  Google Scholar 

  51. 51.

    Currie J, Davis L, Greenstone M, Walker R. Environmental health risks and housing values: evidence from 1,600 toxic plant openings and closings. Am Econ Rev. 2015 Feb 1;105(2):678–709.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Allard SW, Small ML. Reconsidering the urban disadvantaged the role of systems, institutions, and organizations. The ANNALS of the American Academy of Political and Social Science. 2013 May 1;647(1):6–20.

    Article  Google Scholar 

  53. 53.

    Sharkey P, Elwert F. The legacy of disadvantage: multigenerational neighborhood effects on cognitive ability. Am J Sociol. 2011 May 1;116(6):1934–81.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Thorpe R, Griffith D, Bruce M, Brown L. Racism as a fundamental determinant of health for Black boys. In: Linking Health and Education for African American Students’ Success. New York: Routledge; 2017. p. 13–26.

  55. 55.

    Do DP, Wang L, Elliott MR. Investigating the relationship between neighborhood poverty and mortality risk: a marginal structural modeling approach. Soc Sci Med. 2013 Aug;91:58–66.

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Bonilla-Silva E. The structure of racism in color-blind, “post-racial” America. Am Behav Sci. 2015 Oct 1;59(11):1358–76.

    Article  Google Scholar 

  57. 57.

    Bonilla-Silva E. Rethinking racism: toward a structural interpretation. Am Sociol Rev. 1997;62(3):465–80.

    Article  Google Scholar 

  58. 58.

    Winant H. Race and race theory. Annu Rev Sociol. 2000;26:169–85.

    Article  Google Scholar 

  59. 59.

    Riley A, Hawkley LC, Cagney KA. Racial differences in the effects of neighborhood disadvantage on residential mobility in later life. J Gerontol B Psychol Sci Soc Sci. 2016 Nov 1;71(6):1131–40.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Osypuk TL, Joshi P, Geronimo K, Acevedo-Garcia D. Do social and economic policies influence health? A Review Curr Epidemiol Rep. 2014 Jun 1;1(3):149–64.

    Article  PubMed  Google Scholar 

  61. 61.

    Sabo S, Shaw S, Ingram M, Teufel-Shone N, Carvajal S, de Zapien JG, et al. Everyday violence, structural racism and mistreatment at the US-Mexico border. Soc Sci Med. 2014 May;109:66–74.

    Article  PubMed  Google Scholar 

  62. 62.

    Crowder K, Downey L. Inter-neighborhood migration, race, and environmental hazards: modeling micro-level processes of environmental inequality. AJS. 2010 Jan;115(4):1110–49.

    PubMed  PubMed Central  Google Scholar 

  63. 63.

    Muller C, Wildeman C. Geographic variation in the cumulative risk of imprisonment and parental imprisonment in the United States. Demography. 2016 Aug 8;53(5):1499–509.

    Article  PubMed  Google Scholar 

  64. 64.

    Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006 Sep 12;3(9):e260.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014 Feb;103:42–50.

    Article  PubMed  PubMed Central  Google Scholar 

  66. 66.

    Wallace ME, Mendola P, Liu D, Grantz KL. Joint effects of structural racism and income inequality on small-for-gestational-age birth. Am J Public Health. 2015 Jun 11;105(8):1681–8.

    Article  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Montez JK, Hayward MD, Wolf DA. Do U.S. states’ socioeconomic and policy contexts shape adult disability? Soc Sci Med. 2017 Apr;178:115–26.

    Article  PubMed  Google Scholar 

  68. 68.

    Hayward MD, Miles TP, Crimmins EM, Yang Y. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Am Sociol Rev. 2000;65(6):910–30.

    Article  Google Scholar 

  69. 69.

    Krieger N, Chen JT, Coull BA, Beckfield J, Kiang MV, Waterman PD. Jim Crow and premature mortality among the US black and white population, 1960–2009. Epidemiology. 2014 Jul;25(4):494–504.

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Liu SY, Linkletter CD, Loucks EB, Glymour MM, Buka SL. Decreased births among black female adolescents following school desegregation. Soc Sci Med. 2012 Apr;74(7):982–8.

    Article  PubMed  PubMed Central  Google Scholar 

  71. 71.

    Lauderdale DS. Birth outcomes for Arabic-named women in California before and after September 11. Demography. 2006 Feb;43(1):185–201.

    Article  PubMed  Google Scholar 

  72. 72.

    Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017 Jan;22

  73. 73.

    Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015 Dec 8;112(49):15078–83.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  74. 74.

    Mechanic D. Disadvantage, inequality. And Social Policy Health Aff. 2002 Mar 1;21(2):48–59.

    Article  Google Scholar 

  75. 75.

    García JJ, Gee GC, Jones M. A critical race theory analysis of public park features in Latino immigrant neighborhoods. Du Bois Review: Social Science Research on Race. 2016 Oct;13(2):397–411.

    Article  Google Scholar 

  76. 76.

    Nazroo JY. The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health. 2003 Feb 1;93(2):277–84.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Alicia R. Riley.

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Riley, A.R. Neighborhood Disadvantage, Residential Segregation, and Beyond—Lessons for Studying Structural Racism and Health. J. Racial and Ethnic Health Disparities 5, 357–365 (2018).

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  • Structural racism
  • Racial inequality
  • Neighborhood disadvantage
  • Residential segregation
  • Neighborhood effects
  • Health disparities