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Social Determinants of Health and Wealth

Paper Session

Saturday, Jan. 5, 2019 10:15 AM - 12:15 PM

Hyatt Regency Atlanta, Hanover G
Hosted By: UNION FOR RADICAL POLITICAL ECONOMICS
  • Chair: Michelle Holder, City University of New York-John Jay College

The Effects of Residential Segregation on Mortality Disparities in the United States

Nancy Breen
,
National Institutes on Minority Health and Health Disparities
Mark Fossett
,
Texas A&M University
Marcia Gómez
,
National Institutes on Minority Health and Health Disparities
Ernest Moy
,
U.S. Centers for Disease Control and Prevention

Abstract

Public health studies have shown persistently higher rates of mortality among African-Americans compared to White Americans. Understanding the causes for this disparity has eluded researchers. Economic studies have shown that mortality is associated with a range of social determinants, including education, income, and wealth. Living in segregated areas --whether segregated by race/ethnicity or income-- affects health, schooling, employment and other factors including quality of life, and the effects accumulate over the life course. Historically, laws, regulations, and zoning have crowded African Americans into areas isolated from jobs and schools, which has led to the poor schools, unemployment, and over policing seen in resource-deprived African-American neighborhoods today. Because segregation may have protective and negative aspects, the pathway considers the joint effects of two causal variables, namely social isolation and economic deprivation, or racialized poverty isolation (RPI). The pathway from RPI to premature mortality for African Americans is tested and compared with racial isolation alone. The outcome is age-adjusted mortality in metropolitan counties stratified by race (non-Hispanic White and non-Hispanic Black) from the US National Vital Statistics System. Structural, community, and household stressors from the 2010 US Census are used to test whether metropolitan areas with high rates of RPI are associated with stress-related mortality. The innovation of this approach is to consider the long-term effects of social isolation and economic deprivation in combination. The RPI is used to explore how working-class African American communities are uniquely impacted by the history of racial exclusion, and how race, class and gender intersect in the United States. The study finds that counties with RPI have higher rates of black mortality than counties with racial isolation alone.

Quality Public Transportation Can Improve Access to Care

Darrell Gaskin
,
Johns Hopkins University

Abstract

Little is known about the association between quality of public transportation systems and access to healthcare. This is a more pertinent issue for Medicaid and low-income populations that live in urban areas and are reliant on public transportation system. This study explores whether adults covered by Medicaid, and adults who are poor/near poor who reside in urban communities report better access to care. We use access to care data from the 2010 Medical Expenditures Panel Survey (MEPS) and public transportation quality data from The Center for Neighborhood Technology (CNT) for 2011. Our samples include adult Medicaid beneficiaries and adults below 125% FPL. We estimate logistic, multinomial logit and ordered logit models to determine the association between public transportation quality and access to care for Medicaid and poor and near poor adults. We control for age, gender, race/ethnicity, educational attainment, health status, region, and racial composition and poverty level of the census tract. We found that in areas with better connectivity adult Medicaid beneficiaries were less likely to report unmet needs, delays in obtaining care and difficulty getting to their usual source of care. We also found that public transportation coverage was associated with better access to care. To our knowledge, this is the first national study to show that quality public transportation lowers barrier to care for Medicaid beneficiaries. State and local policymakers should be cognizant of the potential synergies between their public transportation systems and their Medicaid program. Future research should explore the relationship between access to care and other attributes of public transportation quality, i.e., price and safety.

Intersection of Race Incarceration and Wealth

Darrick Hamilton
,
New School for Social Research
William A. Darity
,
Duke University

Abstract

We will be presenting descriptive statistics regarding the wealth position of individuals in Baltimore by race and incarceration status, along with elements of asset building related to incarceration status.

Affordable Housing in Westchester County

Laurence O’Connell
,
New School of Social Research

Abstract

As municipalities across the United States struggle to provide affordable housing for its citizens, they face a myriad of ethical, legal, legislative, economic and social issues. This paper first traces the ethical and moral reasons for municipalities providing affordable housing; next, it synthesizes the major legal and national legislation pieces related to affordable housing and exclusionary practices and finally investigates inclusionary land practices in Westchester County, NY. Many practices have been implicated to deter African Americans, Hispanic and “non-whites” to own homes in predominately white suburbs: zoning laws, lot size, public transportation as well as other impediments. Another impediment that has not been addressed adequately in the literature is the financial decision-making process of local government. After reviewing the operating budgets of villages and towns in Westchester County, I find that towns sited by the Anti-Discriminatory Center in 2006 as being discriminatory, generally tilted their operating budgets toward projects such as libraries, playgrounds, arts centers and cultural events; whereas, villages that were primarily African American or Hispanic dominated, tended toward operating projects such as sewer systems, sanitation and the like. From this, I make the distinction between say: enriching / nourishing / amenity public goods and functional / basic public goods.
Discussant(s)
Patrick Mason
,
Florida State University
Robert B. Williams
,
Guilford College
JEL Classifications
  • J1 - Demographic Economics
  • I1 - Health