br Introduction After World War II population

Introduction After World War II, population growth and rapid urbanization in the U.S. led to dramatic political and geographic changes in urban areas. Scholars have explored how changes in the urban landscape affected economic growth as well as social and racial inequalities (Akai & Sakata, 2002; Bollens, 1986; Oates, 1985; Schneider, 1986; Stansel, 2008; Weiher, 1991). We build on this literature and focus on a relatively unexplored aspect: whether, and to what extent, increasing decentralization of political authority, in the form of governmental fragmentation, corresponds with rising health disparities between whites and African-Americans. Political fragmentation refers to the process of redistributing functions, powers, or people away from a central authority by incorporating autonomous entities such as municipalities and special districts (Judd & Swanstrom, 2009). Decentralization of urban areas by population movement and urban sprawl in the U.S. led to a proliferation of local jurisdictions that established autonomous entities such as municipalities (Judd & Swanstrom, 2009; Morgan & Mareschal, 1999). Along with local governments, smaller jurisdictional boundaries resulting from fragmented governance allow residents to make locational decisions, considering the quality of schools, crime rates, racial composition and other public services (Weiher, 1991). Empirical studies report that political fragmentation accelerates spatial income and racial segregation (Bischoff, 2008; Miller, 1981; Morgan & Mareschal, 1999). Hutson, Kaplan, Ranjit, and Mujahid (2012) used a cross-sectional analysis to examine the relation between fragmented governments and health disparities for large metropolitan statistical areas (MSA). The Authors examined data in the late 1990s and report that the number of local governments varies positively with a disparity between white and African-American mortality. Their study provides a “proof of concept” of an association between political fragmentation and health disparities. However, Hutson and colleagues employed a fragmentation metric only for one time leukotriene receptor antagonist in 1997. The pace of political fragmentation occurred rapidly in the 1970s and 1980s but significantly slowed in the 1990s. Such differences indicate that we cannot know the external validity of Hutson and colleagues\' findings in understanding the health implications of urban landscapes that evolve over time. In addition, MSAs do not define legal or administrative municipal boundaries; rather, they define economically and socially integrated areas. Given that many local agencies are established primarily at the county level, Hutson and colleagues\' choice of MSA as the unit of analysis may obscure meaningful county variation in political fragmentation that occurs within an MSA.
“White flight” and political fragmentation In the 1960s and 1970s, metropolitan areas witnessed drastic growth in outer areas. The middle class moved from inner cities to suburban areas. Such urban sprawl and central city decline contributed to an outward movement of the economic base and employment opportunities (Jargowsky, 2002). This economic and demographic shift precipitated inequality between urban and suburban jurisdictions in access to public services, health care, affordable housing, education, infrastructure and job opportunities (Hutson et al., 2012). In addition, federal policies accelerated these inequalities by providing fewer opportunities for ethnic minorities. The Federal Housing Administration (FHA), the Veterans Administration (VA), and the Federal-Aid Highway Act helped affluent whites relocate to the suburbs and encouraged racial segregation (Cashin, 2010; Jackson, 1985; Judd & Swanstrom, 2009). Coupled with urban sprawl, political fragmentation exerted a considerable impact on racial segregation. Newly incorporated government entities allowed middle class communities to segregate from the ethnic minorities or the less affluent, adopted zoning and planning restrictions, and provided tailored public goods and services for residents in that local jurisdiction (Bischoff, 2008; Hart, Kunitz, Sell & Mukamel, 1998). Researchers contend that this process of segregation promotes health disparities through several pathways, including through poverty concentration, insufficient housing, high unemployment rates, and low incomes (Acevedo-Garcia & Lochner, 2003; Hart et al., 1998; Jargowsky, 1997; La Veist, 1989; Massey & Denton 1993; Polednak, 1996; Wilson, 1996).