Why do poverty, poor health, and unequal opportunity persist in the lives of so many African Americans and to what extent are these trends a function of segregation, institutional or otherwise? Unfortunately, we have all struggled in our attempt to sufficiently articulate and explain this complex and sensitive relationship and why it results in such drastically different health outcomes in minority communities. Research on segregation and health has developed in number in recent years; however, studies and public health programming that specifically analyze and address segregation in the context of measurable social determinants and avoidable environmental health risks are in their infancy.
It has been frustrating to watch so many health professionals and policymakers wrestle with the well-documented relationship between segregation, opportunity, and health and that few lines of program and policy development have incorporated models to measure exposure to segregation and economic opportunity and subsequently include them as key factors in epidemiological analysis and public health interventions. In order to achieve meaningful progress in the field of health justice, public health professionals and researchers must devise consistent and reliable metrics to allow public health advocates and other champions of health equity to put forth compelling arguments tying unjust segregation to avoidable health outcomes. However, even once such quantifiable relationships between segregation and poverty are established, underserved communities will still need to address residual cultural issues that have resulted from decades of isolation and stigmatization in order to successfully access opportunity and pursue the American dream.
The major systemic impediments to good or improved health continue to include both the institutionalized legacy of racism and dramatic economic changes that have fallen with disproportionate severity on African Americans, but there are additional factors that our routine analysis has yet to account for. Such factors are perhaps most poignantly reflected in the disturbingly nihilistic attitudes among African American youth with respect to their own communities, well-being, and future. These unexplored factors are only amplified by racial mistrust and in turn contribute to the miserably low health services utilization we see in many African American communities. Concurrently, economic changes having nothing to do with race have aggravated the problems of segregated housing patterns and made isolation a permanent feature of African American life. Today many residents of predominantly African American communities have virtually no contact with mainstream American society or the traditional job market – a link more important than ever. In such communities, an ethic of hard work, investment in the future, and deferred gratification are not terribly compelling when community surroundings present few, if any, chances for legitimate and sustained employment that will support residents and their families. The mission of social justice requires us, advocates for health justice, to begin the hard work not only creating systematic policy change and opportunity, but also of fostering trust in communities that have no reason to believe the outside world cares about them. For far too long, there has been a disconnect between our public institutions and the daily struggles of the disadvantaged. Like the poor and isolated around the world, Connecticut’s vulnerable populations need predictability: specifically, predictably good outcomes for good behaviors. As such, it will take complex and aggressive public policies that create reliable systems that develop the trust and predictability among our communities to break the destructive cycle of poverty and unequal opportunity.
So what role should leaders in health justice play in this fight to end segregation and its adverse effects on predominantly minority communities in Connecticut? For those who find themselves living in environments marked by poverty and compromised opportunity, the American healthcare system offers meaningful engagement far too late in life as health destinies have already been shaped by social determinants and the law’s arm is not nearly long enough to reach overtly racist practices that occurred in the past, nor can it sufficiently address the complex economic and demographic changes that have devastated cities and towns across America. Thus, the segregated, underserved, and often isolated, urban poor need remedies that our healthcare and legal systems cannot produce alone: public and private investment to create opportunity – vocational training to help them learn new skills and navigate the modern job market; jobs that pay a living wage; and perhaps most important, a chance to move into, and create, racially and economically integrated neighborhoods where there are healthier cultural norms and more promising opportunities for everyone.
In closing, while it seems many attempts at intervention and public health programming are still struggling with the development of a pragmatic approach to measuring and addressing the public health consequences of segregation in African American communities, there are a number of encouraging and inspirational projects going on in Connecticut. Given the heightened awareness of social determinants and their impact on health, many studies and projects are now looking at how specific environmental exposures and social determinants are increased or compounded by the degree of racial residential segregation, and how such factors have health significance across racial/ethnic lines. The progress of groups like the Health Equity Alliance, a Connecticut initiative taking up the challenge of quantifying the health consequences of segregation, will be important to monitor as it presents a dynamic opportunity to apply powerful empirical evidence in our fight against injustice. Such data-driven projects are leading the way in their novel approach to collecting meaningful information that can be marshaled by public health professionals, community activists, and policymakers to redress unjust institutionalized policies and practices and to support the development of new policies necessary to alleviate the lack of opportunity that has crippled segregated minority communities for far too long.
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