Invited commentary: integrating a life-course perspective and social theory to advance research on residential segregation and health

Abstract

Research on racial residential segregation and health typically uses multilevel, population-based, slice-in-time data. Although research using this approach, including that by Kershaw et al. (Am J Epidemiol. 2013;177(4):299-309), has been valuable, I argue that to advance our understanding of how residential segregation influences health and health disparities, it is critical to incorporate a life-course perspective and integrate social theory. Applying a life-course perspective would entail modeling transitions, cumulative risk, and developmental and dynamic processes and mechanisms, as well as recognizing the contingency of contextual effects on different social groups. I discuss the need for analytic methods appropriate for modeling health effects of distal causes experienced across the life course, such as segregation, that operate through multiple levels and sequences of mediators, potentially across decades. Sociological theories of neighborhood attainment (e.g., segmented assimilation, ethnic resurgence, and place stratification theories) can guide effect-modification tests to help illuminate health effects resulting from intersections of residential processes, race/ethnicity, immigration, and other social determinants of health. For example, nativity and immigration history may crucially shape residential processes and exposures, but these have received limited attention in prior segregation-health literature.