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Mixed Messages: Billboards, other communications encountered in neighborhoods linked to racial inequalities in health

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In the early 1990s, community activists in Chicago, New York and other cities undertook “billboard beautification projects” in which they whitewashed billboards advertising alcohol and tobacco products in African American and minority neighborhoods.

The tactics led to arrests, and ultimately to change. Chicago and Baltimore were among the first cities to ban cigarette and alcohol billboards in residential neighborhoods. Eventually, the Tobacco Settlement Agreement banned all billboard and transit advertising of tobacco products.

Chiquita Collins
Dr. Chiquita Collins
Assistant Professor
Department of Sociology

Billboards, however, can still be found in much larger concentration in poor and minority neighborhoods than in white neighborhoods. And they are a long way from promoting health in those areas.

Given that a significant gap between the health of African Americans and whites has existed for 50 years and has not significantly improved, this may be of critical importance.

“The media make a profound impact on the ways that people engage in certain behaviors,” says Dr. Chiquita Collins, assistant professor in the Department of Sociology. “We’re trying to understand what type of imagery people encounter as it relates to health in those neighborhoods. We can speculate, but now we’re collecting empirical data to substantiate it.”

Collins is working with Dr. Jerome Williams, the F.J. Heyne Centennial Professor in Communication in the Department of Advertising, to examine and map the billboards and outdoor advertising in Austin and Travis County. It’s a local approach to a national issue, an approach shared with researchers in Los Angeles, Fresno, Calif., Philadelphia and Sacramento.

The project captures not just the location and content of billboards, but also of other printed materials, including bus bench advertisements, convenience and supermarket store displays, sandwich boards and one-sheet posters. When examining these with a focus on food, beverage and physical activity, initial findings are in line with what researchers suspected.

“We find more alcohol advertising and very little promotion of physical activity or healthy products in areas with large black or Latino populations,” Collins says. “You don’t find the magnitude of billboards in predominantly white areas.

We find more alcohol advertising and very little promotion of physical activity or healthy products in areas with large black or Latino populations. Dr. Chiquita Collins“We don’t find any type of proactive health messages in black neighborhoods.”

And yet African Americans are dying of heart disease, stroke, cancer, diabetes and kidney disease at higher rates than whites. Infant mortality rates for African Americans are nearly triple that of whites. In Texas, seven out of 10 African Americans are overweight or obese, a cause of many health problems. Health disparities are an issue African American communities cannot ignore.

Is the answer to spray paint the billboards? Not this time. Collins and Williams intend to understand the issue at a more detailed level than ever before.

In addition to identifying the billboards and signage in the area, they are also identifying all of the quick serve (fast food) restaurants. They are working with area grocery stores to use their scanner data technology to determine what people buy, at the neighborhood level and at the household level. They hope to be able to even determine what television programs they’re watching.

“We have a unique opportunity to really get at health issues in a neighborhood context,” Collins says. “We’re using a geographic information system to map where billboards are located, where quick service restaurants are located, where grocery stores are located. We’re finding a cluster with a large concentration of billboards and quick service restaurants in predominantly Latino or African American neighborhoods.

“So it’s quicker to find a Church’s Chicken in east Austin than an ATM machine.”

Facts like this may be fundamental to health disparities, Collins believes, and this has been the focus of her work her entire career. When it comes to your health, where you live matters.

Racial Inequalities in Health

For the 15 leading causes of death in the United States in 1999, African Americans had higher death rates than whites for:
  • Heart Disease
  • Cancer
  • Stroke
  • Accidents
  • Diabetes
  • Flu and Pneumonia
  • Kidney Disease
  • Septicemia
  • Cirrhosis of the Liver
  • Hypertension
  • Homicide

“Most people have the preconceived notion that people choose where they want to live,” says Collins. “However, there are some structures that have been systematically implemented and tactics that have been practiced to dissuade certain segments of our population from residing in certain areas.

“African Americans are the most segregated population in America today, and that holds true even looking at recent statistics.”

Although the Civil Rights Act of 1968 made discrimination in the sale and rental of property illegal, geographic segregation remains a fact of American life. The 2000 census identified 57 metropolitan areas with levels of segregation characterized as extremely high.

“In my previous research, I found that blacks who live in highly segregated cities have higher rates of mortality on a significant number of measures than blacks in less segregated cities,” Collins says.

Racial segregation shapes the socioeconomic conditions for blacks not only at the individual and household levels, but also at the neighborhood and community levels. At all levels, it affects health.

Poor and minority neighborhoods are less likely to have access to health care facilities like hospitals, clinics and pharmacies. They are less likely to have parks and recreation facilities for community use and exercise. And eating well in the neighborhoods may be more challenging than elsewhere.

“We tell people to adhere to a good diet,” Collins says. “But if I want to do that, how possible is that for me if there isn’t a supermarket in my neighborhood and I have to travel long distances, which is challenging to my restricted budget?

Of all the forms of inequality, injustice in health care is the most shocking and inhumane. Dr. Martin Luther King Jr.“Some studies have shown that stores in predominantly black neighborhoods carry food that is lower in quality and higher in price than in stores in other neighborhoods.”

Eliminating inequalities in health, then, is not simply a matter of biology. It is a matter of environment. And part of improving the environment is eliminating barriers to adopting healthy lifestyles. This includes a clear understanding of the advertising and messaging that people encounter in their neighborhoods.

“We have to be sure we’re looking at the underlying factors and reasons behind the choices people make,” Collins says. “We can’t talk about behavior as if behavior occurs out of thin air.”

Collins and Williams will be talking about their work in April at the 20th annual Heman Sweatt Symposium. Named for the first African American to attend The University of Texas at Austin School of Law, the symposium will focus this year on health care disparities. Attendees will participate in a week-long discussion of the health care system, access to health care, communication and health care issues as they relate to the minority community.

What the symposium and Collins and Williams recognize is that the issue of health disparities is not simply an issue of health. It’s an issue of civil rights as well.

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  Updated 3 April 2006
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