Date of Award

January 2020

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Katie Wang


Stigma persists through systematic exclusion of black persons from mobility and resources in society (i.e., structural racism). Residential segregation, like other forms of structural racism, may impair health by hindering access to important resources such as housing, food, health insurance coverage, and governmental benefits. Recent literature has proposed that stigma be considered a fundamental cause of population health inequalities.

We examined the relation between county-level residential segregation dissimilarity indices and various social determinants of health outcomes within Indiana using generalized estimating equation (GEE) modeling. Primary outcomes included housing instability, food insecurity, health insurance status, and enrollment in governmental assistance programs (i.e., Medicaid and SNAP). We used social determinants of health data provided by the Indiana Department of Health collected by Indiana 2-1-1 and residential segregation dissimilarity indices calculated by the University of Wisconsin Population Health Institute.

The GEE models, adjusted for county based on the assumption that subject responses within the same county are correlated, regressed SDOH outcomes against segregation indices. In the adjusted models, we controlled for race and income level. Interactions between residential segregation and race were tested. Residential segregation was significantly associated with housing instability (OR = 1.2916, 95%CI (1.0877, 1.5338), p = 0.0035), food insecurity (OR = 1.1294, 95%CI (1.0292, 1.2394), p=0.0103), and SNAP benefits (OR = 1.1640, 95%CI (1.0559, 1.2831), p = 0.0023). Residential segregation was not significantly associated with health insurance status or Medicaid enrollment.

Structural racism is a fundamental cause of some social determinants of health inequalities. People living in counties with higher residential segregation were found to have significantly higher odds of being food insecure, housing insecure, and receiving SNAP benefits. Insurance status and type were not found to be significant outcomes. State and federal governmental programs and policy changes, paired with anti-stigma campaigns, can be implemented to decrease structural racism and subsequently racial health inequities.


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