idothisformyculture on Xanga

Weblog

Thursday, 09 August 2007

Municipal Underbounding Leaves Minority Communities without Basic Resources

Every year, tourists flock to plush Moore County, North Carolina, in massive numbers, bringing with them hundreds of millions of dollars in annual revenue.
But, unbeknownst to many, in this county known for its pristine golf courses, $14 million dollar spa facilities, and luxury resort accommodations, the new face of American residential segregation lives.
Moore County ranks among the wealthiest counties in the state, but many of its residents have been shut out of its new-found prosperity and isolated from the area's more affluent communities.
These enclaves, which tend to be overwhelmingly African American and poor, house residents who live their day-to-day lives without the most basic services, including trash collection, sewer systems, street lights, and, in some cases, running water.
According to a 2006 report released by the University of North Carolina (UNC) Center for Civil Rights, these conditions are created by a process called "municipal underbounding."
This modern form of residential segregation occurs when cities and towns expand around communities of color without including them in the municipal boundaries where city services are provided, thus denying these communities basic municipal resources.
According to the study, this new trend is not unique to Moore County, and although most prevalent in rural, Southern communities, it is a nationwide phenomenon. Latino residents in Modesto, California, for instance, have experienced similar exclusion.
In the case of Moore County, five minority enclaves in particular – Jackson Hamlet, Waynor Road, Midway, Monroe Town, and Lost City – have been left behind, in some instances bordered on every side by more affluent communities that receive the municipal services their poorer neighbors have been denied.
UNC researchers discovered sewage and water lines, which, while running only feet from residents' homes, passed through their communities without servicing them, on their way to neighboring developments.
Under North Carolina law, local governments may designate neighborhoods as what are called "exterritorial jurisdiction zones," allowing them to run sewage lines, for example, through neighborhoods for the sole purpose of servicing communities on the other side.
Jackson Hamlet resident Carol Henry told researchers: "We're sitting right in the middle of everything and nobody wants to claim us. Sometimes it feels like we don't even exist."
As a result, researchers discovered, residents of excluded communities are particularly vulnerable to short and long-term public health hazards. Unable to afford private trash collection, many residents are forced to burn their trash, a major threat to respiratory health. Residents are also at high risk of being exposed to water-born diseases, as routine septic tank failures lead to the leaking of raw sewage into private wells that residents must rely on for drinking water.
"We have our own cesspools, which is not easy, because water doesn't sink in like it used to," said Jackson Hamlet resident Ida Mae Murchinson in the report, "We definitely need sewers."
In addition to serious health and safety concerns, the UNC study said that underbounding has had severe economic consequences that have widened the region's economic divide, sometimes along racial lines.
According to the study, Jackson Hamlet, which is 95 percent African American, has a poverty rate of 43 percent and a medium family income of $25,625 per year, compared to neighboring Pinehurst, whose poverty and African American residency rate are both about three percent with a medium family income of $67,353.
These gaps, however, show little hope of narrowing, as minority enclaves are left with little recourse. Researchers and residents alike are quick to note the difficulty of pressuring public officials into extending municipal services to these communities, as their residents cannot vote in municipal elections, despite being subject to town land use and zoning regulations.
"We can't do nothing standing on the outside... hollering, nobody hearing our voice," said Midway resident Steve Utley in the report. "Everybody outside has a voice, but inside the little circle, no voice. Just making noise and saying nothing."
Source: civilrights.org

Monday, 30 July 2007

Currently Listening
KANYE WEST - CAN'T TELL ME NOTHING (MIXTAPE)
Us Placers
see related
My First Post

In the Literature
Many studies have documented that minority patients receive lower-quality health care than non-minority patients at the same medical facilities. Relatively few, however, have attempted to explain the source of racial and ethnic disparities in care. Are observed disparities due to racial discrimination or bias? Do they result from a lack of cultural understanding on the part of health care providers? Or do minority patients receive care from lower-quality providers? According to a study supported by The Commonwealth Fund, disparities are largely the result of differences in where minority and non-minority patients seek health care.
In "Disparities in Health Care Are Driven by Where Minority Patients Seek Care" (Archives of Internal Medicine, June 25, 2007), a research team including Romana Hasnain-Wynia, Ph.D., of the Health Research and Educational Trust, Joel Weissman, Ph.D., of Harvard Medical School, and Fund senior program officer Anne Beal, M.D., M.P.H., examined quality-of-care data reported by U.S. hospitals participating in the Hospital Quality Alliance, a public–private collaboration formed to measure and publicly report on the quality of hospital care. The researchers found minority patients receive lower quality care, especially counseling services, and that lower-performing hospitals tend to serve a larger proportion of minority patients. "An underlying cause of disparities may be that minority patients are more likely to receive care in lower-performing hospitals," the authors write.
Who You Are, or Where You Seek Care?
The study looked at the quality of care received by 320,970 patients age 18 and older at 123 teaching hospitals nationwide. Of these, 40 percent were minority patients. The Hospital Quality Alliance measures included recommended treatments (e.g., providing aspirin, beta blockers, or antibiotic therapy) for three clinical conditions: acute myocardial infarction, congestive heart failure, and community-acquired pneumonia, as well as patient counseling. The study divided the hospitals into top-performers and low-performers for 13 measures, then determined the percentage of minorities served by each.
The researchers found small but statistically significant disparities for 12 of 13 measures. After adjusting for site of care, the magnitudes of disparities decreased substantially—suggesting, say the authors, that minority patients are more likely to receive care in lower-performing hospitals.
The most pronounced disparities were for counseling services—discharge instructions or smoking cessation counseling—which require time, interaction with patients, and documentation. Noting that these disparities exist even within hospitals, the authors suggest that "communication training may improve the rates of the counseling measures for minority patients." Previous research suggests communication training benefits can be enhanced by considering patients' race, ethnicity, and culture.
The study also found that hospitals that performed less well on the measures tend to serve a higher percentage of minority patients. For example, on the indicator that measured smoking cessation counseling for acute myocardial infarction patients, only 20 percent of patients were minorities in the top-performing hospitals, compared with almost 70 percent of patients in the lower-performing hospitals.
Moving Forward
Low-performing hospitals may be "underresourced" in a number of ways, from a shortage of nurses to inadequate budgets and a lack of health information systems. "Yet these same hospitals may have providers who are hardworking and efficient, providing care with fewer resources to more disadvantaged patients," write the authors. They suggest future research is needed to determine which factors contribute to low performance in hospitals and how performance may be related to disparities in care. "Policy recommendations may need to focus on pay-for-improvement metrics for those underresourced providers caring for the most disadvantaged populations," the authors write, concluding that programs and polices to reduce and potentially eliminate disparities should be informed by research that identifies and targets the underlying causes of lower performance in hospitals.