This document discusses health inequities between different communities in Nassau County, New York. It finds higher rates of teen pregnancy, STDs, diabetes, cancer mortality, assaults, and HIV/AIDS in poorer communities like Roosevelt and Hempstead compared to Nassau County averages. Segregation concentrates poverty and negatively impacts access to education, employment, housing, healthcare and social supports. However, the needs of suburban communities are often overlooked due to perceptions they are not as problematic as inner cities. Addressing social determinants of health and disparities is important for the future growth and vitality of Long Island.
Cardiac Output, Venous Return, and Their Regulation
Suburban Health Inequity
1. Suburban Health Inequity: Social
Determinants, Health Outcomes and Missing
Pieces
Martine Hackett
Hofstra University
2.
3.
4. What is the
contribution of
suburban space
in Nassau County
to health
inequities?
What are the
challenges to
creating health
equity in Nassau
County?
9. Massey and Denton
(1993): …"the key
structural factor for
the perpetuation of
Black poverty in the
U.S." and the
"missing link" in
efforts to understand
urban poverty.
10. Condition Disparity
Teen Pregnancy Rate • 4X higher in Roosevelt than Nassau County
average
• 3X higher in Westbury, Uniondale, Hempstead
Chlamydia Incidence • 5X higher in Roosevelt than Nassau County
average
• 4X higher in Hempstead
Diabetes Hospitalization 3x higher in blacks vs. whites
Cancer Mortality Highest among black males
Assault Hospitalizations 5x higher in Roosevelt than Nassau County average
Poisoning hospitalizations 2.5X higher in Roosevelt than Nassau County
average
People living with HIV/AIDS Significantly higher in Roosevelt and Hempstead
incident rates
Source: Nassau County Department of Health, 2010
11. Segregation determines SES by affecting
quality of education and employment
opportunities.
Segregation can create negative
neighborhood and housing conditions.
Conditions linked to segregation can
constrain the practice of health behaviors and
encourage unhealthy ones.
Segregation can adversely affect access to
medical care and to high-quality care.
12. Built environment
Housing hazards
Environmental hazards
Lack of social supports,
community
Cumulative
disadvantage builds in
segregated
neighborhoods
13. Too suburban to be Too many inner-city
a problem like problems to be
compared to inner- considered
city suburban
14. Poverty
Race/Ethnicity
Aging population
Aging infrastructure
High housing costs,
shortage of rentals
15.
16.
17.
18. Familiar thinking about the suburbs
influences current decisions—denying current
reality and changes to maintain traditional
ways of life
Taxes already high for services that are
expected
High level of governmental fragmentation
19.
20. Suburban social services and safety
net inadequate
Decentralization in times of
economic crisis means priorities shift
away from those in need
Fewer public and private resources
for suburban health equity
Advocacy efforts to connect
segregation, economic
opportunities and health outcomes
in Nassau County
21. • Failure to address Long Island’s
current challenges—and the social
disparities associated with them—
threatens future growth and
vitality in the region
• Health disparities hurt those
directly affected by them, but they
also harm the social and economic
well-being of the greater
community.
• Public health is at the core of
sustainability
Notas del editor
I am going to start with a familiar story. In the late 1940s in the United States when veterans from World War 2 returned home, there was a housing shortage and a baby boom. The construction of the suburban communities during this postwar period promised an arcadia or ideal space to live and raise a family, and in later years these suburbs were seen as a fortress from the hazardous health conditions of crowded and contaminated and seemingly dangerous urban areas.
Nassau County, in particularly Levittown, was the birthplace of these now “mature suburbs”. It has been sixty years since this representation of the American dream of home ownership, great schools, safe neighborhoods, and homogeneous communities was created. However, the dream was not the same for everyone. Developments like Levittown explicitly stated that they sell these affordable new homes to returning African American veterans. Through the 1950s, the Federal Housing Administration’s (FHA) underwriting manuals expressly warned that Blacks were considered “adverse influences” on property values. The agency instructed its personnel not to insure mortgages on homes unless they were in “racially homogenous” White neighborhoods. Under these guidelines, the FHA actually refused to lend money to—or underwrite loans for—Whites if they moved to areas where people of color lived. The outcome of these arrangements is that the suburbs became a haven for White families; with Black families were steered to their own communities. Today we live with the consequences of those policies.
Considered a wealthy suburb, good overall health outcomes
Living in a highly segregated and isolated neighborhood is associated with poor-performing schools; poor performing schools are associated with high drop-out rates; high drop-out rates are associated with low-paying jobs; and low-paying jobs are associated with living in segregated inner-city neighborhoods. These disadvantages accumulate over time.
Segregation was imposed by legislation, supported by major economic institutions, enshrined in the housing policies of the federal government, enforced by the judicial system and vigilant neighborhood organizations, and legitimized by the ideology of white supremacy that was advocated by the church and other cultural institutions
In Nassau County, communities with the higher levels of poverty experience greater incidences of pregnancies with late or no prenatal care and significantly higher rates of infant mortality.
Institutional discrimination can restrict socioeconomic attainment and group differences in SES and health.•Segregation can create pathogenic residential conditions.•Discrimination can lead to reduced access to desirable goods and services.•Internalized racism (acceptance of society’s negative characterization) can adversely affect health.•Racism can create conditions that increase exposure to traditional stressors (e.g. unemployment). •Experiences of discrimination may be a neglected psychosocial stressor.
Long Island median household income is down 11% since 2002. From 2008-2011, the number of Hispanics grew by 48,000 to reach 16% of Long Island’s population. Blacks and Asians each grew by 10,000 and were 9% and 5% of Long Island’s population, respectively, in 2011. The number of non-Hispanic whites decreased by 45,000, and other non-Hispanics grew by 15,000. Over the last 21 years, the population share represented by these racial and ethnic minorities has doubled from 16% in 1990 to 32% in 2011.(LI Index) 15% of population is 65 or older in Nassau County Long Island remains the place with by far the smallest share of rental housing, compared to the other suburbs in the region. The share has fluctuated around 20% since 2000. While only one out of five occupied housing units is a rental household on Long Island, the ratio in the region’s other suburbs is at least one out of three.