Distrust of the health system is a longstanding issue for ethnoracial minorities, especially for Blacks. Not well understood, however, is the role that ethnoracial segregation within a city plays in this distrust. While segregation is typically associated with neighborhood ills, there is evidence that it can also moderate distrust. This study draws on the 2008 wave of the Public Health Management Corporation's Southeastern Pennsylvania Household Health Survey and the 2005–2009 American Community Survey to explore the possibility that segregation affects healthcare system distrust. Using hierarchical linear modeling, we find that residence in predominantly Black neighborhoods was associated with less distrust in the healthcare system for Black respondents, while residence in mixed neighborhoods was associated with more distrust for Black respondents. These findings call for a reevaluation of how healthcare system distrust is understood. Distrust has been connected to poorer health outcomes, playing into wider gaps in ethnoracial minority health outcomes.
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References
1.
AbascalMaria, and BaldassarriDelia. 2015. “Love Thy Neighbor? Ethnoracial Diversity and Trust Reexamined.” American Journal of Sociology121(3):722–82.
2.
AhernMelissa M., and HendryxMichael S.2003. “Social Capital and Trust in Providers.” Social Science, and Medicine57(7):1195–203.
3.
ArmstrongKatrina, McMurphySuzanne, DeanLorraine T., MiccoEllyn, PuttMary, HalbertChanita H., SchwartzJ. Sanford, SankarPamela, PyeritzReed E., BernhardtBarbara, and SheaJudy A.2008. “Differences in the Patterns of Health Care System Distrust Between Blacks and Whites.” Journal of General Internal Medicine23(6):827–33.
4.
ArmstrongKatrina, PuttMary, HalbertChanita H., GrandeDavid, SchwartzJ. Sanford, LiaoKaijun, MarcusNoora, DemeterMirar B., and SheaJudy A.2013. “Prior Experiences of Racial Discrimination and Racial Differences in Health Care System Distrust” Medical Care51(2):144–50.
5.
ArmstrongKatrina, RoseAbigail, PetersNikki, LongJudith A., McMurphySuzanne, and SheaJudy A.2006. “Distrust of the Health Care System and Self–Reported Health in the United States.” Journal of General Internal Medicine21(4):292–97.
6.
BakkerLinda, and DekkerKarien. 2012. “Social Trust in Urban Neighbourhoods: The Effect of Relative Ethnic Group Position.” Urban Studies49(10):2031–47.
7.
BellingerDavid C.2016. “Lead Contamination in Flint—an Abject Failure to Protect Public Health.” New England Journal of Medicine374(12):1101–03.
8.
BenjaminsMaureen R.2006. “Religious Influences on Trust in Physicians and the Health Care System.” International Journal of Psychiatry in Medicine36(1):69–83.
9.
BerkmanLisa F., KawachiIchiro, and Maria GlymourM.2014. Social Epidemiology. 2nd edn. New York, NY: Oxford University Press.
10.
BetancourtJoseph R., GreenAlexander R., CarrilloJ. Emilio, and ParkElyse R.2005. “Cultural Competence and Health Care Disparities: Key Perspectives and Trends.” Health Affairs24(2):499–505.
11.
BlendonRobert J.2007. “Why Americans Don't Trust the Government and Don't Trust Healthcare.” In ShoreDavid A. (ed.), The Trust Crisis in Healthcare: Causes, Consequences, and Cures, pp. 21–31. New York, NY: Oxford University Press.
12.
BoulwareL. Ebony, CooperLisa A., RatnerLloyd E., LaVeistThomas A., and PoweNeil R.2003. “Race and Trust in the Health Care System.” Public Health Reports118(4):358.
13.
BraggCubie A.2011. “The Black Barbershop: Increasing Health Awareness among Minority Men.” AABSS Journal15:1–20.
14.
BriggsLaura. 2002. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. Berkeley, CA: University of California Press.
15.
ChungAngie Y.2007. Legacies of Struggle: Conflict and Cooperation in Korean American Politics. Palo Alto, CA: Stanford University Press.
16.
CollinsChiquita A., and WilliamsDavid R.1999. “Segregation and Mortality: The Deadly Effects of Racism?” Sociological Forum14(3):495–523.
17.
CooperLisa A., RoterDebra L., CarsonKathryn A., BeachMary Catherine, SabinJanice A., GreenwaldAnthony G., and InuiThomas S.2012. “The Associations of Clinicians’ Implicit Attitudes about Race with Medical Visit Communication and Patient Ratings of Interpersonal Care.” American Journal of Public Health102(5):979–87.
18.
CutlerDavid, GlaeserEdward, and VigdorJacob. 1999. “The Rise and Decline of the American Ghetto.” Journal of Political Economy107(3):455–506.
19.
DeanLorraine, SubramanianS.V., WilliamsDavid R., ArmstrongKatrina, CharlesCamille Zubrinsky, and KawachiIchiro. 2014. “The Role of Social Capital in African–American Women's Use of Mammography.” Social Science, and Medicine104(March):148–56.
20.
Du BoisW. E. B.1899. The Philadelphia Negro: A Social Study. Philadelphia, PA: University of Pennsylvania Press.
21.
EllenIngrid G.2000. Sharing America's Neighborhoods: The Prospects for Stable Racial Integration. Cambridge, MA: Harvard University Press.
22.
FriedmanSamantha. 2008. “Do Declines in Residential Segregation Mean Stable Neighborhood Racial Integration in Metropolitan America? A Research Note.” Social Science Research37(3):920–33.
23.
GambleVanessa Northington. 1997. “Under the Shadow of Tuskegee: African Americans and Health Care.” American Journal of Public Health87(11):1773–78.
24.
GibbonsJoseph R., and SchiaffinoMelody K.2016. “Determining the Spatial Heterogeneity Underlying Racial and Ethnic Differences in Timely Mammography Screening.” International Journal of Health Geographics15(1):39.
25.
GibbonsJoseph R., and YangTse–Chuan. 2014. “Self–Rated Health and Residential Segregation: How Does Race/Ethnicity Matter?” Journal of Urban Health91(4):648–60.
26.
GibbonsJoseph R., and YangTse–Chuan. 2016. “Connecting Across the Divides of Race/Ethnicity How Does Segregation Matter?” Urban Affairs Review52(4):531–58.
27.
GibbonsJoseph R., and YangTse–Chuan. 2018. “Searching for Silver Linings: Is Perceived Medical Discrimination Weaker in Segregated Areas?” Applied Spatial Analysis and Policy11(1):37–58.
28.
GreifMeredith J.2009. “Neighborhood Attachment in the Multiethnic Metropolis.” City & Community8(1):27–45.
29.
HallMark A., DuganElizabeth, ZhengBeiyao, and MishraAneil K.2001. “Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?” Milbank Quarterly79(4):613–39.
30.
HernandezVictor Vazquez. 2005. “From Pan–Latino Enclaves to a Community: Puerto Ricans in Philadelphia, 1910–2000.” In Theresa WhalenCarmen (ed.), The Puerto Rican Diaspora: Historical Perspectives, pp. 88–106. Philadelphia, PA: Temple University Press.
31.
HuntMatthew O., WiseLauren A., JipguepMarie–Claude, CozierYvette C., and RosenbergLynn. 2007. “Neighborhood Racial Composition and Perceptions of Racial Discrimination: Evidence from the Black Women's Health Study.” Social Psychology Quarterly70(3):272–89.
32.
JacobsJane. 1961. The Death and Life of Great American Cities. New York, NY: Random House.
33.
JohnstonRon, PoulsenMichael, and ForrestJames. 2014. “Segregation Matters, Measurement Matters.” In LloydChristopher D., ShuttleworthIan, and WongDavid (eds.), Social–Spatial Segregation: Concepts, Processes and Outcomes, pp. 13–44. Bristol: Policy Press at the University of Bristol.
34.
KevlesDaniel. 1985. In the Name of Eugenics: Genetics and the Uses of Human Heredity. New York, NY: Knopf.
35.
KotlowitzAlex. 1991. There Are No Children Here: The Story of Two Boys Growing Up in The Other America. New York, NY: Doubleday.
36.
KramerMichael R., and HogueCarol J.2009. “Is Segregation Bad for Your Health?” Epidemiologic Reviews31(1):178–94.
37.
LaVeistThomas A., NickersonKim J., and BowieJanice V.2000. “Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients.” Health Policy, and Services57(1):146–61.
38.
LoganJohn R., StultsBrian J., and FarleyReynolds. 2004. “Segregation of Minorities in the Metropolis: Two Decades of Change.” Demography41(1):1–22.
39.
MalyMichael. 2005. Beyond Segregation: Multiracial and Multiethnic Neighborhoods in the United States. Philadelphia, PA: Temple University Press.
40.
MasseyDouglas S., and DentonNancy A.1988. “The Dimensions of Residential Segregation.” Social Forces67(2):281.
41.
MasseyDouglas S., and DentonNancy A.1993. American Apartheid: Segregation and the Making of the Underclass. Cambridge, MA: Harvard University Press.
42.
McMillanDavid W.1996. “Sense of Community.” Journal of Community Psychology24(4):315–25.
43.
McPhersonMiller, Smith–LovinLynn, and JamesM.Cook. 2001. “Birds of a Feather: Homophily in Social Networks.” Annual Review of Sociology27(1):415–44.
44.
McRobertsOmar M.2003. Streets of Glory: Church and Community in a Black Urban Neighborhood. Chicago, IL: University of Chicago Press.
45.
NealZachary, and NealJennifer Watling. 2014. “The (In) Compatibility of Diversity and Sense of Community.” American Journal of Community Psychology53(1–2):1–12.
46.
PHMC. 2008. 2008 Household Health Survey Documentation. Philadelphia, PA: Public Health Management Corporation.
47.
PutnamRobert D.2000. Bowling Alone: The Collapse and Revival of American Community. New York, NY: Simon, and Schuster.
48.
PutnamRobert D. 2007. “E Pluribus Unum: Diversity and Community in the Twenty–First Century the 2006 Johan Skytte Prize Lecture.” Scandinavian Political Studies30(2):137–74.
49.
RayRashawn. 2014. “An Intersectional Analysis to Explaining a Lack of Physical Activity Among Middle Class Black Women: Intersectionality, Physical Activity, and Middle Class Black Women.” Sociology Compass8(6):780–91.
50.
RelefordBill J., FrencherStanley K.Jr, and YanceyAntronette K.2010. “Health Promotion in Barbershops: Balancing Outreach and Research in African American Communities.” Ethnicity, and Disease20(2):185.
51.
ReverbySusan M.2011. “‘Normal Exposure’ and Inoculation Syphilis: A PHS ‘Tuskegee’ Doctor in Guatemala, 1946–1948.” Journal of Policy History23(01):6–28.
52.
RichardsonNorris. 2010. “Access to Health and Health Care: How Race and Ethnicity Matter.” Mount Sinai Journal of Medicine77:166–77.
53.
RoseAbigail, PetersNikki, SheaJudy A., and ArmstrongKatrina. 2004. “Development and Testing of the Health Care System Distrust Scale.” Journal of General Internal Medicine19(1):57–63.
SampsonRobert J.2012. Great American City: Chicago and the Enduring Neighborhood Effect. 1st ed.Chicago, IL: University of Chicago Press.
56.
Sanchez–JankowskiMartin. 2008. Cracks in the Pavement. Berkeley, CA: University of California Press.
57.
SchiaffinoMelody K., NaraAtsushi, and MaoLiang. 2016. “Language Services in Hospitals Vary by Ownership and Location.” Health Affairs35(8):1399–403.
58.
SewellAbigail A.2015. “Disaggregating Ethnoracial Disparities in Physician Trust.” Social Science Research54(November):1–20.
59.
SheaJudy A., MiccoEllyn, DeanLorraine T., McMurphySuzanne, Sanford SchwartzJ., and ArmstrongKatrina. 2008. “Development of a Revised Health Care System Distrust Scale.” Journal of General Internal Medicine23(6):727–32.
60.
ShoffCarla, and YangTse–Chuan. 2012. “Untangling the Associations among Distrust, Race, and Neighborhood Social Environment: A Social Disorganization Perspective.” Social Science, and Medicine74(9):1342–52.
61.
SmedleyBrian D., StithAdrienne Y., and NelsonAlan R., eds. 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Board on Health Sciences Policy. Washington, DC: The National Academies Press.
62.
SquiresGregory D., and KubrinCharis E.2006. Privileged Places: Race, Residence, and the Structure of Opportunity. Boulder, CO: Lynne Rienner Publications.
63.
StepanikovaIrena, MollbornStefanie, CookKaren S, ThomDavid H., and KramerRoderick M.2006. “Patients’ Race, Ethnicity, Language, and Trust in a Physician.” Journal of Health and Social Behavior47(4):390–405.
64.
StrullyKate W.2011. “Health Care Segregation and Race Disparities in Infectious Disease: The Case of Nursing Homes and Seasonal Influenza Vaccinations.” Journal of Health and Social Behavior52(4):510–26.
65.
ThompsonWanda M., BerryDiane, and HuJie. 2013. “A Church–Based Intervention to Change Attitudes about Physical Activity among Black Adolescent Girls: A Feasibility Study.” Public Health Nursing30(3):221–30.
66.
TomarkenAndrew J., and WallerNiels G.2005. “Structural Equation Modeling: Strengths, Limitations, and Misconceptions.” Annual Review Clinical Psychology1:31–65.
67.
TranVan C., GraifCorina, JonesAlison D., SmallMario L., and WinshipChristopher. 2013. “Participation in Context: Neighborhood Diversity and Organizational Involvement in Boston.” City & Community12(3):187–210.
68.
UsherCarey Leigh. 2007. “Trust and Well–Being in the African American Neighborhood.” City & Community6(4):367–87.
69.
UslanerEric M.2011. “Trust, Diversity, and Segregation in the United States and the United Kingdom.” Comparative Sociology10(2):221–47.
70.
WashingtonHarriet A.2006. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York, NY: Doubleday.
71.
WongDavid. 2014. “Using a General Spatial Pattern Index to Evaluate Spatial Segregation.” In LloydChristopher D., ShuttleworthIan, and WongDavid (eds.), Social–Spatial Segregation: Concepts, Processes and Outcomes, pp. 45–64. Bristol: Policy Press at the University of Bristol.
72.
YangTse–Chuan, MatthewsStephen A., and HillemeierMarianne M.2011. “Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania.” American Journal of Public Health101(7):1297.
73.
YangTse–Chuan, MatthewsStephen A., and ShoffCarla. 2011. “Individual Health Care System Distrust and Neighborhood Social Environment: How Are They Jointly Associated with Self–Rated Health?” Journal of Urban Health88(5):945–58.
74.
ZhengHui. 2015. “Losing Confidence in Medicine in an Era of Medical Expansion?” Social Science Research52(July):701–15.
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