Arguably, the most decisive way in which racism can affect health is through institutional mechanisms of racism. The aspect of institutional discrimination most widely studied for its health implications has been residential segregation (Williams and Collins 2001; Acevedo-Garcia et al. 2003). This body of research indicates that residential segregation can shape SES and thus health by restricting access to education and employment opportunities, discounting the economic value of a given level of SES, and creating health-damaging conditions in residential environments. Historically, two pronounced patterns of residential segregation in the U.S. have been the geographic isolation of American Indians on reservations and the residential concentration of African Americans in poor urban areas. There is growing concern about the health consequences of the persisting segregation of blacks and American Indians and the increasing segregation of Latinos (Acevedo-Garcia et al. 2008). Although the majority of poor persons in the U.S. are white, poor white families are not concentrated in the ways that poor blacks and Latinos are. The critical determinant of the problems linked to segregation is not racial composition per se but the concentration of economic and social disadvantage and the absence of an infrastructure that promotes opportunity.
