Environmental injustice: health and inequality in mobile county, Alabama

Abstract

This research set out to better understand the impact of socioeconomic characteristics, environmental risk, and the built environment on health in Mobile County, Alabama. A multilevel statistical analysis was used to identify those characteristics that had the greatest impact on health. The variables determined to be the most significant in defining health in Mobile County were used in the development of a health inequity index (HIQ). The index was used to identify the zip code tabulation areas (ZCTAs) in Mobile County that were likely to exhibit greater health inequality, and as a result, a higher potential for health inequity. In this study, a mailed survey on the built environment and health was conducted to gain a better understanding of the characteristics of individual residences, perceptions of individuals in regards to neighborhood health, citizen activism, and the environmental justice movement. Because there was a low response rate for the mailed surveys, fieldwork with face-to-face interviews was conducted in July, 2009. In conjunction with the survey data, mortality data obtained from the Alabama Department of Public Health was incorporated into the multilevel analysis. Using crude death rate, cause-specific death rate for cancer, and cause-specific death rate for heart disease as dependent variables and factors associated with socioeconomic status, environmental risk, and the built environment as independent variables, multiple linear regression was performed. The results of the multiple linear regression identified factors of socioeconomic status, environmental risk, and the built environment that had the greatest impact on health in Mobile County. Geographically weighted regression was performed to test local model strength by ZCTA in Mobile County. It was determined that the health inequity index developed as a result of the multilevel analysis was a reasonable measure of population health. Calculations of HIQ for each ZCTA in Mobile County helped to identify those ZCTAs most in need of intervention. The ZCTAs with high HIQ values were also those where the built environment was extremely poor, indicating that health is impacted by the places where people live.