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the National Survey of American Life

Sociological research has also shed important light on how factors linked to race contribute to racial differences in health. This work has identified multiple ways in which racism initiates and sustains health disparities (Williams and Mohammed 2009). This research explicitly draws on the larger literature in sociology on racism and conceptualizes it as a multilevel construct, encompassing institutional and individual discrimination, racial prejudice and stereotypes as well as internalized racism (Feagin and McKinney 2003Bonilla-Silva, 1997Massey and Denton 1993).

At the institutional level, sociological research has underscored the role of residential racial segregation as a primary institutional mechanism of racism and a fundamental cause of racial disparities in health (Massey and Denton 1993LaVeist 1989Williams and Collins 2001) and has helped shape local and federal policies. Sociologists have documented how segregation produces the concentration of poverty, social disorder and social isolation, and creates pathogenic conditions in residential environments (Massey 2004Schulz et al. 2002Williams and Collins 2001). For example, an examination of the 171 largest cities found that the worst urban context in which white individuals lived was better than the average context of black neighborhoods (Sampson, and Wilson 1995). These differences in neighborhood quality and community conditions are driven by residential segregation by race – a neglected but enduring legacy of institutional racism in the U.S. Considerable evidence suggests that because of segregation, the residential conditions under which African Americans, American Indians and an increasing proportion of Latinos live are distinctive from those of the rest of the population.

Sociologists have also identified multiple pathways through which segregation can adversely affect health (Morenoff 2003Williams and Collins 2001Schulz et al. 2002). First, segregation restricts SES attainment by limiting access to quality elementary and high school education, preparation for higher education and job opportunities. Second, the residential conditions of concentrated poverty and social disorder created by segregation make it difficult for residents to eat nutritiously, exercise regularly and avoid advertising for tobacco and alcohol. For example, the lack of recreation facilities and concerns about personal safety can discourage leisure time physical exercise. Third, the concentration of poverty can lead to exposure to elevated levels of financial stress and hardship as well as other chronic and acute stressors at the individual, household and neighborhood level. Fourth, the weakened community and neighborhood infrastructure in segregated areas can also adversely affect interpersonal relationships and trust among neighbors. Fifth, the institutional neglect and disinvestment in poor, segregated communities contributes to increased exposure to environmental toxins, poor quality housing and criminal victimization. Finally, segregation adversely affects both access to care and the quality of care. Research has linked residential segregation to an elevated risk of illness and death and shown that it contributes to the racial disparities in health (Williams and Collins 2001