Neighborhood racial segregation linked to shorter life spans

The study examined 63,694 census tracts (small, relatively permanent geographic entities within counties) across the U.S. and found the national average life expectancy was 78 years old. In predominantly Black neighborhoods with high racial segregation, the average life expectancy was 75 years old, which is significantly lower than the average life expectancy (79 years old) in neighborhoods with low racial segregation. In high- versus low-segregated neighborhoods, a higher percent of residents lacked acollege education (81% vs. 69%, respectively), were living below the federal poverty line (24% vs. 11%, respectively) and wereunemployed (16% vs. 8%, respectively), the study found.

Other factors — access to healthcare, housing stability and environmental pollution — were not included in the study model but arerelated to structural racism and likely to influence the association between segregation and life expectancy, Khan said. 

“While the mechanisms by which neighborhood segregation may contribute to differences in life expectancy are many, we sought to focus on key socioeconomic factors that are likely attributable to redlining and downstream differences by neighborhood in economic investment and resources in communities, which all have downstream consequences on health,” Khan said. “These factors explained more than half of the differences in life expectancy across neighborhoods in our analysis.”

“For some time we’ve studied neighborhood traits associated with health outcomes, but this is among the first studies associating segregation per se at the local level with health outcomes,” said senior author Kiarri Kershaw, associate professor of epidemiology at Feinberg. “The solution is less about the decision of where people live and more about changing the circumstances in which they live.”

What happens before one even walks in to a clinic

The study findings could help inform policy decisions to improve overall health in the U.S., Khan said.

“This isn’t an individual-level issue in which we say we need to improve someone’s blood pressure control or cholesterol level,” Khan said. “Those are really important, but without tackling this on a bigger level, making sure there’s equity in terms of educational opportunities, employment and a healthy environment without air pollution or excessive heat exposure at the local level where people are born, live and grow, we are going to miss a large part of what’s already happened before people walk into our clinics.” 

Dr. Clyde Yancy, vice dean for diversity and inclusion and chief of cardiology at Feinberg, said local challenges require local solutions. “No single intervention fundamentally changes risk at a neighborhood level. Public health advocacy helps, but economic opportunities and high-quality education are immensely valuable.”

Two Northwestern initiatives aim to tackle just that, Yancy said. A new Bronzeville initiative through Northwestern Medicine intends to provide local care for the residents of Bronzeville, a neighborhood on the South Side of Chicago, and create economic opportunities for contractors, vendors and health care workers from that same neighborhood. Additionally, the legacy of the Northwestern Scholars program, whose goal is to increase access and successful matriculation of underrepresented Chicago Public Schools students with an interest in STEM to top-tier colleges and universities, “is an exemplary model of elevating the next generation and offers hope where previously there was only despair,” Yancy said.

Other Northwestern co-authors on the study include Cyanna McGowan and Laura Seegmiller.