Recent research has considered the role of racial/ethnic residential segregation as it relates to health and health care outcomes in the United States. In this article, I employ key theories of segregation and urban inequality to explain the spatial distribution of healthrelated organizations. Using data from the 2010 County Business Patterns and the U.S. Census in a series of spatial regression models, I examine the distribution of a variety of health-related organizations across the United States. I find that the concentration and clustering of racial/ethnic minorities (blacks and, to a lesser extent, Latinos and Asians) in urban neighborhoods is inversely associated with the number of health-related organizations, including food resources, physical fitness facilities, health care resources, civic associations, and social service organizations. The spatial distribution of health-related organizations could help to explain broader links between racial/ethnic minority segregation and health. K E Y W O R D S : residential segregation; organizations; race/ethnicity; health; health care. As a system of stratification and racial subordination, racial/ethnic segregation favors numerous social problems (Massey and Denton 1993). In particular, several studies show that racial/ethnic minority segregation can be devastating to health and functioning across the life course (Williams and Collins 2001). For example, research suggests that various indicators of racial/ethnic segregation are associated with higher rates of mortality (Polednak 1997; Williams and Collins 2001), infant mortality and low birth weight (Ellen, Cutler, and Dickens 2000; Hearst, Oakes, and Johnson 2008), overall poor health (Anderson and Fullerton 2014; Subramanian, Acevedo-Garcia, and Osypuk 2005), nutrition and obesity (Chang 2006), and access to health care (Anderson and Fullerton 2012, 2014). Although various theoretical mechanisms have been proposed to explain the health consequences of racial/ethnic segregation, such as socioeconomic concerns, stress, and access to resources, few studies have formally tested any of them (Williams and Collins 2001). The author would like to thank Joseph Galaskiewicz, Andrew Fullerton, Terrence Hill, Erin Leahey, and Corey Abramson for their helpful comments on earlier drafts of this article. The author also presented this article at the annual meeting of the American Sociological Association in 2015 in Chicago, IL. This material is based upon work supported by the National Science Foundation Doctoral Dissertation Research Improvement Grant (SES-1518873). Direct correspondence to: Kathryn Freeman Anderson, Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX 77204-3012. E-mail: kateanderson@uh.edu. VC The Author 2017. Published by Oxford University Press on behalf of the Society for the Study of Social Problems. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 256 Social Problems, 2017, 64, 256–276 doi: 10.1093/socpro/spw058 Article D ow naded rom http/academ ic.p.com /socpro/articlact/64/2/256/3065804 by Txas &M U niersity user on 04 M ay 2019 In this study, I examine the association between race/ethnic segregation and health-related organizations. This work builds on previous research in two principal ways. First, it takes the initial step in establishing health-related organizations as a viable mechanism of the broader association between race/ethnic segregation and health. Second, it pushes the literature beyond narrow black and white distinctions to include other urban minority groups. With these considerations in mind, the overarching research question that this study addresses is the following: How are health-related organizations distributed across urban space in the United States? More specifically, are racial/ethnic minority neighborhoods less likely to have many and diverse health-related organizations compared to (nonHispanic) white neighborhoods? What other contextual factors are related to the distribution of such resources? Here, I address these questions by examining how the distribution of health-related organizations differs by the racial/ethnic composition of such neighborhoods and how this may relate to other theoretically important factors according to theories of urban neighborhood inequality. Generally, I expect that minority neighborhoods will be less likely to have such establishments, which may provide a mechanistic link between our understanding of segregation and health outcomes. In the pages that follow, I consider current theories of urban inequality and racial/ethnic segregation and how they may be related to the distribution of organizations. Next, I review the current literature on the distribution of health-related organizations in space and how this relates to race and segregation. Finally, I describe the present study and its central findings. T H E O R I E S O F S E G R E G A T I O N , U R B A N I N E Q U A L I T Y , A N D O R G A N I Z A T I O N S Community Organizations and Urban Inequality In general, scant attention has been paid to the role of organizations in creating and promoting community well-being. Michael McQuarrie and Nicole P. Marwell (2009), in a review of organizational research in the urban sociology literature, argue that urban sociology treats organizations as derivative of the urban context rather than productive. They refer to this as the “missing organizational dimension” and assert that organizations contribute to the urban environment and its consequences, and are not simply the result of the urban environment. From this perspective, it is not just the people that make up a neighborhood, but the people, the organizations, and the interplay between the two. Some scholars have addressed this missing dimension and provide evidence that organizations are productive of the urban environment and the accompanying inequalities (Allard and Small 2013; McQuarrie and Marwell 2009). Scholars in this tradition argue that organizations form essential components of urban life and community well-being. In particular, organizations represent the key sites in the community through which individuals can access material resources or information through a variety of means, such as employment opportunities, retail, as well as through nonprofit and government social service agencies that directly allocate goods or provide services and activities (Galaskiewicz, Mayorova, and Duckles 2013; Marwell and Gullickson 2013; Small and McDermott 2006). Furthermore, organizations may also provide less tangible support as well, as these represent the locations where individuals can meet and form connections. Thus, they also provide the space for the formation of social networks and social capital, which may also contribute to community vitality (Allard and Small 2013; Galaskiewicz et al. 2012; Oldenburg 1989; Small 2009). In this sense, they serve as “producers” of the neighborhood though both these physical and social means. Yet, in this line of research, little attention has been given to the role of segregation or to health-related organizations more specifically. Despite the general lack of attention to organizations, urban sociological theory carries a rich tradition of explaining and interpreting urban inequality due to segregation. These theories can be extended to the case of organizations in urban space and imply different theoretical mechanisms for why segregated areas may lack important community resources. Wilson’s Geographic Concentration of Poverty Theory and Deinstitutionalization In 1987, William Julius Wilson brought renewed attention to the plight of the urban poor in his pivotal work, The Truly Disadvantaged. Using the case of Chicago, he outlines a theory of urban Residential Segregation and Health-Related Organizations 257 D ow naded rom http/academ ic.p.com /socpro/articlact/64/2/256/3065804 by Txas &M U niersity user on 04 M ay 2019 inequality in an attempt to understand the growth of black urban “underclass” communities that was occurring throughout this time period. Although these problems occur principally in black urban neighborhoods, he argues that important demographic and structural changes prompted the growth of poverty and its accompanying problems in these neighborhoods (Wilson 1987, 1996). As a result of these various mechanisms, Wilson argues that poverty and its consequences thus become concentrated in urban black communities. In this work, Wilson was one of the first to articulate a theory of inequality that accounts for the role of organizations in communities—what he terms deinstitutionalization. He posits that one of the main consequences of concentration effects is organizational flight. As poverty mounts in the inner city, this condition drives away organizations that support community vitality. Essentially, these areas become organizational deserts, where basic community institutions no longer exist. This condition becomes cyclical as the lack of institutions perpetuates joblessness, poverty, and its effects. In sum, Wilson provides a class-based perspective, where segregation compounds poverty and social problems into one space, which in turn leads to organizational flight. From this perspective then, I draw the following hypothesis: H1: As poverty increases across urban neighborhoods, the density of neighborhood organizations and service providers will decrease, net of racial/ethnic composition. Racial Segregation and Place Stratification Several scholars have critiqued Wilson’s theoretical approach to urban inequality. Most notably, many have criticized Wilson for downplaying the significance of race in these processes. Of course his theory does not ignore the role of race and racial segregation, but many have argued that his theory places too strong of an emphasis on class and poverty, and that it ignores the central role of segregation as an institutionaliz

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城市街区种族居住隔离与卫生组织分布

最近的研究考虑了种族/民族居住隔离的作用，因为它与美国的健康和医疗保健结果有关。在本文中，我采用隔离和城市不平等的关键理论来解释与健康相关的组织的空间分布。在一系列空间回归模型中使用来自 2010 年县商业模式和美国人口普查的数据，我检查了美国各种与健康相关的组织的分布。我发现城市社区中种族/族裔少数群体（黑人，以及在较小程度上，拉丁美洲人和亚洲人）的集中和聚集与健康相关组织的数量成反比，包括食品资源、健身设施、医疗保健资源、公民协会和社会服务组织。健康相关组织的空间分布有助于解释种族/少数民族隔离与健康之间更广泛的联系。关键词：住宅隔离；组织；种族/民族；健康; 卫生保健。作为分层和种族从属制度，种族/民族隔离有利于许多社会问题（梅西和丹顿，1993 年）。特别是，一些研究表明，种族/少数族裔隔离可能对整个生命过程中的健康和功能造成破坏（威廉姆斯和柯林斯，2001 年）。例如，研究表明种族/民族隔离的各种指标与较高的死亡率（Polednak 1997；Williams 和 Collins 2001）、婴儿死亡率和低出生体重（Ellen、Cutler 和 Dickens 2000；Hearst、Oakes 和约翰逊 2008), 整体健康状况不佳（Anderson 和 Fullerton 2014；Subramanian、Acevedo-Garcia 和 Osypuk 2005）、营养和肥胖（Chang 2006）以及获得医疗保健的机会（Anderson 和 Fullerton 2012、2014）。尽管已经提出了各种理论机制来解释种族/民族隔离的健康后果，例如社会经济问题、压力和资源获取，但很少有研究正式测试其中任何一个（威廉姆斯和柯林斯 2001）。作者要感谢 Joseph Galaskiewicz、Andrew Fullerton、Terrence Hill、Erin Leahey 和 Corey Abramson 对本文早期草稿的有益评论。作者还在 2015 年在伊利诺伊州芝加哥举行的美国社会学协会年会上发表了这篇文章。本材料基于国家科学基金会博士论文研究改进补助金 (SES-1518873) 支持的工作。直接通信至：Kathryn Freeman Anderson，休斯顿大学社会学系，3551 Cullen Blvd, PGH Building, Room 450, Houston, TX 77204-3012。电子邮件：kateanderson@uh.edu。VC The Author 2017. 牛津大学出版社代表社会问题研究学会出版。版权所有。如需许可，请发送电子邮件至：journals.permissions@oup.com 256 Social Problems, 2017, 64, 256–276 doi: 10.1093/socpro/spw058 文章目录 rom http/academ ic.p.com /socpro/articlact /64/2/256/3065804 作者：Txas & M U niersity 用户，2019 年 5 月 4 日 在本研究中，我研究了种族/民族隔离与健康相关组织之间的关联。这项工作以两个主要方式建立在先前的研究基础上。首先，它在建立与健康相关的组织方面迈出了第一步，作为种族/民族隔离与健康之间更广泛关联的可行机制。其次，它推动文学超越狭隘的黑人和白人的区别，将其他城市少数民族纳入其中。考虑到这些因素，本研究解决的首要研究问题如下：与健康相关的组织如何分布在美国的城市空间中？更具体地说，与（非西班牙裔）白人社区相比，种族/少数民族社区是否不太可能拥有许多和多样化的健康相关组织？还有哪些其他背景因素与此类资源的分布有关？这里，我通过研究与健康相关的组织的分布如何因这些社区的种族/民族构成而有所不同，以及根据城市社区不平等理论这与其他理论上重要的因素如何相关来解决这些问题。一般来说，我预计少数族裔社区不太可能有这样的机构，这可能会在我们对种族隔离的理解和健康结果之间提供一种机制联系。在接下来的几页中，我会考虑当前关于城市不平等和种族/民族隔离的理论，以及它们与组织分布的关系。接下来，我回顾了当前有关太空中与健康相关的组织的分布以及这与种族和种族隔离之间的关系的文献。最后，我描述了本研究及其核心发现。隔离、城市不平等、组织的理论 社区组织和城市不平等 总的来说，组织在创造和促进社区福祉方面的作用很少受到关注。Michael McQuarrie 和 Nicole P. Marwell (2009) 在对城市社会学文献中的组织研究的回顾中认为，城市社会学将组织视为城市环境的衍生物，而不是生产性的。他们将此称为“缺失的组织维度”，并断言组织对城市环境及其后果做出了贡献，而不仅仅是城市环境的结果。从这个角度来看，构成社区的不仅仅是人，还有人、组织以及两者之间的相互作用。一些学者已经解决了这个缺失的维度，并提供了证据表明组织对城市环境和随之而来的不平等有生产力（Allard 和 Small 2013；McQuarrie 和 Marwell 2009）。这一传统的学者认为，组织是城市生活和社区福祉的重要组成部分。特别是，组织代表社区中的关键站点，个人可以通过这些站点通过各种方式获取物质资源或信息，例如就业机会、零售，以及通过直接分配商品或提供服务的非营利和政府社会服务机构。和活动（Galaskiewicz、Mayorova 和 Duckles 2013；Marwell 和 Gullickson 2013；Small 和 McDermott 2006）。此外，组织也可能提供较少的有形支持，因为这些代表了个人可以见面和建立联系的地点。因此，它们也为社会网络和社会资本的形成提供了空间，这也可能有助于社区活力（Allard and Small 2013; Galaskiewicz et al. 2012; Oldenburg 1989; Small 2009）。从这个意义上说，他们通过这些物质和社会手段充当社区的“生产者”。然而，在这方面的研究中，很少关注隔离的作用，或者更具体地关注与健康相关的组织。尽管普遍缺乏对组织的关注，但城市社会学理论具有解释和解释由于隔离造成的城市不平等的丰富传统。这些理论可以扩展到城市空间中的组织的案例，并暗示为什么隔离区域可能缺乏重要的社区资源的不同理论机制。威尔逊关于贫困理论和去制度化的地理集中 1987 年，威廉·朱利叶斯·威尔逊在他的关键著作《真正的弱势群体》中重新关注了城市贫民的困境。他以芝加哥为例，概述了城市住宅隔离和健康相关组织的理论 257 D ow naded rom http/academ ic.p.com /socpro/articlact/64/2/256/3065804 by Txas & M U niersity user 2019 年 5 月 4 日的不平等现象，试图了解在此期间发生的黑人城市“下层阶级”社区的增长。虽然这些问题主要发生在城市黑人社区，他认为，重要的人口和结构变化导致了这些社区的贫困及其伴随问题的增长（Wilson 1987, 1996）。由于这些不同的机制，威尔逊认为贫困及其后果因此集中在城市黑人社区。在这项工作中，威尔逊是最早阐明不平等理论的人之一，该理论解释了组织在社区中的作用——他称之为去制度化。他假设集中效应的主要后果之一是组织逃逸。随着内城贫困的加剧，这种情况驱散了支持社区活力的组织。从本质上讲，这些领域变成了组织沙漠，基本的社区机构不再存在。由于缺乏制度会导致失业、贫困及其影响长期存在，这种情况会变得周期性。总而言之，威尔逊提供了一种基于阶级的视角，其中种族隔离将贫困和社会问题融合到一个空间中，这反过来又导致了组织逃逸。然后从这个角度，我得出以下假设： H1：随着城市社区的贫困程度增加，社区组织和服务提供者的密度将下降，扣除种族/民族构成。种族隔离和地方分层 一些学者批评了威尔逊解决城市不平等的理论方法。最值得注意的是，许多人批评威尔逊淡化了种族在这些过程中的重要性。当然，他的理论并没有忽视种族和种族隔离的作用，