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Suburban Health Inequity


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  • I am going to start with a familiar story. In the late 1940s in the United States when veterans from World War 2 returned home, there was a housing shortage and a baby boom. The construction of the suburban communities during this postwar period promised an arcadia or ideal space to live and raise a family, and in later years these suburbs were seen as a fortress from the hazardous health conditions of crowded and contaminated and seemingly dangerous urban areas.
  • Nassau County, in particularly Levittown, was the birthplace of these now “mature suburbs”. It has been sixty years since this representation of the American dream of home ownership, great schools, safe neighborhoods, and homogeneous communities was created. However, the dream was not the same for everyone. Developments like Levittown explicitly stated that they sell these affordable new homes to returning African American veterans. Through the 1950s, the Federal Housing Administration’s (FHA) underwriting manuals expressly warned that Blacks were considered “adverse influences” on property values. The agency instructed its personnel not to insure mortgages on homes unless they were in “racially homogenous” White neighborhoods. Under these guidelines, the FHA actually refused to lend money to—or underwrite loans for—Whites if they moved to areas where people of color lived. The outcome of these arrangements is that the suburbs became a haven for White families; with Black families were steered to their own communities. Today we live with the consequences of those policies.
  • Considered a wealthy suburb, good overall health outcomes
  • Living in a highly segregated and isolated neighborhood is associated with poor-performing schools; poor performing schools are associated with high drop-out rates; high drop-out rates are associated with low-paying jobs; and low-paying jobs are associated with living in segregated inner-city neighborhoods. These disadvantages accumulate over time.
  • Segregation was imposed by legislation, supported by major economic institutions, enshrined in the housing policies of the federal government, enforced by the judicial system and vigilant neighborhood organizations, and legitimized by the ideology of white supremacy that was advocated by the church and other cultural institutions
  • In Nassau County, communities with the higher levels of poverty experience greater incidences of pregnancies with late or no prenatal care and significantly higher rates of infant mortality.
  • Institutional discrimination can restrict socioeconomic attainment and group differences in SES and health.•Segregation can create pathogenic residential conditions.•Discrimination can lead to reduced access to desirable goods and services.•Internalized racism (acceptance of society’s negative characterization) can adversely affect health.•Racism can create conditions that increase exposure to traditional stressors (e.g. unemployment). •Experiences of discrimination may be a neglected psychosocial stressor.
  • Long Island median household income is down 11% since 2002. From 2008-2011, the number of Hispanics grew by 48,000 to reach 16% of Long Island’s population. Blacks and Asians each grew by 10,000 and were 9% and 5% of Long Island’s population, respectively, in 2011. The number of non-Hispanic whites decreased by 45,000, and other non-Hispanics grew by 15,000. Over the last 21 years, the population share represented by these racial and ethnic minorities has doubled from 16% in 1990 to 32% in 2011.(LI Index) 15% of population is 65 or older in Nassau County Long Island remains the place with by far the smallest share of rental housing, compared to the other suburbs in the region. The share has fluctuated around 20% since 2000. While only one out of five occupied housing units is a rental household on Long Island, the ratio in the region’s other suburbs is at least one out of three.
  • Transcript

    • 1. Suburban Health Inequity: SocialDeterminants, Health Outcomes and Missing Pieces Martine Hackett Hofstra University
    • 2.  What is the contribution of suburban space in Nassau County to health inequities? What are the challenges to creating health equity in Nassau County?
    • 3. Source: Vital Signs, 2009
    • 4. Source: Vital Signs, 2009
    • 5.  Massey and Denton (1993): …"the key structural factor for the perpetuation of Black poverty in the U.S." and the "missing link" in efforts to understand urban poverty.
    • 6. Condition DisparityTeen Pregnancy Rate • 4X higher in Roosevelt than Nassau County average • 3X higher in Westbury, Uniondale, HempsteadChlamydia Incidence • 5X higher in Roosevelt than Nassau County average • 4X higher in HempsteadDiabetes Hospitalization 3x higher in blacks vs. whitesCancer Mortality Highest among black malesAssault Hospitalizations 5x higher in Roosevelt than Nassau County averagePoisoning hospitalizations 2.5X higher in Roosevelt than Nassau County averagePeople living with HIV/AIDS Significantly higher in Roosevelt and Hempsteadincident ratesSource: Nassau County Department of Health, 2010
    • 7.  Segregation determines SES by affecting quality of education and employment opportunities. Segregation can create negative neighborhood and housing conditions. Conditions linked to segregation can constrain the practice of health behaviors and encourage unhealthy ones. Segregation can adversely affect access to medical care and to high-quality care.
    • 8.  Built environment Housing hazards Environmental hazards Lack of social supports, community Cumulative disadvantage builds in segregated neighborhoods
    • 9. Too suburban to be Too many inner-city a problem like problems to becompared to inner- considered city suburban
    • 10.  Poverty Race/Ethnicity Aging population Aging infrastructure High housing costs, shortage of rentals
    • 11.  Familiar thinking about the suburbs influences current decisions—denying current reality and changes to maintain traditional ways of life Taxes already high for services that are expected High level of governmental fragmentation
    • 12.  Suburban social services and safety net inadequate  Decentralization in times of economic crisis means priorities shift away from those in need Fewer public and private resources for suburban health equity Advocacy efforts to connect segregation, economic opportunities and health outcomes in Nassau County
    • 13. • Failure to address Long Island’s current challenges—and the social disparities associated with them— threatens future growth and vitality in the region• Health disparities hurt those directly affected by them, but they also harm the social and economic well-being of the greater community.• Public health is at the core of sustainability