Elucidating the Role of Place in Health Care Disparities: The Example of Racial/Ethnic Residential Segregation

Authors

  • Kellee White,

    Corresponding author
    • Department of Epidemiology and Biostatistics, University of South Carolina—Arnold School of Public Health, Columbia, SC
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  • Jennifer S. Haas,

    1. Division of General Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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  • David R. Williams

    1. Department of Society, Human Development and Health, Harvard School of Public Health and the Department of African and African American Studies and Sociology, Boston, MA
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Address correspondence to Kellee White, Ph.D., M.P.H., Department of Epidemiology and Biostatistics, University of South Carolina—Arnold School of Public Health, 800 Sumter Street, Room 205, Columbia, SC 29208; e-mail: kwhite@mailbox.sc.edu.

Abstract

Objective

To develop a conceptual framework for investigating the role of racial/ethnic residential segregation on health care disparities.

Data Sources and Settings

Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011.

Study Design

The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course.

Principal Findings

The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified.

Conclusions

Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions.

Ancillary