University of California at Berkeley, Berkeley, CA 94720, USA.
Milbank Q. 2012 Mar;90(1):187-207. doi: 10.1111/j.1468-0009.2011.00659.x.
This article explores the relationship between metropolitan fragmentation, as defined by the total number of governmental units within a metropolitan statistical area (local municipalities, special service districts, and school districts), and racial disparities in mortality among blacks and whites in the 1990s. The presence of numerous governmental jurisdictions in large metropolitan areas in the United States can shape the geography of opportunity, with adverse consequences for health.
We conducted a regression analysis using U.S. Census of Government data and Compressed Mortality File data for the country's largest 171 metropolitan statistical areas.
We found a link between increased metropolitan area fragmentation and greater racial differences in mortality between blacks and whites for both children and working-age adults. Although increasing fragmentation is associated with a higher mortality rate for blacks, it is not associated with a higher mortality rate for whites. These findings suggest that research is needed to understand how governance can positively or negatively influence a population's health and create conditions that generate or exacerbate health disparities.
We need to understand the extent to which metropolitan fragmentation contributes to racial segregation, whether racism contributes to both, and the role of poverty and antipoverty policies in reducing or exacerbating the consequences of metropolitan fragmentation. The exact pathways by which metropolitan fragmentation contributes to differences between blacks' and whites' mortality rates are unknown. Uncovering how institutions influence the social, economic, and environmental conditions, which in turn contribute to the current racial and ethnic health disparities in the largest metropolitan areas, is key. Understanding these "upstream" determinants of a population's health and the disparities in health between subgroups in the overall population must be at the core of any attempt to reduce disparities in health. Building bridges between urban planning and public health can be critical to these efforts.
本文探讨了都市碎片化（以大都市统计区（地方自治市、特殊服务区和学区）内政府单位总数来定义）与 20 世纪 90 年代黑人和白人之间死亡率差异的关系。美国大型都市地区存在众多政府管辖范围，这可能会影响机会的分布，对健康产生不利影响。
我们使用美国政府普查数据和全国最大的 171 个大都市统计区的压缩死亡率文件数据进行回归分析。
我们发现，大都市地区碎片化程度的增加与黑人和白人之间死亡率的种族差异之间存在联系，无论是儿童还是劳动年龄成年人。尽管碎片化程度的增加与黑人的死亡率较高有关，但与白人的死亡率较高无关。这些发现表明，需要研究治理如何积极或消极地影响人口健康，并创造产生或加剧健康差异的条件。
我们需要了解大都市碎片化在多大程度上导致了种族隔离，种族主义是否同时导致了这两个问题，以及贫困和扶贫政策在减少或加剧大都市碎片化后果方面的作用。大都市碎片化导致黑人和白人死亡率差异的具体途径尚不清楚。揭示机构如何影响社会、经济和环境条件，进而导致最大都市地区当前的种族和族裔健康差异，是关键。了解人口健康的“上游”决定因素以及总人口中不同亚组之间的健康差异，必须成为减少健康差异努力的核心。在城市规划和公共卫生之间建立桥梁对于这些努力可能至关重要。
