Residential Segregation as a Policy Priority to Address Health Disparities: a Multilevel Analysis

To address racial residential segregation, considered a reflection of structural racism, and its relative importance to social determinant of health (SDOH) pathways to health disparities, we analyze self-reported health, a known predictor of health outcomes. We use County Health Rankings, a public dataset provided by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Using a panel dataset (2016 to 2019) with multilevel modelling techniques, we compare racial residential segregation at the county level to other health-outcome related county level characteristics considered pathways to disparate health outcomes. Consistent with prior research we find that higher racial residential segregation is associated with greater reporting of fair or poor health. However, the effects of education and economic stability measures of SDOH are more important for predicting fair/poor health outcomes than segregation. Our research highlights the need for more multi-level analysis and a better understanding of the complex nature of SDOH in a structural racism approach to inform where, when, how, and for whom policies are developed, funded, and implemented at the local level.