Health Disparities in St. Louis, Our 2024 Conference City

The 2024 Interdisciplinary Association of Population Health Sciences (IAPHS) Conference is in St. Louis, Missouri. As the theme of the conference is “Tackling Declining Life Expectancy in the US: Investigating Social Drivers and Policy Solutions,” the Student Committee thought it pertinent to look into St. Louis health disparities and share them with the wider IAPHS community.

St. Louis History

The area of St. Louis was first a major center for Mississippian Native Americans, including the Osage and Illini tribes. St. Louis was obtained by the United States through the Louisiana Purchase in 1804. St. Louis grew to be the fourth largest American city by the early 20th century. However, over the course of the 20th century, St. Louis city became one of the infamous “shrinking cities” in which jobs and people left cities en masse. 

In addition to losing population, the city’s racial makeup changed drastically in the 20th century, with the African American population growing to 18% by 1950. This increase in the Black population in the city was coupled with white flight to St. Louis County — on the Western side of the city.

Demographics in St. Louis Today

Today, St. Louis is one of the most segregated metropolitan areas in the United States. The city of St. Louis has continued to experience a decline in population up to today.

As of 2020, according to the Census, roughly 43% of St Louis City and 25% of St Louis County report their race as Black or African American alone, compared to 44% and 63% reporting white alone, respectively. Even with the larger share of African Americans in St. Louis City, the city itself experiences segregation, with the “Delmar Divide” being known locally as a physical racial and economic barrier. 

In recent years, the populations of other racial groups have also boomed. Between 2010-2020, the Asian population in St. Louis County increased by more than 40% and in the city, by roughly 30%. Asians now make up 5% of the county’s population and 4% of the city’s. Of the Asian population in the city, 89% are over the age of 18. (While St. Louis does not have a “Chinatown” — which in other cities has its roots in racial segregation and white supremacy — the neighborhoods of Central West End, Dutchtown, and Tower Grove South have higher concentrations of Asian citizens. The South Grand area in the Tower Grove South neighborhood is well known for its festivals and restaurants that celebrate Asian food and culture, amongst other regions of the world as well.)

Racial Inequities in St. Louis

The continuing economic and racial stratification of St. Louis city and the broader county is coupled with racial health inequities. Below, we discuss trends in cardiovascular disease, cancer, and mental health in St. Louis County and the City of St. Louis. Largely, St. Louis health disparities mirror those seen across the United States.

HOLC redlining map from Mapping Inequality (Nelson & Winling, 2023). HOLC maps in St. Louis followed racial lines, like across the country, with any non-white neighborhoods receiving lower scores

Heart Disease Disparities 

Heart disease is the leading cause of death in St. Louis. Black individuals have the highest age-adjusted death rate due to heart disease and are most likely to be admitted to the ER due to heart failure and hypertension, compared to other racial groups.

Cancer Disparities

Similarly, for cancer, the second leading cause of death, Black individuals have the highest cancer mortality rates. Like national disparities, both Hispanics and Asians/Pacific Islanders have significantly lower cancer incidence rates and mortality rates than whites and Blacks. Interestingly, St. Louis county has breast cancer incidence rates that are higher than most other American counties. 

Mental Health Disparities

Regarding mental health, the areas in St. Louis with the highest concentrations of Black, Indigenous, Latinx and other people of color have the greatest mental health needs. Shortages of clinical mental health services and providers in St. Louis compound the health problems faced by minority individuals in St. Louis. Notably – perhaps due to associations with being a metropolitan area – compared to the majority of other US counties, St. Louis fares worse in drug and opioid overdose deaths, firearm-related deaths, and incidence rates of sexually-transmitted infections.

Asian Populations in St. Louis: Data Disaggregation Is Needed

The recent growth in the Asian population presents a new area for health disparities research and interventions in St. Louis. Like across the US, Asians in St. Louis tend to have better health than their white and Black counterparts, yet there is evidence that the Asian population is pointedly not a monolith. In general, there are gaps in health data on Asian Americans, Pacific Islanders, Native Hawaiians, and Hispanics in St. Louis with the St. Louis City only presenting its data via the broader single race categories, “some other race” category, and “two or more races” category. With the broad “Asian” population growing in the St. Louis area, more detailed information will be needed to understand the health of such a diverse group