Disparities in health between blacks and whites aren’t solely due to poverty. African-Americans have higher rates of diabetes than whites, for instance, even when their economic status is comparable. But the evidence points to poverty as the fundamental cause of health disparities. And a growing body of research suggests that racial segregation itself worsens health. The threat of violence in segregated, disadvantaged neighborhoods causes residents to spend more time indoors, which means they get less exercise. It may also weaken immune systems, which, combined with time spent in close quarters, may increase the spread of tuberculosis and other infectious diseases.
The stress of living amid violence and unrelenting poverty may also make residents more susceptible to disease. Inferior diets, smoking, alcoholism, and drug addiction all are more common in poor neighborhoods and are linked with higher rates of cancer, heart disease, stroke, and diabetes. Unintentional injury, another leading killer in Chicago and nationally, is also associated with drug abuse: in Chicago, the number one underlying cause of death in this category was accidental drug overdose. (Three times as many people died of accidental overdoses in the five poorest neighborhoods as in their counterparts.)
A research review in the June issue of Health Services Research pointed to studies indicating that such neighborhoods have trouble attracting high-quality health care providers; offer less access to primary care for children; have fewer specialists available; and have longer wait times for kidney transplants. Pharmacies in segregated neighborhoods are less likely to stock sufficient medicines. End-of-life care is also inferior, with “substantial disparities in nursing home quality.”