The social determinants of health: Race, resources, and neighborhoods in the Detroit tri-county area

Using data from the 1995 Detroit Area Study (N = 1,106) I develop and test several hypotheses regarding the social determinants of physical health. My inquiry utilizes several operationalizations of physical health and emphasizes two distinct but strongly related phenomena within social epidemiology: (1) race-specific morbidity differentials; and (2) neighborhood effects on individuals' physical health. Findings suggest that external appraisals and experiences with discriminatory behaviors significantly mediate the increased risk among non-Hispanic black respondents to be health pessimists (e.g., report worse self-rated health than their objective health levels would suggest). In addition, increased exposure to stressful life events and chronic stressors significantly mediate the observed neighborhood effect on physical health. Neighborhood stability is found to moderate the relationship between stress and physical health; residence in a stable residential community is found to reduce the negative impact of stress on individual's health. I conclude with suggestions for future research in this area and policy recommendations based on these findings.