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As a social construct, race has been and remains a powerful organizing feature of American social life. Racial categories both reflect and reinforce group differences in access to economic, political, and social resources. In the United States, racial ideologies operate politically, legally, and socially to limit African Americans' and other labeled racial groups' access to economic resources (Darden 1986; Farley et al. 1994; Hummer 1996; Krieger 1999; LaVeist 1992; Massey and Denton 1993; Williams 1996, 1999). For example, institutional or structural forms of systematic discrimination can limit educational, employment, and housing opportunities.

In this article, we suggest that efforts to reduce or eliminate well-established racial disparities in health must consider the complex relationships between race and socioeconomic status, including the political, social, and economic processes that create and maintain racial differences in access to social and economic resources.

African Americans in the United States have a higher than average risk of morbidity and mortality, despite declining mortality rates for many causes of death for the general population. This article examines race-based residential segregation as a fundamental cause of racial disparities, shaping differences in exposure to, and experiences of, diseases and risk factors. The spatial distribution of racial groups, specifically the residential segregation of African Americans in aging urban areas, contributes to disparities in health by influencing access to economic, social, and physical resources essential to health. Using the Detroit metropolitan area as a case study, this article looks at the influences of the distribution of African American and white residents on access to these resources and discusses the implications for urban policies to reduce racial disparities in health status.