There are multiple pathways through which segregation can adversely affect health.62,69 First, segregation limits socioeconomic mobility by limiting access to quality elementary and high school education, preparation for higher education and employment opportunities. Second, the conditions created by concentrated poverty and segregation make it more difficult for residents to adhere to good health practices. The higher cost, poorer quality, and lower availability of healthy foods in economically disadvantaged neighborhoods can lead to poor nutrition. The heavy targeting of disadvantaged minority communities with advertising for tobacco and alcohol can encourage the use of these products. 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 economic hardship and 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.
