Association for Public Policy Analysis & Management

This paper explores the spatial relationship between health outcomes and the distribution of concentrated poverty and residential segregation across U.S metro areas. Much empirical attention has traditionally been placed on the link between economic inequality and health. However, the link between concentrated metro level poverty and health has yet to be unpacked in full, with a particular emphasis on the interplay between the spatio-temporal dynamics of poverty and the still strong residential sorting by race across U.S. metro regions in affecting the unequal distribution of metro level health outcomes. This paper recognizes a gap in the research by way of looking at the effect of concentrated poverty on the processes furthering disparities in health attainment through economic isolation of neighborhoods and increasing geographic marginalization of urban population groups. The author constructs a multilevel model to analyze pooled data for the years 2001 and 2010 from the BRFSS and ACS national level surveys at both the individual and metropolitan/micropolitan (MMSA) levels of analysis. The analysis consists of a series of multilevel models utilizing a panel of 86 contiguous U.S. MMSAs. Spatial indices of racial segregation and poverty concentration are constructed using the Global Moran’s I spatial autocorrelation measure. The second component to the analysis relies on spatial autocorrelation and the estimation of the Global Moran's I index using GIS software to identify and quantify hot spots of high poverty (at the census tract level) within MSAs, as well as identify trends and changes over the time period of the analysis as these relate to health outcomes and risk factors. Preliminary results show a relatively strong, persistent, and significant association between the metro-level geographic distribution and patterning of concentrated poverty (concentrated poverty tracts defined as those census tracts with a poverty rate of 40 percent and over) and the level of health disparities for a given MSA – meaning that the spatial concentration of poverty works to exacerbate the impact of person level poverty at a given level of metro wide poverty. However, the association becomes mixed when introducing a spatial racial residential segregation index. Finally, the paper concludes with practical implications for urban policy solutions toward expanding the scope to include social and economic policies as they bear on the health inequities among urban communities.