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Can segregation make you sick? Researchers study effects on health

This article first appeared in the St. Louis Beacon. - When June Green’s eyesight is so weak that she is unable to drive, her first thought is about the tiring uphill trek to reach a Metro stop to board a bus to shop for groceries, visit a doctor or run other errands.

“On a good day,” she says, “I can make that walk. It might take me 25 minutes, but I can make it."

During those walks, she says she also thinks about how her diabetes, hypertension and overall quality of life are affected by residing in a racially isolated community near Union Boulevard, north of Interstate 70.

“This is a segregated area that appears to have been forgotten. The closest Schnucks is 2.2 miles from my front door. That’s not a long way -- if you have a car. If there is a community center around here, I don’t know where it is. There’s not only a lack of services but a lack of information to let people know how to find services that are not here.”

Green's experiences reinforce some of the observations in the latest in a series of briefs on the health, education and economic status of African Americans in St. Louis. Previous briefs have delved into topics ranging from poverty and education, to health and the school dropout rate.

Authors of the latest brief, which looks at ways that racial segregation affects health and social and economic opportunity, are Keon Gilbert, an assistant professor in the College for Public Health and Social Justice at Saint Louis University; and Melody S. Goodman, assistant professor at the Washington University School of Medicine. Their work, as well as the other briefs, are part of a project called "For the Sake of All,” funded by a grant from the Missouri Foundation for Health.

Much of the racial segregation, they say, is no accident but was spurred by public policies over time. Examples, they say, range from the Supreme Court’s separate-but-equal doctrine in the Plessey vs. Ferguson decision to restrictive covenants in housing, along with segregated and frequently underfunded medical services for blacks in St. Louis.

“Segregation is one of the many causes of disparities in health,” Gilbert and Goodman write. They say most of the effects are due to high concentrations of poverty coupled with limited access to addressing problems resulting from being poor. The neighborhoods with high concentrations of poverty, they find, also happen to be places with “higher rates of death from heart disease and all cancers.”

The authors point to findings showing how segregation also results in disinvestments, which in turn leads to a lower quality of life of those left behind. The region should do more to reduce racial segregation, the authors say, by:

  • Investing in quality neighborhoods for all residents.
  • Spurring more housing choices without displacing residents who already live in neighborhoods targeted for redevelopment.
  • Promoting the benefits of diverse neighborhoods while safeguarding fair housing laws.

Until a few years ago, Green, the city resident, did lab work and had good insurance to take care of her health needs. She quit her job to care for her seriously ill mother. Years later, she reapplied for lab work and discovered her skills were outdated. She now relies on Medicaid for health insurance.
Living in a segregated neighborhood can be stressful, Green says, because “you know you can have a better life than you see outside the community. But those opportunities are not going to drop in our lap. Some people may not know how to go get it. You’ve had to fight for everything you ever got and now you say, ‘I’m tired. I don’t feel like fighting anymore.’"

On the other hand, she sees positive things that outsiders might not notice about poor black neighborhoods. “There is a certain amount of pride there. People cut their grass, people pick up their trash and watch out for each other. Unless you lived in the neighborhood, you wouldn’t know that.”

She says, “I always say that segregation doesn’t have to be a bad thing if we are all on an equal playing field. If I want to live around my people, that’s me.”

But she points back to the poverty of knowledge, the lack of information and services that can come from living in racial isolation. “That,” she says, “is the other side of me. It says that when you are segregated, you are isolated; you only get one point of view. Diversity is important because we don’t exist by ourselves.”

A different variation of that thought comes from Will Jordan, executive director of the Metropolitan St. Louis Equal Housing Council.

“In an economy like this, it’s not like you are going to see a mass number of people moving from north county to better school opportunities. When they do that, they also lose transportation opportunities, and most of their family support is also going to still be in north county.”

The solution for part of the impact of racial isolation, he says, is to make communities viable.

“We’d like opportunities and integration to be something that is encouraged throughout the metropolitan area. But history shows that it is not. Sometimes, it is by choice. For numerous good reasons people decide to stick around.”

In that case, he asks, “why shouldn’t good food, grocery stores, good health care, banking and hospitals exist even in those segregated communities?”

One of the goals of Jordan's organization is to try to prevent or reverse disinvestment, which he says tends to occur whenever a ZIP code has a black population of 65 percent or more.

Over time, he says, black residents experiencing a growing level of racial isolation tend to experience a lot of adverse health consequences.

“Because there are so few places that sell fresh vegetables and fruits in racially concentrated impoverished areas, you see a direct correlation in everything from behavior of young children that have to do with nutritional deficiencies, or health issues among people who have lived most of their lives near quick stores that sell cigarettes, candy, chips and pops. They might sell bread and milk along with the candy and chips. But they don’t offer fresh fruits and vegetables.”

Green mentions another way in which she thinks racial isolation coupled with ignorance prevents some residents in her segregated neighborhood from making good choices. She mentions an acquaintances who suffers from gout, the painful swelling of joints in the toes. Green and her husband urged him to visit a clinic, which charges the very poor $2 to $3 for care.

When asked later about visiting the clinic, the acquaintance replied that “I got my medicine,” then produces a can of beer.

Green says, “He decided not to go to the clinic and maybe come back not feeling any better. He is saying, ‘I am going to save my $2 and get me a beer because I know that’s going to put me to sleep.”

Shaking her head, she says, “That’s sad.”

Learn more:

OneSTL advances a prosperous, healthy and vibrant St. Louis region. It is funded East-West Gateway.

The Voluntary Interdistrict Choice Corp., a voluntary school desegregation program.

BBC clipon "Delmar Divide."

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.