May 06, 2011

A matter of healing and health: our segregation dilemma

After withstanding the longest filibuster in history, the Civil Rights Act was signed into law on May 6, 1960 paving the way for much stronger legislation includig the 1964 Civil Rights Act and the Voting Rights Act of 1965. You can see here progress as an iterative process requiring time and tenacity. Justice is slow, but steady.  The 1964 civil rights laws declared hospital segregation illegal.
Yet, the persistence of racial residential segregation continues to drive disparities in health. [1] Social factors in local settings result in variations of population health across communities. [2,3] The segregation dilemma among African Americans is distinctive because other minority groups have not lived within the historical context of the African American population, our closet kin are Native Americans. The landscape of America is changing rapidly with increasing Latin and Asian populations revealing a new story of complexity.

In growing numbers, people of different cultures and ethnic backgrounds are coexisting in communities, workplace settings, schools, playgrounds. While religious and faith centers remain some of the most segregated places in America. A few weeks ago a provocative talk considering “Race and Racism in America: Are We A Color Blind Society?” hosted by the W.K. Kellogg Foundation offered some insight into the practice of engaging into this challenging dialogue. For example, while 50% of African Americans have dated across racial lines, 98% of African Americans have experienced have first-hand experiences with discrimination. Discussions about bias, stereotyping and discriminatory practices do help to improve attitudes as well as behaviors. Silence may perpetuate pain and suffering.  Race is an illusion discounted by the the science of human biology and modern genetics, but race is a social reality. A Joint Center for Political and Economic Studies report indicates racial inequalities in health care access and quality added more than $50 billion a year to direct U.S health care costs from 2003 to 2006. In Seeing Patients: Unconscious Bias in Health Care physician-educator Augustus White offers that the Unequal Treatment report “shocked the medical world into recognition of what was going on with racial and other prejudices.” [4,5]   Deeply rooted health care disparities are entangled in the larger story in our society.  
“Housing policy is health policy. Educational policy is health policy. Antiviolence policy is health policy. Neighborhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.”  
                                                                                   —David R. Williams, UNNATURAL CAUSES

The public conversation continues next week with a meeting offered via webcast on “America Healing” including Florence & Laura Norman Professor of Public Health, Harvard University sociologist David R. Williams. These professional meetings push beyond anecdotes so that the evidence of disparities can be seen and addressed.  In considering "What determines health?" and the social factors related to healthier lives, Robert Wood Johnson Foundation will also host a webinar on “Place and Health: Why Conditions Where We Live, Learn, Work and Play Matter” and the chat continues via Twitter hashtag #healthissocial with an expert panel.[6] These are open-door meetings, offering virtual presence attendance. We all need to consider new possibilities for healing and health in our lives.  Join the conversation.


  1. Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev 2009;31(1):178 –94. 
  2. Miller DM, Pollack CE, Williams DR. Healthy homes and communities: putting the pieces together.  Am J Prev Med 2011;40(1S1):S48–S57. 
  3. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep 2001;116(5): 404 –16.
  4. White AA, Chanoff D. Seeing Patients: Unconscious Bias in Health Care. Cambridge, MA: Harvard University Press, 2011.
  5. Smedley B, Stith A, Nelson A, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington,DC: Institute of Medicine, The National Academies Press, 2003.
  6. Lavizzo-Mourey R, Williams DR. Strong medicine for a healthier America: introduction. Am J Prev Med 2011;40(1S1):S1–S3. 

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