Health equity study compares segregation, low birth weight in Chicago, Toronto

"Toronto has broken the link between segregation and low birth weight. It sets up an example of what can be accomplished when health equity is a priority," said lead researcher Fernando De Maio, co-director of the center and an associate professor of sociology at DePaul. The researchers chose two cities with very different health care systems and histories of disadvantage "to show how the relationships between social determinants of health and low birth weight can vary from place to place."

The study, "Racial/ethnic minority segregation and low birth weight: a comparative study of Chicago and Toronto community-level indicators," will be published in a forthcoming issue of Critical Public Health.

Co-authors from the Center for Community Health Equity include center co-director Dr. Raj C. Shah, associate professor in the Department of Family Medicine and the Rush Alzheimer's Disease Center and Dr. David Ansell, senior vice president for community health equity of Rush University Medical Center; and Kellie Schipper and Realino Gurdiel of DePaul University. Researchers found:

• The problem of low birth weight was worse overall in Chicago. The average community proportion of low birth weight deliveries in Chicago is 10.1, while in Toronto it is 7.3

• In Toronto, the rates of low birth weight did not vary significantly across communities. Places where most residents are minorities had rates of low birth weight that were similar to areas with low minority populations. Other social determinants of health, including unemployment and low educational attainment, were not associated with rates of low birth weight in Toronto.

• Segregation is more pronounced in Chicago, with more areas that have a high percentage of a single racial or ethnic population. As De Maio described: "The more segregated a community is in Chicago, the worse the outcome for low birth weight."

• Communities in Chicago with highly segregated African-American populations fared the worst, while many segregated Latino communities "did fine" and had rates that were in-line with the rest of the city, De Maio explained.

Researchers compared publicly available community health data from Chicago and Toronto to examine low birth weight within specific neighborhoods and communities. This uncommon approach allowed researchers to "keep the differences between neighborhoods present, while comparing across cities," explained De Maio.

While the study does not reveal the causes of low birth weight in either city, De Maio believes it can be a starting point in examining "structural determinants of health" such as access to health care and systemic segregation and racism. "There's a shift now in the literature, and researchers increasingly recognize it's not the color of a person's skin, but the social process of racism that can influence health outcomes," said De Maio.

As next steps, researchers plan to compare data from other cities to find if Chicago is an extreme example or if similar trends exist elsewhere in the U.S. "This research shows it doesn't have to be the way that it is, and we can break the link between factors like segregation and poor health outcomes," said De Maio. "It doesn't show us how to do it just yet, but it shows us it's possible."