October 10, 2011

Place, not race, may be larger determinant of health disparities

Where you live could play a larger role in health disparities than originally thought, according to a new study by researchers from the Johns Hopkins Bloomberg School of Public Health.

Examining a racially integrated low-income neighborhood in Baltimore, the researchers found that, with the exception of smoking, nationally reported disparities in hypertension, diabetes, obesity among women and use of health services disappeared or narrowed. The results are featured in the October issue of Health Affairs.

“Most of the current health disparities literature fails to account for the fact that the nation is largely segregated, leaving racial groups exposed to different health risks and with variable access to health services based on where they live,” said Thomas LaVeist, lead author of the study, director of the Johns Hopkins Center for Health Disparities Solutions and the William C. and Nancy F. Richardson Professor in Health Policy and Management at the Bloomberg School.

“By comparing black and white Americans who are exposed to the same set of socioeconomic, social and environmental conditions, we were better equipped to discern the impact of race on health-related outcomes and have concluded [that] social factors are essentially equalized when racial disparities are minimized,” he said.

To conduct their research, LaVeist and colleagues identified communities in the United States containing a population of at least 35 percent African-American and 35 percent white residents, and where the African-American and white residents have similar income and education. Two communities in Baltimore were selected as study sites, and in-person interviews were conducted with adult residents. Blood pressure was measured in a number of participants.

Researchers used data from the National Health Interview Survey to compare national and study-site data on obesity, smoking and diabetes; the National Health and Nutrition Examination Survey to compare national and study-site data on hypertension; and data from the Medical Expenditure Panel Survey to compare the use of health services nationally and in the study area. Researchers concluded that racial differences in social environments explained a significant portion of disparities typically found in national data.

“When whites are exposed to the health risks of an urban environment, their health status is compromised similarly to that of blacks, who more commonly live in such communities,” said Darrell Gaskin, co-author of the study, deputy director of the Johns Hopkins Center for Health Disparities Solutions and an associate professor in the Bloomberg School’s Department of Health Policy and Management.

“Policies aimed solely at health behavior change, biological differences among racial groups or increased access to health care are limited in their ability to close racial disparities in health,” he said. “A more effective policy approach would be to address the differing resources of neighborhoods and improve the underlying conditions of health for all.”

The study was written by LaVeist, Keshia Pollack, Roland Thorpe, Ruth Fesahazion and Gaskin.

The research was supported in part by the National Center on Minority Health and Health Disparities and Pfizer.