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Public Beliefs about Housing Affordability as a Key Social Determinant of Health and its Impact on Support for Affordable Housing Policy

Caryn N. Bell University of Maryland: Jessica L. Owens-Young American University: 2019-005

Recent attention to the interrelationship between racism, socioeconomic status (SES) and health has led to a small, but growing literature of empirical work on the role of structural racism in population health. Area-level racial inequities in SES are an indicator of structural racism, and the associations between structural racism indicators and self-rated health are unknown. Further, because urban-rural differences have been observed in population health and are associated with different manifestations of structural racism, explicating the role of urban-rural classification is warranted. This study examined the associations between racial inequities in SES and self-rated health by county urban-rural classification. Using data from County Health Rankings and American Communities Surveys, black-white ratios of SES were regressed on rates of fair/poor health in U.S. counties. Racial inequities in homeownership were negatively associated with fair/poor health ( β  = −0.87, s.e. = 0.18), but racial inequities in unemployment were positively associated with fair/poor health ( β  = 0.03, s.e. = 0.01). The associations between structural racism and fair/poor health varied by county urban-rural classification. Potential mechanisms include the concentration of resources in racially segregated counties with high racial inequities that lead to better health outcomes, but are associated with extreme black SES disadvantage. Racial inequities in SES are a social justice imperative with implications for population health that can be targeted by urban-rural classification and other social contextual characteristics.

Alex Ortega, Principal Investigator, Center for Population Health and Health Disparities, Professor, Department of Health Services, University of California

Fathers and Urban Poverty

Amy O. Tsui, Director, The Bill & Melinda Gates Institute of Population & Reproductive Health, Professor, Population, Family & Reproductive Health, Johns Hopkins University

Harriet B. Presser, Distinguished University Professor, Department of Sociology, University of Maryland

Georges Reniers, Assistant Professor, Office of Population Research, Woodrow Wilson School of Public & International Affairs, Department of Sociology, Princeton University

Shelley Clark, Associate Professor, Department of Sociology, McGill University

Edmond D. Shenassa, Director, Maternal and Child Health Program, Associate Professor, Department of Family Science, University of Maryland