The unequal distribution of disease and disability across racial/ethnic groups accompanied with the disproportionate settlement of racial/ethnic minority groups in urban cities could have implications for urban health, specifically in terms of the contribution that minority health makes to the overall health in the city. However, in order to explain and understand the relationship between health and urban life, it is important to disentangle the effects of person and place. For example, although 73% of U.S. counties are classified as nonmetropolitan or rural areas, 80% of the American population lives in counties classified as metropolitan or urban areas (Eberhardt, et al., 2001). The Northeast region, which contains the lowest percent of the U.S. population (19%), exhibits the highest percentage (90.1%) of people living in metro areas, while the Midwest, home of 23% of the U.S. population, exhibits the highest proportion of people living in non-metropolitan (26.4%) with 14.4% of those living in rural counties.
Although the association between urban areas and health has not been directly investigated, per se, findings from social science research (Coleman, 1988, 1990; Harris, 1999; Jargowsky, 1996; Massey and Denton, 1993; Sampson and Morenoff, 1997; Sampson, et al., 1997; 1995; Shaw and McKay, 1969; Wilson, 1987; 1996) suggest that urban areas provide both advantages and disadvantages to their residents. Economic development and the higher levels of community resources can facilitate dissemination of health related information that potentially leads to better health. Obverse, the impact on family and community organization of the lack of resources and organization within the social milieu of urban areas could lower the health benefits of other resources and information related to health.
The overall benefit of community resources to all their residents is what Rose (1985) has called a preventive paradox, that is everybody benefits by being exposed to multiple sources of information and services (Rose, 1985). A good example of this paradox is the case of health promotion leading to positive health behaviors, such as physical activity, anti-smoking campaigns, and sexual education among adolescents. People living in urban areas are more likely to be active than those living in rural settings, regardless of their race/ethnicity, and as a result less likely to be overweight (Eberhardt, et al., 2001). Cigarette smoking and birth rates among adolescents are lower in urban setting than in rural areas (Eberhardt, et al., 2001). In fact, there is evidence that black adolescents in urban cities have lower rates of smoking than whites and are more likely to initiate later in life (Bachman, et al., 1991; Mcintosh, 1995; Nelson, et al., 1995; Siegfried, 1991). However, not all resources are part of this paradox.
The impact on family and community organization resulting from the lack of resources and organization within the social milieu of urban areas could lower the health benefits of resources and information related to health. Access to care has been underscored as a reason for better health in urban areas but members of minority groups, specifically blacks and latinos are consistently among the uninsured in comparison to their white counterparts, regardless of the region where they reside in the U.S. (Freid, et al., 2003). Moreover, the proportion of blacks and latinos without insurance living in urban cities is higher than the proportion living in rural areas (Eberhardt, et al., 2001). Lack of insurance could limit access to care for these populations. To complicate matters, during the 1970s and 1980s, many American cities experienced the closings and relocations of hospitals, especially voluntary and public hospitals. These hospitals, in some cases, were the only source of care for minority communities. These closings had a tremendous impact on access to care and the creation of a spatial mismatch between needs and services. Furthermore, Sager (1983) found that one of the most significant predictors for hospitals closing and relocations was the proportion of blacks in the area (Sager, 1983).
Another problem of urban cities is the high proportion of people living below poverty levels. For years, poverty has been associated with poor health due to inadequate nutrition, substandard housing, exposure to environmental hazards, unhealthy lifestyles and behaviors, and decreased access to and use of health care services (Andrulis and Goodman, 1999; Pamuk, et al., 1998). There is pervasive evidence that poor people exhibited more disease, disability and are more likely to die than their higher socioeconomic status (SES) counterparts (Williams and Collins, 1995). In 1999, 12.4% of Americans lived below the poverty threshold (Bishaw and Iceland, 2003). Furthermore, race/ethnicity is strongly associated with poverty in U.S. urban life. Although 54% of poor Americans belong to racial/ethnic minority groups, the distribution of poverty nationwide follows the concentration of minority population, specifically blacks and latinos. Blacks and latinos are more likely to live in urban areas with a high proportion of people living below poverty than their white counterparts (Freid, et al., 2003). In 1999, 1 in 4 blacks or latinos lived below poverty level (Bishaw and Iceland, 2003). These figures have remained nearly unchanged in 2003 (DeNavas-Walt, et al., 2004). For example, Figures 1, 2 and 3 show first an overlay of urban areas and poverty; and second, urban areas,
Urbanized areas % of populations below poverty level I | 0 - 15.6 |III | 15.6 - 34.3 34.3 - 68.0
US Census, 2000
Figure 1. Poverty and Urbanized areas, 1999.
Urbanized areas % of populations below poverty level | | 0 - 15.6 I/// | 15.6 - 34.3 Hon 34.3 - 68.0 % Black
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