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ABSTRACT Much of the current health disparities literature fails to account for the fact that the nation is largely segregated, leaving racial groups exposed to different health risks and with variable access to health services based on where they live. We sought to determine if racial health disparities typically reported in national studies remain the same when black and white Americans live in integrated settings. Focusing on a racially integrated, low-income neighborhood of Southwest Baltimore, Maryland, we found that nationally reported disparities in hypertension, diabetes, obesity among women, and use of health services either vanished or substantially narrowed. The sole exception was smoking: We found that white residents were more likely than black residents to smoke, underscoring the higher rates of ill health in whites in the Baltimore sample than seen in national data. As a result, we concluded that racial differences in social environments explain a meaningful portion of disparities typically found in national data. We further concluded that when social factors are equalized, racial disparities are minimized. Policies aimed solely at health behavior change, biological differences among racial groups, or increased access to health care are limited in their ability to close racial disparities in health. Such policies must address the differing resources of neighborhoods and must aim to improve the underlying conditions of health for all.
There is extensive documentation of persistent health disparitiesamong the racial and ethnic groups that make up the United States. In recent years, researchers have attempted to understand the reasons for these disparities and to find ways to eliminate them. Much of this research relies on data from national studies. These data are suboptimal for the study of racial health disparities for two reasons.
First is the confounding of race with socioeconomic status.1 Health status varies by both race and socioeconomic status, and socioeconomic status tends to be lower among black Americans than among white Americans. Consequently, the overlap between these two factors complicates efforts to determine whether it is "race and class" or "race or class" that produces disparities in health status.2
The second challenge resulting from using national data is complex and, we suspect, even more powerful. The United States is segregated along racial lines. Racial segregation creates different exposures to economic opportunity and...