Racial Residential Segregation and Access to Health Care Coverage: a Multilevel Analysis

Abstract

A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. Researchers theorize that segregation, as a form of structural racism, can have negative health impacts as it concentrates poverty and social problems into one geographical area of a city. However, little is known about the effect of residential segregation on access to health care. The study uses health data from the 2008 Behavioral Risk Factor Surveillance System in multilevel binary logistic regression models to examine the association between Black/White segregation in 139 metropolitan statistical areas in the United States and one health care access outcome, health care coverage. Overall, the effect of Black isolation is related to a decreased likelihood of having health insurance for Black residents of segregated cities. Additionally, higher levels of Black/White segregation had no effect on White respondents' ability to obtain health insurance, indicating that segregation contributes to the Black-White gap in health care coverage. These effects were substantial even when testing for the effects of educational, social and economic factors at both the individual and the metropolitan area level, and could help explain the persistent Black-White health gap in the United States.