Gomez-Vidal & Gómez: Unincorporated Community Status as a Determinant of Health
In Invisible and Unequal: Unincorporated Community Status as a Structural Determinant of Health, Cristina Gomez-Vidal and Anu Manchikanti Gómez (both Social Welfare, U.C. Berkley) study an area of the population that has traditionally lacked much formal data-gathering: the unincorporated community (defined as a territory surrounded by a municipal boundary and lacking locally elected government). Using examples ranging from COVID-19 infection rates to access to functioning sewage treatment systems, the authors argue that a lack of political representation in unincorporated communities leaves residents vulnerable to neglect, adverse social conditions, and increased risk for poor health outcomes, particularly in low-income communities of color.
Focusing on public health data-gathering, Gomez-Vidal and Gómez acknowledge that traditional data-gathering has tended to overlook unincorporated spaces because data is collected via census tract and zip code or by comparing rural versus urban spaces–not on communities designated “incorporated” versus “unincorporated.” Such methodology has left an underdeveloped data pool regarding the public health outcomes for inhabitants of unincorporated spaces. Public health research seeks to determine relationships between health outcomes and geo-political factors. Here, the authors claim that the geo-political factor of municipal incorporation status operates as a structural determinant of health outcomes.
The authors contend that “local government is an established determinant of health.” They point to the disparity between what municipalities can and counties cannot provide their residents. Inherent to its limited revenue-generating and administrative powers, a county expressly does not provide the same qualitative level of identified social health factors. Those factors discussed are housing mobility, service delivery, protection from undesirable land use, and civic participation. In contrast, and because they are incorporated, municipalities are much better equipped to provide those factors to their residents. The result is visible in water and sanitation services. While residents of municipalities experience cohesive municipal-provided water and sewage service, unincorporated communities often rely on self-help water or septic systems that break down and have to be substituted with bottled water.
The practical reality of municipal versus unincorporated space, as put forth by the authors, is that the lack of incorporation directly impacts lived health outcomes. By making visible a group of overlooked sufferers who exist, despite not being structurally recognized, Gomez-Vidal and Gómez’s article is a demand for justice for residents of unincorporated spaces.
This digest was written by Lauren Olsen, a 2023 graduate from the University of Nebraska College of Law. This digest was prepared as part of Professor Jessica Shoemaker's Rural Lands Seminar.
