Racial Residential Segregation and the Distribution of Health-Related Organizations in Urban Neighborhoods

Recent research has considered the role of racial/ethnic residential segregation as it relates to health and health care outcomes in the United States. In this article, I employ key theories of segregation and urban inequality to explain the spatial distribution of healthrelated organizations. Using data from the 2010 County Business Patterns and the U.S. Census in a series of spatial regression models, I examine the distribution of a variety of health-related organizations across the United States. I find that the concentration and clustering of racial/ethnic minorities (blacks and, to a lesser extent, Latinos and Asians) in urban neighborhoods is inversely associated with the number of health-related organizations, including food resources, physical fitness facilities, health care resources, civic associations, and social service organizations. The spatial distribution of health-related organizations could help to explain broader links between racial/ethnic minority segregation and health. K E Y W O R D S : residential segregation; organizations; race/ethnicity; health; health care. As a system of stratification and racial subordination, racial/ethnic segregation favors numerous social problems (Massey and Denton 1993). In particular, several studies show that racial/ethnic minority segregation can be devastating to health and functioning across the life course (Williams and Collins 2001). For example, research suggests that various indicators of racial/ethnic segregation are associated with higher rates of mortality (Polednak 1997; Williams and Collins 2001), infant mortality and low birth weight (Ellen, Cutler, and Dickens 2000; Hearst, Oakes, and Johnson 2008), overall poor health (Anderson and Fullerton 2014; Subramanian, Acevedo-Garcia, and Osypuk 2005), nutrition and obesity (Chang 2006), and access to health care (Anderson and Fullerton 2012, 2014). Although various theoretical mechanisms have been proposed to explain the health consequences of racial/ethnic segregation, such as socioeconomic concerns, stress, and access to resources, few studies have formally tested any of them (Williams and Collins 2001). The author would like to thank Joseph Galaskiewicz, Andrew Fullerton, Terrence Hill, Erin Leahey, and Corey Abramson for their helpful comments on earlier drafts of this article. The author also presented this article at the annual meeting of the American Sociological Association in 2015 in Chicago, IL. This material is based upon work supported by the National Science Foundation Doctoral Dissertation Research Improvement Grant (SES-1518873). Direct correspondence to: Kathryn Freeman Anderson, Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX 77204-3012. E-mail: kateanderson@uh.edu. VC The Author 2017. Published by Oxford University Press on behalf of the Society for the Study of Social Problems. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 256 Social Problems, 2017, 64, 256–276 doi: 10.1093/socpro/spw058 Article D ow naded rom http/academ ic.p.com /socpro/articlact/64/2/256/3065804 by Txas &M U niersity user on 04 M ay 2019 In this study, I examine the association between race/ethnic segregation and health-related organizations. This work builds on previous research in two principal ways. First, it takes the initial step in establishing health-related organizations as a viable mechanism of the broader association between race/ethnic segregation and health. Second, it pushes the literature beyond narrow black and white distinctions to include other urban minority groups. With these considerations in mind, the overarching research question that this study addresses is the following: How are health-related organizations distributed across urban space in the United States? More specifically, are racial/ethnic minority neighborhoods less likely to have many and diverse health-related organizations compared to (nonHispanic) white neighborhoods? What other contextual factors are related to the distribution of such resources? Here, I address these questions by examining how the distribution of health-related organizations differs by the racial/ethnic composition of such neighborhoods and how this may relate to other theoretically important factors according to theories of urban neighborhood inequality. Generally, I expect that minority neighborhoods will be less likely to have such establishments, which may provide a mechanistic link between our understanding of segregation and health outcomes. In the pages that follow, I consider current theories of urban inequality and racial/ethnic segregation and how they may be related to the distribution of organizations. Next, I review the current literature on the distribution of health-related organizations in space and how this relates to race and segregation. Finally, I describe the present study and its central findings. T H E O R I E S O F S E G R E G A T I O N , U R B A N I N E Q U A L I T Y , A N D O R G A N I Z A T I O N S Community Organizations and Urban Inequality In general, scant attention has been paid to the role of organizations in creating and promoting community well-being. Michael McQuarrie and Nicole P. Marwell (2009), in a review of organizational research in the urban sociology literature, argue that urban sociology treats organizations as derivative of the urban context rather than productive. They refer to this as the “missing organizational dimension” and assert that organizations contribute to the urban environment and its consequences, and are not simply the result of the urban environment. From this perspective, it is not just the people that make up a neighborhood, but the people, the organizations, and the interplay between the two. Some scholars have addressed this missing dimension and provide evidence that organizations are productive of the urban environment and the accompanying inequalities (Allard and Small 2013; McQuarrie and Marwell 2009). Scholars in this tradition argue that organizations form essential components of urban life and community well-being. In particular, organizations represent the key sites in the community through which individuals can access material resources or information through a variety of means, such as employment opportunities, retail, as well as through nonprofit and government social service agencies that directly allocate goods or provide services and activities (Galaskiewicz, Mayorova, and Duckles 2013; Marwell and Gullickson 2013; Small and McDermott 2006). Furthermore, organizations may also provide less tangible support as well, as these represent the locations where individuals can meet and form connections. Thus, they also provide the space for the formation of social networks and social capital, which may also contribute to community vitality (Allard and Small 2013; Galaskiewicz et al. 2012; Oldenburg 1989; Small 2009). In this sense, they serve as “producers” of the neighborhood though both these physical and social means. Yet, in this line of research, little attention has been given to the role of segregation or to health-related organizations more specifically. Despite the general lack of attention to organizations, urban sociological theory carries a rich tradition of explaining and interpreting urban inequality due to segregation. These theories can be extended to the case of organizations in urban space and imply different theoretical mechanisms for why segregated areas may lack important community resources. Wilson’s Geographic Concentration of Poverty Theory and Deinstitutionalization In 1987, William Julius Wilson brought renewed attention to the plight of the urban poor in his pivotal work, The Truly Disadvantaged. Using the case of Chicago, he outlines a theory of urban Residential Segregation and Health-Related Organizations 257 D ow naded rom http/academ ic.p.com /socpro/articlact/64/2/256/3065804 by Txas &M U niersity user on 04 M ay 2019 inequality in an attempt to understand the growth of black urban “underclass” communities that was occurring throughout this time period. Although these problems occur principally in black urban neighborhoods, he argues that important demographic and structural changes prompted the growth of poverty and its accompanying problems in these neighborhoods (Wilson 1987, 1996). As a result of these various mechanisms, Wilson argues that poverty and its consequences thus become concentrated in urban black communities. In this work, Wilson was one of the first to articulate a theory of inequality that accounts for the role of organizations in communities—what he terms deinstitutionalization. He posits that one of the main consequences of concentration effects is organizational flight. As poverty mounts in the inner city, this condition drives away organizations that support community vitality. Essentially, these areas become organizational deserts, where basic community institutions no longer exist. This condition becomes cyclical as the lack of institutions perpetuates joblessness, poverty, and its effects. In sum, Wilson provides a class-based perspective, where segregation compounds poverty and social problems into one space, which in turn leads to organizational flight. From this perspective then, I draw the following hypothesis: H1: As poverty increases across urban neighborhoods, the density of neighborhood organizations and service providers will decrease, net of racial/ethnic composition. Racial Segregation and Place Stratification Several scholars have critiqued Wilson’s theoretical approach to urban inequality. Most notably, many have criticized Wilson for downplaying the significance of race in these processes. Of course his theory does not ignore the role of race and racial segregation, but many have argued that his theory places too strong of an emphasis on class and poverty, and that it ignores the central role of segregation as an institutionaliz