Spatial Context and Health Inequity: Reconfiguring Race, Place, and Poverty

Abstract

Intimate connections among race, place, and poverty are increasingly featured in the health disparities literature. However, few models exist that can guide our understanding of these interconnections. We build on the Chicago School of Sociology's contributions in urban research and one of its contemporary elaborations, often described as the "neighborhood effects approach," to propose a three-axis model of health inequity. This model, in alignment with Chicago School theory, postulates a dynamic and adaptive relationship between spatial context and health inequity. Compositional axes of race and poverty form the foundation of the model. These compositional axes then intersect with a third axis of place to compose the built and social environment planes. We develop this model to provide conceptual guidance for clinical, policy, and public health researchers who aim to examine how these three features, taken together, have important implications for urban health.

Keywords: Chronic disease; Health disparities; Health inequity; Neighborhood effects; Place; Racial and ethnic disparities; Urban sociology.

Fig. 1

A three-axis model of health inequity

Fig. 2

Multinomial planes of neighborhood effects