Racial Segregation as a Social Determinant of Health: Evidence from the State of Georgia

Background: ​Despite decades of research, determining the causes of racial disparities in health remains a pernicious problem in the public health arena. Challenges include further refining definitions of health as well as expanding frameworks for social determinants of health to include relevant and related predictors. Racial segregation as a social determinant of health is understudied but of growing interest in the discourse on health disparities. This paper explores empirically the relationship between racial segregation and other predictors of social determinants of health and their collective impact on health outcomes defined in both objective and subjective terms. Methods: ​Ordinary least squares regression analysis was used to analyze health outcomes from the Robert Wood Johnson 2018 County Health Rankings for Georgia. At the county level we considered two distinct categories of health outcomes as the dependent variables, including objective measures of health status such as age-adjusted mortality and more subjective measures from the person’s perspective of quality of life such self-reported health. The independent variables representing racial segregation included the black-white segregation and nonwhite-white segregation indices. Results: ​Our findings are that racial segregation is not significantly associated with objective health outcome measures. Conversely and surprisingly, counties with higher levels of black-white and nonwhite-white segregation show better self-reported health. Control variables have the expected impact on health outcomes based on previous literature. Conclusions: ​While segregation does not suggest poorer health status, the findings of higher quality of life assessment is concerning as a person’s perspectives on their health predicts healthy behaviors and access to needed care. We suggest that racial segregation is an important addition to social determinants of health frameworks and models and worthy of continued multidisciplinary research on a national basis.