Designing a syndemic risk environment: racial containment and health in historical context.

This chapter describes the creation and reproduction of Washington D.C’s syndemic risk environment. I examine how it became a space creating disproportionate vulnerability to syndemic disease (multiple, overlapping and interacting epidemics) among African Americans in particular in the early years of the city’s founding. I then examine how this environment was reproduced and/or reconstituted in subsequent historical periods. I focus on a key mechanism through which racial health disparities between White and Black Americans were produced: racial containment. Specifically, I show how the city’s health crises were built into and institutionalized in the making and remaking of Washington D.C through three different eras and strategies of racial containment – tertiary and secondary segregation (1790-1900), primary segregation (1900-1970), and the Chocolate City/Vanilla Suburbs (1970-2010). As I will illustrate, the containment of Blacks, and especially poor Blacks, in particular spaces in the city, was in effect also containing them in spaces where they were then subject to disproportionate illness and premature death. I also examine the role of intra-racial dynamics in contributing to these trends – in living arrangements and livelihoods, in health outcomes, where data is available, and in the enactment of policies contributing to racial health disparities. Overall, I show the persistent and direct connections between where Blacks lived and their health outcomes and show how the mechanism of racial containment perpetuated racial health inequality across generations.