Tag Archives: 2010 Census

More Better Mapping of Oakland’s Populations

OAKLAND

Maps have long been described or conceived as windows–analogous in ways to pictorial perspective–that invite viewers to look into a space in new ways.  But both word maps as the above, made of the names of Oakland’s almost 150 different neighborhoods, or more statistically derived data visualizations of the city are mirrors that present a less homogeneous or continuous image of the city that we want to see:  if the roughly type-set image above suggest a make-do approach of the somewhat scruffy post-industrial port city with big loading docks, but erase its dirt or drastically depressed areas with lively type.

Data visualizations offer mirrors of the city’s inhabitants and shifting neighborhoods that are both dependent on the source-data that they use, and how they obtained it, but also on the dynamic layers that digital mapping allows us to place as overlays on the base-map of the city’s mountains and shores.  While these maps are only as good as the data that they use, they reflect back some of the divisions in the city that we might not otherwise notice or want to see.

And while not based in prose in the same manner as the Ozan Berke’s word-map that nicely knit together the city’s 146 vastly different neighborhoods, they offer ways of reading the city’s multiple divides.  The increased data that is available from Open Oakland and other sources will doubtless offer further–and far more refined–images of the city’s deep differences and their bridging, and can serve as better and more detailed maps of its populations.  But in the meantime, the sorts of mirrors these maps offer can also provide ways to imagine paths toward a future for Oakland, and better understand ways forward in its public policies.  Many of them draw from the American Community Survey, created by the US Census and discussed in earlier posts, but all seek to focus attention on the city and to serve, as mirrors, to show differently refracted visions of its divides, in the hope that few distort Oakland’s diverse populations.

A famous image of the distinctly uneven distributions of Oakland’s inhabitants is clear in a recent mashup of maps of the Bay Area Rapid Transit system’s public transport map–or, more simply, BART map–with the very zip codes that the American Community Survey mapped, which offers a condensation of the remarkable disparities and differences between income, education, child health and life expectancy at separate stations on the same public transport lines:

BART Health Map:Life Expectancy at BART stops

While, to be sure, the system includes suburbs such as Walnut Creek or Fremont, its focus on the East Bay  immediately indicates the deep divisions in a city where a BART stop can take one between areas of over ten years difference in life expectancy, and two more stops down either line sees life expectancy rise by seven or eight years once again.  The huge rise in childhood hospitalizations because of asthma in the City Center–far greater than in Fruitvale–suggests the unique pollution habits of a city whose air quality is still shaped by its proximity to a port.

The image of the diverse city whose neighborhoods are bound together as one unit starts to reveal fissures when one examines its ethnic and voting distribution at a somewhat finer grain, adding to the historical variations in the picture of the city summarized and surveyed in an earlier post.  The problem of mapping those populations adequately, both to reveal the ongoing inequalities and spatial injustice within the city, is not inherent in the city’s structure or divisions, but something that compels visualization in a myriad of ways, and in which we can look for different understandings of the shifting nature of the city’s socioeconomic (and sociocultural) divides.  As well as mapping the lay of the land, mapping the habitation of space creates even more of a “mirror” on the organization of th eplace.

Census_Mosaic

The census mosaic only shows part of the inhabitants’ picture.  Indeed, perhaps a “racial dot” map can be rehabilitated, rendering one dot/twenty-five people, to create a rough distribution Bay Area-wide that respects the looser definition of “neighborhoods,” and does not impose strict racial segregation, as in this image by Eric Fischer, using red dots representing whites, blue representing blacks, green representing Asian and orange Latino populations, in trying to prevent  overlapping and blending of color-points,  and better to define neighborhoods as an ethnic or racial enclave:

Racial Map SF--25:dot Eric Fischer

Fischer seeks to respect Bill Rankin’s cautionary words that boundaries of neighborhoods are never so stark as on informational graphics, and that a cartographical index of one dot for twenty-five people is better able to allow “transitions also [to] take place [registered] through gradients and gaps” in the map’s surface, suggesting an urban geography without clear boundary lines, clear spatial differentials clearly emerge across the neighborhoods of Oakland, CA:
Oakland Alone--Fischer

And while the city was once historically predominantly black, or African American, in its population, one still found clearly define enclaves of blacks that are, sadly, starkly isolated in census blocks, based on results of the 2005-9 U.S. Census:

2005-2009 % Afr Am Oakland

One can map, in relation to the racial composition of the city, the relative percentages of kids in public schools, one index of its community, and the stark dividing lines created by some of its highways and major roads, which divide the regions of the hills from the flats, where few kids attend private schools.

Elementary School Kids in Private Schools

This is given much further definition by the map of those who have completed high school, already used in in my earlier post in a slightly different version, which suggests a chasm between cultures of neighborhood far deeper than race alone.

High School Graduation

Perhaps the starkest underpinnings of this cultural divide is a map using the 2010 Census to define an ESRI visualization, of the city’s divide in income levels in the city and outlying areas:

oakland's Income in bay Area

Which one can zoom into for the City of Oakland, revealing a clearer divide in incomes around  Highway 24, still using Census Blocks, that again reveals some intermingling albeit with sharp divergences in Oakland that stand in sharp contrast to the larger Bay area:

Median household Income East Bay-Oakland in it

To track a deep change in the population of the city that occurred in only recent years,  Pietro Calogero tracked racial displacement from many neighborhoods that illuminate this divide in incomes, around the aftermath o California’s housing crisis.  The map of foreclosed real estate in west and southeast Oakland, the former “industrial areas,” which stand in sharp contrast to wealthier areas in the hills, to illuminate an economic ravaging of the city that shows up in no other way in a simple map–and indeed masks innumerable individual stories of foreclosure and moving out:

Foreclosures OAK

Although perhaps the map of foreclosed houses is difficult to tie to race, Calogero comes closest to revealing stories with a map in choosing to map how African American families were in fact disproportionately effected by foreclosures, and how former African American neighborhoods were gutted from the inside out as residence became unsustainable:

African Americans and Foreclosure in Oakland

The effective narrative of racial displacement that these dynamic maps isolate and present is not only compelling, but raises questions of social justice–and perhaps of social justice and urban mapping.   Despite the broad interpretation of displacement, both when occupied by owner or purchased as an investment, the clear overlap between categories of race and foreclosure seems not only unjust, but a deep crisis, underscoring and mirroring the deep segregation that continues in so many American cities.

And the repercussions of this sort of segregation are evident in the apparent disenfranchisement of despair, revealed in this simple map of voter participation that Ofurhe Igbinedion so astutely thought to create from Alameda County electoral data, which shows a valley of voter absenteeism in an area where the 2010 voting held low potential or positive prospect:

Oakland Voter Turnout

(Igbinedion’s striking–and dismaying–map, reduced in size above, may be viewed in far greater detail here, and will be posted in full with a commentary at http://www.infoalamedacounty.org).

The huge fall-off in turnout among the same population of a territory of disclosure suggests a political disconnect scary in its dimensions, if sadly typical for most American inner cities.  But the cavities of voter turnout in an election for which turnout was itself particularly high–or just short of 75% (74.52%)–suggests a sense of a politics of abandonment.  What, indeed, did the election accomplish for a large percentage of the city?   What resonance did the candidates even hold, or could they hold?  The topography of disenfranchisement is arresting if not puncturing of a vision of a city united in its neighborhoods, and sort of undoes the unity of its own mapping of continuity.

It is a sort of inversion of density.  Mapping the density of population in Oakland by census blocks reveals not only clear neighborhood divides but a uniquely geographic dispersal of demographics, most dense between the freeways and thinning out to the hills and the flats:

Oak Pop Density

There may be real reasons for not living by the shore below the freeway:  the area is not only late-industrial, but the ships spewing sulfur dioxide and pollutants exceeding standards for vehicles that are registered in the United States create a spew of particulate matter over the downtown area not confined to West Oakland, but reaching in to Chinatown, Emeryville and the Downtown area, areas downwind of the port, in this truly terrifying map, posted in 2013 by Sarah Brady and Alfred Twu, and charting the sulfur dioxide and particulate emissions of ships, using the Port of Oakland Emissions Inventory:

oakland-port-and-highway-air-pollution-map

The map reveals regions with air pollution up to 10 times the national average a couple of miles from the port, but whose effects increase risks of cancer and asthma extending twenty miles inland, creating a poorly-known map of particulate matter as an argument to raise pollution standards in Oakland’s port.  Notwithstanding the much-vaunted clean-up of the Port of Oakland, which were aimed primarily at legal safeguards at the level of diesel particulate emissions–emissions that have been largely blamed for sever respiratory problems among local residents–which have indeed decreased from 261 tons to some 77 tons in seven years. (If this was a reduction of 70%, the stated goal of the Port is to further reduce the emissions by 80% by 2020; since July 2009, ships have been required to use low-sulfur fuels within twenty-five miles of the coast, however, and the sulfur-dioxide emissions tied to asthma are not likely to decrease.)

Perhaps it’s not uncommon to value (and inhabit) property away from the shoreline.  Examining relations between elevation and population density in the wake of the shifting consciousness of the relation between water-elevation and land-use after Hurricane Sandy, Stephen von Worley offered the following interesting alternative visualization mapping elevation and population density on a spectrum moving from white to yellow to orange to blue, to show the sharp divide between hills and flats in the East Bay:

Stephen Whorley, Elevation and Poopulation Density (2010)scale von whorley

A nice register of how this space is actually used or perceived, and, equally important, moved through, based on a collation of the adjustments to Open Street Maps of the city, suggests the well-travelled nature of Oakland’s major arteries and downtown roads.   How might this be registered in the surface of the map? is a question that is nicely resolved in this map of Oakland’s self-mapping of its major roadways.

Oakland, McConchie-every line, every point- OaklandAlan McConchie–Stamen design

The Open Street Map view of Oakland, rendered so distinctively by Alan McConchie, tells a perfect story of the inhabitation of Oakland’s space by its routes of mobility, recalling the sort of GPS-derived maps increasingly common from artists like Jeremy Wood, who practiced “drawing with GPS” as a line of work:  it would be interesting to be able to map street-use at different times of the day, if possible, though deriving data of the abandonment of downtown Oakland when dark is undoubtedly difficult.

The divergence of nighttime and daytime is evoked, if not measured, in Michal Migurski’s brilliant layering of a “heat map” of crime–based on police visits per unit of time–over an OSM template, both layered with a semitransparent streets that interact smoothly with the underlaid data; the combination of layers effectively allowed Migurski to adapt a heat-map of crime to downtown Oakland, using police visits per unit of time as a metric as part of his active and for its time particularly innovative Oakland Crimespotting, in the hope that the HeatMap APIs won’t obscure either context or specifics, and provide a legible text.

map-13

One could argue that this mapping of hot-spots excessively illuminates those areas of BART stops, where more police calls would tend to occur–and, in the case of 12th street and downtown, more street folks congregate.  But the increased number of calls provides a basis to register local attention to crime and property protection, or how the city sees itself.

And how Oakland maps its own crime, or tends to monitor its own possessions, is foregrounded in this striking map of the downtown density of security cameras, often placed in response to fears as much as evidence.  This final map of the installation of security cameras downtown points up the increased anxieties of its safety, almost in response to and the perceived need to monitor public life, and registers the odd dynamic of a downtown business zone that has few residents, and whose topography of suspicion vastly changes as one moves from daytime into night–when downtown is increasingly abandoned by workers or street populations.
WATCHING Oakland

We’re clearly fascinated by the different images of the city’s different composition and divides, and in understanding how best to work within them, or to heal them as best we can. The mapping of security cameras–if focussed in the downtown area–reveals a sense of deep divides, and a perceived in security, no doubt partly voiced as inadequate police coverage among businesses, as much as the city’s residents.  This map, also a mirror, in part doubtlessly contributes to the image Oakland projects, an image that is underscored by deep divide Eric Fischer revealed in his remarkable ‘Bay Area’ map of photographs uploaded by “tourists” v. “locals,” red v. blue, in a database that charts a tale of the visual interest of two cities:

Eric Fischer- Locals v non-Locals in SF:Oak

There are many other, more positive maps of the city’s populations, no doubt, and other mirrors that reveal great changes in the city’s diverse communities.  But only by understanding the lay of the land, as it were, and situation of these communities, can we hope to understand the unique challenges that the city faces.

The ambitious investment by a generous benefactor of a whopping $34 million in Oakland’s job-training and education efforts in the summer of 2015 may be the start of a broader investment in what the city has to offer.  The distribution of needed resources by the San Francisco Foundation seems both brave and smartly apportioned:  the decision to focus on specific neighborhoods, and improve the access of those regions to both in-school training and potentially productive housing to public health and from public instruction to community arts groups seems a good one, and breaks down along lines that the city could use, with East Oakland getting an important and much-needed injection:

OaklandOpportunityImpactOverview-1024x663

If many public services are lacking in Oakland–and the poor fit between local economy and job-training has been endemic to much of the city–this seems at least to be a fortunate and very well-intentioned start.

The huge impact on introducing training and resources for early childhood education, trauma and health specialities, and, in part, conflict resolution, provides an important start to break from the deep divisions that have long been present in public education, and the lack of needed resources for many public schools not located in neighborhoods that are able to subsidize or assist needed programs.

Impact on Oak Schools

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Filed under mapping racial segregation, Oakland

Mapping the Expanse of our Health Care Debacle

Has racism reared its ugly head in the debate over healthcare?  Dr. Atul Gawande likened attempts of conservatives to reject health care exchanges as “advice that no responsible parent would ever give to a child.”  For it seems a deeply obstructionist tactic that recalls in so many senses the resistance to integrating schools after Brown v. Board of Education under the misnomer “freedom of choice.”  Gawande noted with real disbelief that courts had to intervene to prevent such retroactive obstructions, much as the Voting Rights Act had been designed to allow courts to intervene in obstructions of the right to vote in similar regions.  While Gawande was not alone in finding that the mantra “defund Obamacare” tsponsored by “almost exclusively white members”  elected to represent “bright red districts” to be fueled by racist hatred or be a cover for deeply racist fears, or be a cover for the sense that poorer parts of the society should not be covered by the wealthier, or by the middle class–and a deep dissatisfaction of the apparent redistribution of wealth that this created, as if this constituted an unwanted interference of the government in individual choice.

Not only do we live in a landscape of quite jarring disproportions of health-care and access to health providers, but of deeply disturbing shifts in life expectancies, that undoubtedly are influenced by a truly terrifyingly inequality in access to health care–which may offer the sort of data visualization from which to begin debate on health care.

C_YmGVQXkAE4L8j

Inequalities in Life Expectancy among US Counties, 1980 to 2010/Dwyer-Lindgren, Bertozzi-Villa, Stubbs, et al./FiveThirtyEight

Filtered by a color ramp that less sharply conveys sharp ruptures, the inequities between in life expectancy among individual counties suggests some quite sharp differences that are apparent in the landscape whose populations we may have decided that we’re less interested in working to ensure of up to a decade:

YEars diff Life Exp.pngFiveThirtyEight

The sharper and perhaps more surprising decline of women’s life expectancy during the decade between 1997 and 2007–the first time of such widespread setbacks in longevity in recent memory–betrays a shockingly similar concentration throughout Oklahoma and Kentucky and West Virginia, as well as Nevada, that mirrors the discontinuity in life expectancy nation-wide to the above snapshot, in ways that might suggest a health crisis, and may well mirror the doubling of those classified as obese between 1980 and 2010–and something as simple as widespread dietary change, as well as habits like smoking, contributing to high blood pressure and obesity in an almost national epidemic.  The dismay with which Dr. Christopher Murray, direction of the Institute for Health Metrics and Evaluation at the University of Washington, noted in 2011 that “there are just lots of places where things are getting worse” seems echoed in the infographics above and below, where the sharp discrepancies of an unexpected decline in health and life expectancy mirrors the increasing inequality and economic divide in America, in ways that seem to distinguish the United States, according to the chair of a 2011 National Academies panel on life expectancies, unlike other countries, that effectively pegs health care to income levels.  The decline of life expectancies in Appalachia and the Deep South is not, perhaps, surprising, but speaks to a bizarre division of the nation, especially as many welathier coastal areas in California and the Northeast, as well as Florida, have seen a rise in life expectancy of both women and men.

Life expectandy for women 1987-2007.png

The absence of similar geographic disparities in life expectancy on a very local if not granular level is absent from Great Britain, Canada and Japan, but suggests the growing demographics of inequity that threaten to be only reinforced by the absence of a comprehensive plan for national health care.  It is a terrifying truth that the majority of poor uninsured reside in 114 of 3,000 counties in the nation, of which 52–just under half–have actually adopted or imposed increasing obstacles to access to adequate national health care for their residents as an unwanted federal intervention.

Such discrepancies are not new, and are readily visible in the US Census, a precious record of national discrepancies and continuities that is now increasingly important to determine the allocation of public resources.  But they were strikingly similar in 2012, in ways deserving to send a shock through the nation because of the inequities it exposed:

Life.jpgKelly Johnston, University of Virginia Library  Scholars’ Lab (2011)

 

The historical decline in life expectancies particularly among rural America–a region that even when adjusted for race shows a huge historical divide that demands drilling down very deeply, as it cannot be reduced to a single cause.

 

LifeExpectancyMapsThe New York Times

 

Given the extent of these painful discrepancies, it is telling that almost half of the counties with uninsured populations lie in states that have not accepted the expansion of health care under the Affordable Care Act:  from Texas to South Carolina, state legislatures have created obstacles to its adoption or implementation, rejecting funds needed to expand Medicaid programs–as have twenty-five states–or even to sponsor health exchanges in their states to make programs available as options for health insurance through the Affordable Care Act.  Both such runarounds do disservice to their populations, as are the attempts of other states to limit the possibilities of access to health-care “navigators” who assist people with enrolling at local health-care centers:  states have independently set up obstacles mandating criminal background checks, fees, exams, or additional course work to sabotage folks from selecting health insurance, and in so doing perversely perpetuate the gaping pockets of inequalities in the current status quo which a map divided by the percentage of populations receiving Supplemental Nutrition Assistance Programs (SNAP)–one important indexed of the uninsured–reveals.

SNAP map

The divides within the southern states of America, where a consistently large proportion of the numbers of uninsured reside, suggests something link a deep valley deeply entrenched within the national landscape but rarely appreciated or explicitly mapped.  When Sabrina Tavernise and Robet Gebeloff examined the results by mapping the refusal to accept an expansion of insurance or even Medicaid against census numbers of poor and uninsured in The New York Times; the coincidence between lack of insurance with refusals of government funds for health care was so frightening that it merited a follow-up editorial on the injustice of blocking health reform–asking how we can accept placing at risk the most vulnerable in our society, including uninsured single mothers, children living below the poverty line, and uninsured low-wage earners, according to data also coming from the Kaiser Foundation.

The interactive four-color map used estimates provided by the 2011 Census Bureau‘s  American Community Survey to reveal how the twenty-six states refusing federal funds (through Medicaid or assistance to buy policies) are also distinguished by terrifyingly high levels of poor or uninsured:

% Uninsured in States Saying No

legend- Poor and Uninsured Americans

As the Times noted, this includes all the Deep South save Arkansas.  The twenty-six states, whose governors or legislatures have intentionally hampered the implementation of the Affordable Care Act, have seceded from federal health care reform, by taking advantage of the Supreme Court’s decision that the expansion of health reform was optional, and not able to be federally mandated.

It scarily mirrors the states whose populations of uninsured exceed 8% of their total populations, or where suffering from poverty and inadequate heath care is most intense:

8% poor and uninsured

legend- Poor and Uninsured Americans

To be sure, much of the arguments against the ACA are rooted in the fear that the act will be a nail in the coffin of the United States as we know it and lead to an insurmountable increase of national debt:  but the paranoiac fear that its perpetration is so short-sighted that it is intended to prevent a return to smaller government has deeper roots.

The depth of local opposition to the ACA follows a deeply disturbing map of national disparities.  Indeed, the refusal to implement the law reflects disturbing ties to the sort of census data on large numbers of African American populations, if one compares the distribution of this refusal to the one-to-one mapping of our population provided in the “Racial Dot Map” designed by the statistical demographer Dustin Cable, who used data of racial populations across national census blocks as measured in the 2010 Census to provide a “snapshot” of the national population.  The map assigns each inhabitant a single dot, colored by a collapsed category of racial self-identification.  Mapping the same data on racial classification alone, using a more simplified classification of racial identity than the census itself, reveals an eery echo of deep segregation among those regions rebuffing the plan for national health care:
SouthWest Dot Map with Names

The disturbing nature of this coincidence, while not measuring to poverty or to low wage earnings, reveal a scary image of the very regions that are ready to spurn federal assistance for the uninsured members of their populations.

Indeed, a focus on the Deep South in Cable’s map, here presented with place-names to render it more legible, reminds us of the relatively clear boundaries in many of these regions among areas which are populated by “whites” or by “Blacks” and “Hispanics”, and a focus on the Deep South reveals the striking nature of the lack of integration in counties that single-mindedly stubbornly refused to expand health care.
Dot Map in the South

There are, to be sure, serious criticisms that can be leveled against the categories retained by the census or instantiated within Cable’s map.  But the  esthetically appealing rendering of census data in the Racial Dot Map reveals some deep divides in our nation’s fabric which may well lie at the heart of the refusal of accepting a mandate for health insurance, even though the refusal is regularly framed as an issue of states’ rights or resistance to federally imposed exchanges of health care.

Indeed, even when stripped of place-names, the distributions that the demographer Cable extracted from the data in 2010 Census blocks creates something of a graphic counter-prompt to the assertion of states’ rights that justifies for such recalcitrant and obstructionist refusing to expand health care:

SouthWest Racial Dot

Although the Racial Dot Map is not an exact tool, and randomly redistributes an average of individual color points within census blocks, we might compare the gross level of integration, which only generalize racial characteristics of a population, to urban areas on the Eastern seaboard:

Eastern Seabord and MD Dot Map

While gross data, and hardly refined as an image of how we live, the contrast with the clearly segregated boundaries of isolated cities suggest a topography of not only racial, but social distancing, and one in which one might imagine anger directed toward the devotion of federal monies to those in need.

Of course, the story is not all bad–even if the crafty recalcitrance of these twenty-six states threatens to erode its ability to reach the most needy among us.  For the profiles of counties within states that have accepted the expansion of course contain uninsured who can be expected to benefit greatly from it–most notably in Arkansas, the one state in the Deep South to accept the ACA–and New Mexico, as well as the more rural areas of California’s central valley, rural Virginia, and the Northwest.

% poor and uninsured in state accepting expansion
legend- Poor and Uninsured Americans

The government shutdown from the start of the fiscal year has prevented many Americans from enrolling for health care online, as was long expected to be possible.  Many will, as a result, rely on filling out paper long forms when seeking to enroll in the program most suitable to them.  But the government shutdown may be a smokescreen meant to cover the obstructionism that the expansion of healthcare, as well as a tactic to delay its final implementation–both since the attention to shutdown has absorbed the 24 hour news cycle, and detracts attention from obstacles to the ACA’s effective implementation.  The shutdown seems to appeal not only as a stunt, but as a final line of resistance to providing universal health care, for a contingent convinced that it will be actually impossible to repeal “Obamacare” once it is enacted and goes into effect.

The mean-spirited nature of this obstructionism is revealed once one examines who will be hurt by a refusal to put the ACA into full effect.  Indeed, a  state-by-state examination of the distribution of non-elderly uninsured across the nation offers a somewhat terrifying profile of troughs of national inequities with which we have yet to contend.  Take, for example, the deep pockets of an absence of insurance among populations in South Carolina:

South Carolina

Or, even more scarily, perhaps, the deep trough in much of central Florida and the panhandle:

FLorida

While the entire state suggests a massive picture of uninsured, the central region is dominated by huge numbers of uninsured, which the governor stubbornly refuses federal insurance:

Central Florida

An even more grave disparity of access to health care is revealed in Alabama as a belt across its more rural areas:

Alabama's Belt

The divisions in Arkansas are almost a belt around Little Rock:

Arkansas

Or a dismaying divide within the rural areas of Georgia, where Atlanta seems something like an island of access to insurance only in its best neighborhoods, but swamp-like regions of uninsured spread out at its northwest and southeastern edges:

Georgia

And, in a particularly terrifyingly unethical mosaic, the disparities between rural and urban Texas appear particularly strikingly stark, and reveal a deeply historical artifact of income disparities and economic livelihoods across the state:

Texas

One could continue almost ad infinitum, covering the ground of the United States as if it were a map coextensive with the nation, but one doesn’t have to struggle much to grasp the depth of disparities and the dangerousness of perpetuating such deep divides in access to adequate health care.

When one speaks of two nations in America, divides between red states and blue states mask the depth of divisions between the uninsured and insured, and reveal the increasing difficulty of the blindness of one population to the other.  Discounting populations whose lack of adequate health insurance is, in essence, naturalized as part of the status quo may provide the clearest illustration of the persistence of racism in America.

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Filed under data visualization, Deep South, national health plan, public health, Voting Rights Act