Written by Melody Goodman, PhD, assistant professor at the Washington University School of Medicine
“White fear has manifested itself in outright violence post-slavery through the imposition of Jim Crow segregation. White fear has manifested itself legislatively via redlining laws and cruel lending practices barring blacks from owning property in ‘white neighborhoods.’ White fear has manifested itself in so many structural ways that it has become part and parcel with the fundamental functions of every private and governmental institution in this country … White fear is killing us … It is criminalizing black bodies. It is incarcerating black identities. It is limiting black potential … And, it is shooting black boys in the streets of their own neighborhoods. White fear is the single greatest cause of death for black people today and has been so since this country’s inception” (1).
Where you live, work, play, and pray has broad implications for your health because of the social (e.g., education, income, housing) and environmental (e.g., built, social, physical) determinants of health. Despite major advances in medical technology, given what we currently know scientifically, your zip code predicts health outcomes better than your genetic code. This is especially true in hyper-segregated metropolitan areas such as St. Louis with stark color lines. Stark differences in communities separated by one street is not unique to St. Louis (e.g., 8 mile road in Detroit) but these dividing lines can create fear of the unknown or the other side, fostering an “us” and “them” mentality, where we believe “they” are different from “us”. However, race is a man-made social construct as there is more genetic variability within races than there is between races.
Among the 50 metro areas with the largest black populations in 2010, St. Louis ranked 9th most segregated. The 2010 Black-White Index of Dissimilarity for the St. Louis metropolitan area is 71; a decrease from 81 in 1980 and 93 in 1940 (2,3). The dissimilarity index is measure of segregation that captures the extent of spatial unevenness between two racial groups. Ranging from 0 (complete integration) to 100 (complete segregation) (4); as a frame of reference South Africa under apartheid had an index of dissimilarity of 92. The dissimilarity index can be interpreted as the proportion of Black residents who would have to move into predominately White neighborhoods to create an evenly distributed population; values greater than 60 indicate very high levels of segregation. Despite decades of desegregation at a deliberate pace St. Louis remains a hyper-segregated metropolitan area, one in which the majority (over 70%) of Black residents would have to move into predominately White communities to have complete integration.
Residential segregation continues to be the lynchpin that maintains structural inequality in the United States (5). Here, segregation is more than just the physical isolation of people, it is isolation from opportunity and opportunity structures. These opportunities include neighborhood amenities that have been shown to affect health outcomes (6–9). Neighborhoods that are perceived as safe and have infrastructure that promote physical activity (parks, sidewalks, green space) and healthy diet (lower concentration of fast food restaurants, access to supermarkets with fresh fruits and vegetables) provide a healthy built environment (10–13).
When the community you live in lacks healthy lifestyle amenities there is often a desire to take advantage of the amenities in neighboring communities. However, some communities let you know that outsiders are not welcome. Some have gates, some use cinder blocks in the middle of the street, and others just have that air (no gates or other barriers are needed for you to know you are not welcome here). When neighborhoods show such bifurcation by race, common understandings about who “belongs” in a given space strongly cohere around race. Segregation “reinforces a normative sensibility in settings in which Black people are typically absent, not expected, or marginalized when present;” this is White space (14). White space is expansive covering multiple social settings including neighborhoods, restaurants, schools, parks, universities, workplaces, courthouses and cemeteries (14).
White fear has been used to drive and maintain segregation in this country. This has led to the creation and protection of “White spaces” based on a longstanding history of residential segregation, systematic disinvestment in communities of color, and persistent White flight from cities (15,16). White spaces are places where Whites can feel safe because Blacks (or other non-Whites) are excluded. Whiteness is the primary inclusion criteria required for entry into White spaces. Access to White spaces comes with so much privilege that many immigrants to this country (e.g., Irish, Polish, Italian, Greek, and even some Hispanic groups) give up their ethnicity an classify themselves as White. For some minorities the ability to pass for White (Passe Blanc as they say in New Orleans) allows them to live as White because race in American has more to do with perception than reality.
For many African Americans, surveillance is an unfortunate common experience of day-to-day life especially when navigating White spaces. Individuals may become hypervigilant about their appearance and potentially difficult interpersonal interactions: “Do I look too threatening? Like, maybe I shouldn’t wear this, maybe I shouldn’t wear that” (17); “Am I walking so slowly that the cop is going to think I’m loitering? Or, am I walking so fast that he or she will think that I’m running away from the scene of a crime?”(18) Some say education is the great equalizer but even with my PhD, I have to question if I come on to campus at night or over the weekend, will I be stopped by campus police who think I don’t belong here. “While navigating the white space, [Black people] risk a special penalty—their putative transgression is to conduct themselves in ordinary ways in public while being black at the same time.” (14)
While overt racism is no longer acceptable in society, covert racism is a part of everyday life for many African Americans through racial micro-aggressions that take place in interpersonal encounters within White spaces. Substantial research has documented the health effects of personally-mediated racism (19–22), which make day-to-day life in public space stressful and can reduce health-promoting behaviors (23–28). White fear creates White spaces which not only contribute to the disadvantages of Blacks but also to the advantages of Whites creating the differences in social determinants of health that contribute to the Black-White disparities across multiple health outcomes.
1. Jackson JM. White Fear: The Single Greatest Killer of Black People in the US. Water Cool Convos. 2014. Accessed April 19, 2015.
2. Logan JR, Stults B. The Persistence of Segregation in the Metropolis: New Findings from the 2010 Census.; 2011.
3. Massey DS, Denton NA. American Apartheid: Segregation and the Making of the American Underclass. Cambridge: Harvard University Press; 1993.
4. Massey DS, Denton NA. Hypersegregation in U. S. Metropolitan Areas: Black and Hispanic Segregation AlongFive Dimensions. Demography. 1989;26(3):373-391.
5. Bobo L. Keeping the linchpin in place: Testing the multiple sources of opposition to residential integration. Int Rev Soc Psychol. 1989;2(3):305-323.
6. Diez Roux A V. Residential environments and cardiovascular risk. J Urban Health. 2003;80(4):569-589. doi:10.1093/jurban/jtg065.
7. Diez Roux A V, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125-145. doi:10.1111/j.1749-6632.2009.05333.x.
8. Morland K, Wing S, Diez Roux A. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92(11):1761-1767.
9. Goodman MS, Gilbert KL. Segregation: Divided Cities Lead To Differences In Health.; 2013. forthesakeofall.org.
10. Boehmer TK, Hoehner CM, Deshpande AD, Brennan Ramirez LK, Brownson RC. Perceived and observed neighborhood indicators of obesity among urban adults. Int J Obes (Lond). 2007;31(6):968-977. Accessed November 20, 2012.
11. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009;87(1):123-154. Accessed November 3, 2012.
12. Black JL, Macinko J. Neighborhoods and obesity. Nutr Rev. 2008;66(1):2-20. Accessed October 29, 2012.
13. Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005;(3):CD001871. Accessed November 15, 2012.
14. Anderson E. “The White Space.” Sociol Race Ethn. 2015:10-21. doi:10.1177/2332649214561306.
15. Rothstein R. The Making of Ferguson Public Policies at the Root of Its Troubles. Washington DC; 2014.
16. Tighe JR, Ganning JP. The divergent city: unequal and uneven development in St. Louis. Urban Geogr. 2015;00(00):654-673. doi:10.1080/02723638.2015.1014673.
17. Torres KC, Charles CZ. METASTEREOTYPES AND THE BLACK-WHITE DIVIDE: A Qualitative View of Race on an Elite College Campus. Du Bois Rev Soc Sci Res Race. 2004;1(01):115-149. doi:10.1017/S1742058X0404007X.
18. Levins R. Is captilism a disease? The crisis in U.S. public health. Mon Rev. 2000;52(4):8-33.
19. Brondolo E, Ver Halen NB, Pencille M, Beatty D, Contrada RJ. Coping with racism: A selective review of the literature and a theoretical and methodological critique. J Behav Med. 2009;32(1):64-88. doi:10.1007/s10865-008-9193-0.
20. Mays VM, Cochran SD, Barnes NW. Race, Race-Based Discrimination, and Health Outcomes Among African Americans. Annu Rev Psychol. 2007;58:201-225. doi:10.1055/s-0029-1237430.Imprinting.
21. Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35(4):888-901. doi:10.1093/ije/dyl056.
22. Richman LS, Kohn-Wood LP, Williams DR. The Role of Discrimination and Racial Identity for Mental Health Service Utilization. J Soc Clin Psychol. 2007;26(8):960-981.
23. Smedley BD. The lived experience of race and its health consequences. Am J Public Health. 2012;102(5):933-935. doi:10.2105/AJPH.2011.300643.
24. Smedley BD, Stith AY. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academy Press; 2003.
25. Krieger N. Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: An ecosocial perspective. Am J Public Health. 2003;93(2):194-199. doi:10.2105/AJPH.98.Supplement_1.S20.
26. Krieger N. Methods for the scientific study of discrimination and health: An ecosocial approach. Am J Public Health. 2012;102(5):936-945. doi:10.2105/AJPH.2011.300544.
27. Krieger N. Police Killings, Political Impunity, Racism and the People’s Health: Issues for Our Times. Harvard Public Heal Rev. 2015;3:2-4.
28. Kwate NOA, Goodman MS. An empirical analysis of White privilege, social position and health. Soc Sci Med. 2014;116:150-160. doi:10.1016/j.socscimed.2014.05.041.