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Gomez-Vidal C, Gomez AM. Invisible and unequal: Unincorporated community status as a structural determinant of health. Soc Sci Med 2021; 285:114292. [PMID: 34411968 DOI: 10.1016/j.socscimed.2021.114292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
Despite increasing awareness of the importance of political determinants of health, place-based research has not interrogated one of the most common political statuses: the impact of living in a community without municipal incorporation. In 2010 an estimated 37% of the U.S. population lived in an unincorporated area; despite their ubiquity, unincorporated communities are largely absent from the public health literature. Residents of unincorporated areas typically do not have their own local (e.g., city or municipal) government. This lack of representation leads to political exclusion and diminished access to resources, especially for low-income communities of color, Furthermore, by not disaggregating health data to unincorporated communities, residents are subsumed into county or census tract data that may not be reflective of their community's composition or context. Without jurisdictional distinction in research, there is no accountability for the manufacturing of health inequities in unincorporated communities . In the absence of empirical research on unincorporated communities, this paper uses the Commission on Social Determinants of Health (CSDH) Framework of the World Health Organization to argue that lack of municipal status is a structural determinant of health responsible for social conditions which generate cumulative health risks for residents. This includes using existing evidence on social conditions typical of unincorporated communities to describe patterns of residential segregation, neighborhood disadvantage, and environmental hazards that may increase residents' exposure to unhealthy environments in unincorporated communities. Finally, we provide an agenda for future public health research that can begin to address this health and racial equity gap for low-income unincorporated communities of color who have, until now, been absent in health equity discourse.
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Affiliation(s)
- Cristina Gomez-Vidal
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
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Todić J, Scott J. Unincorporated Health: Understanding Residents' Perspectives on Factors Impacting Their Health and Emergent Place-Based Solutions. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:317-329. [PMID: 33938399 DOI: 10.1080/19371918.2021.1900976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Increased mortality rates and decreased life expectancy in the United States are associated with rurality, even after adjusting for poverty. In unincorporated rural communities, high population density may compound the negative health impact of the upstream factors associated with rurality, yet little is known about how this context contributes to residents' health. We conducted nine focus groups with youth and adults from March-July 2017 in two Texas unincorporated rural communities. Using ecosocial theory and applied thematic analysis for focus groups, we investigated social, political, and historical factors that affect health. We identified two primary themes: upstream barriers to community health and K-12 schools as facilitators of community health. K-12 schools, and full-service community schools, in particular, may have an important role in closing the rural-urban health gap, even in the context of structural constraints associated with unincorporated rural status.
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Affiliation(s)
- Jelena Todić
- Department of Social Work, The University of Texas at San Antonio, College for Health, Community and Policy, San Antonio, TX, USA
| | - Jennifer Scott
- School of Social Work, Louisiana State University, Baton Rouge, LA, USA
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Leker HG, MacDonald Gibson J. Relationship between race and community water and sewer service in North Carolina, USA. PLoS One 2018; 13:e0193225. [PMID: 29561859 PMCID: PMC5862451 DOI: 10.1371/journal.pone.0193225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/07/2018] [Indexed: 11/25/2022] Open
Abstract
Previous evidence has identified potential racial disparities in access to community water and sewer service in peri-urban areas adjacent to North Carolina municipalities. We performed the first quantitative, multi-county analysis of these disparities. Using publicly available data, we identified areas bordering municipalities and lacking community water and/or sewer service in 75 North Carolina counties. Logistic regression was performed to evaluate the relationship between race and access to service in peri-urban areas, controlling for population density, median home value, urban status, and percent white in the adjacent municipality. In the peri-urban areas analyzed, 67% of the population lacked community sewer service, and 33% lacked community water service. In areas other than those with no black residents, odds of having community water service (p<0.01) or at least one of the two services (p<0.05) were highest for census blocks with a small proportion of black residents and lowest in 100% black census blocks, though this trend did not hold for access to community sewer service alone. For example, odds of community water service were 85% higher in areas that were greater than 0% but less than 22% black than in 100% black areas (p<0.001). Peri-urban census blocks without black populations had the lowest odds of community water service, community sewer service, and at least one of the two services, but this difference was only statistically significant for sewer. Peri-urban areas lacking service with no black residents were wealthier than 100% black areas and areas with any percent black greater than 0%. Findings suggest two unserved groups of differing racial and socioeconomic status: (1) lower-income black populations potentially excluded from municipal services during the era of legal racial segregation and (2) higher-income non-black populations. Findings also suggest greater racial disparities in community water than community sewer services statewide.
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Affiliation(s)
- Hannah Gordon Leker
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Jacqueline MacDonald Gibson
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Wu CYH, Evans MB, Wolff PE, Gohlke JM. Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities. JOURNAL OF ENVIRONMENTAL HEALTH 2017; 80:28-36. [PMID: 31777405 PMCID: PMC6880953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous research has suggested differences between public and professional understanding of the field of environmental health (EH) and the role of EH services within urban and rural communities. This study investigated EH priority differences between 1) rural and urban residents and 2) residents and EH professionals, and presents quantitative and qualitative methods for establishing locality-specific EH priorities. Residents (N = 588) and EH professionals (N = 63) in Alabama identified EH priorities via a phone or online survey. We categorized rurality of participant residences by rural-urban commuting area codes and population density, and tested whether or not EH priorities were different between urban and rural residents. Built environment issues, particularly abandoned houses, and air pollution were high priorities for urban residents-whereas, water and sanitation issues, and paper mill-related pollution were high priorities in rural communities. EH professionals ranked food safety and water and sanitation issues as higher priorities than residents did. Results highlight the importance of urbanicity on environmental risk perception and the utility of simple and inexpensive engagement methods for understanding these differences. Differences between residents and EH professionals suggest improving stakeholder participation in local-level EH decision making might lead to greater awareness of EH services, which might in turn improve support and effectiveness of those services.
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Affiliation(s)
- Connor Y H Wu
- Department of Population Health Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech
| | - Mary B Evans
- Center for the Study of Community Health, School of Public Health, University of Alabama at Birmingham
| | - Paul E Wolff
- Survey Research Unit, School of Public Health, University of Alabama at Birmingham
| | - Julia M Gohlke
- Department of Population Health Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech
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Yeary KHCK, Ounpraseuth ST, Kuo DZ, Harris K, Stewart MK, Bryant K, Haynes T, Turner J, Smith J, McCoy S, Sullivan G. To what extent do community members' personal health beliefs and experiences impact what they consider to be important for their community-at-large? J Public Health (Oxf) 2015; 38:502-510. [PMID: 26359314 DOI: 10.1093/pubmed/fdv118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled. METHODS We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues. RESULTS Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority. CONCLUSIONS Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed.
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Affiliation(s)
| | | | - Dennis Z Kuo
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kimberly Harris
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Keneshia Bryant
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tiffany Haynes
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jerome Turner
- Boys, Girls, Adults Community Development Center, Marvell, AR, USA
| | | | - Stephanie McCoy
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Greer Sullivan
- University of California at Riverside, Riverside, CA, USA
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Fernández JS, Langhout RD. "A community with diversity of culture, wealth, resources, and living experiences": defining neighborhood in an unincorporated community. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 53:122-133. [PMID: 24452528 DOI: 10.1007/s10464-014-9631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To obtain a better understanding of how people living in an unincorporated region define their neighborhood, a long-term photovoice project was conducted. Thirty-one photovoice sessions and eight structured interviews were coded and analyzed to assess participants' neighborhood definitions. Participant's difficulties in identifying the geographic, physical and demographic characteristics of their neighborhood led them to use social interactions, place-mediated values, and civic engagement to define neighborhood.
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