In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

In the 1960s, many believed that the civil rights movement’s successes would foster a new era of racial equality in America. Four decades later, the degree of racial inequality has barely changed. To understand what went wrong, Patrick Sharkey argues that we have to understand what has happened to African American communities over the last several decades. In Stuck in Place, Sharkey describes how political decisions and social policies have led to severe disinvestment from black neighborhoods, persistent segregation, declining economic opportunities, and a growing link between African American communities and the criminal justice system. As a result, neighborhood inequality that existed in the 1970s has been passed down to the current generation of African Americans. Some of the most persistent forms of racial inequality, such as gaps in income and test scores, can only be explained by considering the neighborhoods in which black and white families have lived over multiple generations. This multigenerational nature of neighborhood inequality also means that a new kind of urban policy is necessary for our nation’s cities. Sharkey argues for urban policies that have the potential to create transformative and sustained changes in urban communities and the families that live within them, and he outlines a durable urban policy agenda to move in that direction.

Over the last thirty years, the prison population in the United States has increased more than seven-fold to over two million people, including vastly disproportionate numbers of minorities and people with little education. For some racial and educational groups, incarceration has become a depressingly regular experience, and prison culture and influence pervade their communities. Almost 60 percent of black male high school drop-outs in their early thirties have spent time in prison. In Punishment and Inequality in America, sociologist Bruce Western explores the recent era of mass incarceration and the serious social and economic consequences it has wrought. Punishment and Inequality in America dispels many of the myths about the relationships among crime, imprisonment, and inequality. While many people support the increase in incarceration because of recent reductions in crime, Western shows that the decrease in crime rates in the 1990s was mostly fueled by growth in city police forces and the pacification of the drug trade. Getting "tough on crime" with longer sentences only explains about 10 percent of the fall in crime, but has come at a significant cost. Punishment and Inequality in America reveals a strong relationship between incarceration and severely dampened economic prospects for former inmates. Western finds that because of their involvement in the penal system, young black men hardly benefited from the economic boom of the 1990s. Those who spent time in prison had much lower wages and employment rates than did similar men without criminal records. The losses from mass incarceration spread to the social sphere as well, leaving one out of ten young black children with a father behind bars by the end of the 1990s, thereby helping perpetuate the damaging cycle of broken families, poverty, and crime. The recent explosion of imprisonment is exacting heavy costs on American society and exacerbating inequality. Whereas college or the military were once the formative institutions in young men's lives, prison has increasingly usurped that role in many communities. Punishment and Inequality in America profiles how the growth in incarceration came about and the toll it is taking on the social and economic fabric of many American communities.

What happens to black health care professionals in the new economy, where work is insecure and organizational resources are scarce? In Flatlining, Adia Harvey Wingfield exposes how hospitals, clinics, and other institutions participate in “racial outsourcing,” relying heavily on black doctors, nurses, technicians, and physician assistants to do “equity work”—extra labor that makes organizations and their services more accessible to communities of color. Wingfield argues that as these organizations become more profit driven, they come to depend on black health care professionals to perform equity work to serve increasingly diverse constituencies. Yet black workers often do this labor without recognition, compensation, or support. Operating at the intersection of work, race, gender, and class, Wingfield makes plain the challenges that black employees must overcome and reveals the complicated issues of inequality in today’s workplaces and communities.

Local governments play a central role in American democracy, providing essential services such as policing, water, and sanitation. Moreover, Americans express great confidence in their municipal governments. But is this confidence warranted? Using big data and a representative sample of American communities, this book provides the first systematic examination of racial and class inequalities in local politics. We find that non-whites and less-affluent residents are consistent losers in local democracy. Residents of color and those with lower incomes receive less representation from local elected officials than do whites and the affluent. Additionally, they are much less likely than privileged community members to have their preferences reflected in local government policy. Contrary to the popular assumption that governments that are “closest” govern best, we find that inequalities in representation are most severe in suburbs and small towns. Typical reforms do not seem to improve the situation, and we recommend new approaches.

Segregation by Design draws on more than 100 years of quantitative and qualitative data from thousands of American cities to explore how local governments generate race and class segregation. Starting in the early twentieth century, cities have used their power of land use control to determine the location and availability of housing, amenities (such as parks), and negative land uses (such as garbage dumps). The result has been segregation - first within cities and more recently between them. Documenting changing patterns of segregation and their political mechanisms, Trounstine argues that city governments have pursued these policies to enhance the wealth and resources of white property owners at the expense of people of color and the poor. Contrary to leading theories of urban politics, local democracy has not functioned to represent all residents. The result is unequal access to fundamental local services - from schools, to safe neighborhoods, to clean water.

An exploration of how and why American city governments delegated the responsibility for solving urban inequality to the nonprofit sector. American cities are rife with nonprofit organizations that provide services ranging from arts to parks, and health to housing. These organizations have become so ubiquitous, it can be difficult to envision a time when they were fewer, smaller, and more limited in their roles. Turning back the clock, however, uncovers both an eye-opening story of how the nonprofit sector became such a dominant force in American society, as well as a troubling one of why this growth occurred alongside persistent poverty and widening inequality. Claire Dunning's book connects these two stories in histories of race, democracy, and capitalism, revealing an underexplored transformation in urban governance: how the federal government funded and deputized nonprofits to help individuals in need, and in so doing avoided addressing the structural inequities that necessitated such action in the first place. ​Nonprofit Neighborhoods begins in the decades after World War II, when a mix of suburbanization, segregation, and deindustrialization spelled disaster for urban areas and inaugurated a new era of policymaking that aimed to solve public problems with private solutions. From deep archival research, Dunning introduces readers to the activists, corporate executives, and politicians who advocated addressing poverty and racial exclusion through local organizations, while also raising provocative questions about the politics and possibilities of social change. The lessons of Nonprofit Neighborhoods exceed the municipal bounds of Boston, where much of the story unfolds, providing a timely history of the shift from urban crisis to urban renaissance for anyone concerned about American inequality--past, present, or future.