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The Segregated Landscape of Austin, TX:

Medical Facilities and Housing

Sam Hunter, B.S. Urban and Regional Planning at Texas State University


Affordability and inequality are growing concerns in the United States. However, there

is a blatant disparity in the existing literature in regards to how luxury housing development can

affect city planning and development. This paper explores the relationship between luxury

housing and access to medical facilities. Taking a primarily quantitative approach, spatial

accessibility on a zip code scale was assessed utilizing GIS and descriptive statistics. Point data

was assembled using Statistics of U.S. Businesses (SUSB) data collected by the U.S. Census and

housing data from the Austin Board of Realtors (ABoR). Significant results included a strong

positive Pearson’s r correlation between frequency of luxury housing and medical facilities.

Additionally, in GIS medical facilities appeared evenly dispersed according to significant nearest

neighbor results, but had a skewed mean center towards the West side of Austin. These results

further support the inequality reflected in many cities across the U.S.

Keywords: ​medical facilities, housing, spatial disparities, inequality, segregation


By examining the spatial disparities in home values and access to medical facilities in

Austin, Texas, I expected to find a positive relationship between higher housing prices and closer

proximity to medical facilities. Given the current disparity in literature I hope to shed light on the

lack of accessibility for those in neighborhoods of lower socioeconomic status. By drawing

attention to the overall uneven spread of facilities, city planners and developers with the power to

incite change can propose and implement more efforts towards a more balanced development

within the housing market based on discovered disparities.

Study Area

The study area included official

extraterritorial (ETJ) Austin

boundaries and was scaled to

the zip code level. I included

some areas that may not be

considered part of Austin by

locals such as Pflugerville,

Manor, Del Valle, and

Manchaca but that are formally

included as part of Austin’s

official boundaries.


Although literature on affordable housing is abundant, there seems to be a lack of the

contrary—studies focused on luxury housing units. When evaluating the current state of housing

in Austin, currently ranked 1st nationally for socioeconomic segregation, it is essential to

consider underlying historical factors (Florida & Mellander 2017). Reflecting upon the process

of segregation, devaluing, and lastly gentrification, that Austin went through, it is important to

note this historical and systematic process was similarly enacted in many cities in the U.S.

(Tretter 2012). The primary pillar for residential and racial segregation in Austin is the 1928

Koch and Fowler plan. This plan proposed a “solution” to the “racial segregation problem”, by

restricting services for any minority West of East Avenue (later I-35) (Koch & Fowler 1928, 57).

With no black facilities, these populations simply had to move. A lack of city services also

actively turned any black parts of the city into ghettos (Ross & Leigh, 2000). These tactics of

racially segregating the city worked in tandem with the restrictive lending process of redlining.

This nationwide practice by the Home Owners Loan Corporation deemed particular areas too

risky for government-backed mortgages. Where these boundaries were drawn generally relied on

the racial composition of neighborhood rather than careful and factual examination (Zehr, 2015).

A large swath deemed “hazardous” was the “negro district” outlined in Koch and Fowler’s 1928

plan (Tretter, 2012). This process effectively fostered ghettos in which minority populations

were unable to participate in the wealth driving housing market. Following this was a period of

“urban renewal” through the 1960’s-70’s. During this time, areas of the city previously

disinvested in were considered blighted and marked for demolition. Multiple actors participated

in this upheaval, such as the University of Texas at Austin, by displacing 1,000 Eastside

residents in order to build research facilities (Tretter 2016). This further concentrated poverty

and minority populations on the Eastside as well as disrupted healthy and established

communities (Busch 2013).

Today, real estate developers have driven out these same Eastside communities to

capitalize on the cheap land prices— a direct product of our previous disinvestment (Moskowitz

2017). Finally, the foundation of the research & design sectors within Austin transitioned the city

into a more polarized service-based economy with either low paying service sector jobs or

high-skill high-paying college-education technology jobs (Hartenberger et. al. 2012). Even more

recently, with the stagnation of wages and precipitously rising housing prices following further

deregulation of the housing market, we have shifted into a primarily speculative real estate

driven economy. The average U.S. rent has “more than doubled over the last two decades” and

“global real estate is now worth $217 trillion”, making up “60 percent of the world’s assets”

(Stein 2019). The price of Austin housing has increased dramatically as “19.2 out of every 1,000

owner occupied homes” are valued at $1 million or above. Comparatively, this figure in

Houston, ranked second after Austin state-wide, is “15.2 out of 1,000”, and last ranked is San

Antonio with only “8 out of 1,000” homes values at $1 million. (Egan 2017, n.p.). Despite this,

Austin keeps building luxury units. “In the first quarter of 2014, Austin developers built more

homes in the $500,000 to $750,000 range than they did” more reasonably priced “entry-level

homes”, priced at around $100,000 to $200,000 (Lomax 2015, n.p.). With this rise also reflected

nationally, there is a shortage of approximately “7.4 million affordable and available rental

homes for [extremely low income] renter households” (Aurand 2017, 4).

Finally, this inequity has large sequential effects, including the alienation of low income

residents being forced to relocate to the very outskirts of the city, as far as Pflugerville or Buda.

This shift is simply the “suburbanization of poverty” (Solomon, 2015). Other fast growing cities

have experienced growth within black populations— but not Austin. A report by Eric Tang

shows that between 2000 and 2010, Austin’s population has grown overall 20%, but the black

population has actually declined by 5.4% (Tang, 2014) Looking into medical disparities, a study

done by Nancy Kreiger (et.al. 2018) examined class and quality of health. In the presence of

spatial clustering of class brackets, there was a positive correlation between income and

premature deaths. In a similar study, Bellatorre (et. al. 2011) notes that while economic

segregation is a strong indicator, socioeconomic variables such as race are just as significant

indicators when it comes to overall health— not only is your neighborhood a likely indicator of

health and premature death, but so is your identity. We do not often link housing with health, but

as affordable housing becomes a growing issue it is essential to consider the layered and

exponential affects which will result if this trend continues.

Methods & Data Sources

For this study I decided to primarily use GIS for data analysis utilizing the average

nearest neighbor tool, mean center, and standard distance for each variable. To calculate

correlation between frequency of luxury units and medical facilities, I ran a Pearson’s r test on

the frequency table generated by GIS point data. Point data for medical facilities was sourced

from the Statistics of U.S. Businesses (SUSB) database collected by the U.S. Census. I decided

to include services such as ambulatory, surgical and primary care while excluding services such

as dental, mental health, and home health. For luxury housing, I used a data set of homes sold

within the past year valued over $1 million from the Austin Board of Realtors (ABoR), which I

then formatted to GIS from an excel format. I​ ​expected significant results between wealth and

corresponding access to medical facilities, particularly with extreme concentrations of wealth in

areas with clusters of $1 million-dollar homes as the primary indicator.


fig. 1 Histogram of Luxury Housing Sold Prices

fig. 2 Map of point data with mean centers and standards distances of both variables

Average Closest Neighbor

Two individual tests were run on medical facilities and luxury homes. For both, I

received significant results and was able to reject the null. However, each received different

results. Luxury housing had a strong tendency towards clustering with a large negative z-score

(-30.91) and a nearest neighbor ratio close to zero (0.39). Additionally, the observed mean

distance (255.37 m) was much shorter than the expected mean distance (648.92 m). Conversely,

medical facilities trended more towards dispersion and regular spacing. A positive z-score (6.15)

indicates dispersion and the nearest neighbor ratio of 1.47 indicates a more regular pattern of

dispersion. The observed mean distance (4437.58 m) was moderately larger than the expected

mean distance (3010.62 m).

Pearson’s r

Calculating correlation between frequency of medical facilities and luxury housing by zip

code, I was able to find a significant positive relationship between the two variables. With a

critical value of .304 and r value of .485, I rejected the null. An r​2​ value of .235 ascribes 23.5%

of the variance in medical facilities on the presence of luxury housing.

Descriptive Spatial Statistics

Medical facilities trend towards being more broadly dispersed, as shown by the standard

distance. However, the mean center is located within a mile west of Mopac. Luxury houses are

more extremely skewed west and have a tighter standard distance indicating less dispersion.


There is a positive right skewness observed, showing most homes to the lower end, with

a more platykurtic distribution. There is a spike of roughly 40 homes within the $4 million dollar

plus range on the tail of the distributions.


While medical facilities indicated a more even dispersion in the average nearest neighbor

results, mean center shows a skew towards the western part of Austin. Additionally, medical

facilities appear extremely clustered to the west, but much more dispersed to the east, resulting in

a more normalized average between these two extremes. As anticipated, medical facilities

occurred significantly in a positive correlation with luxury housing, indicating that medical

facilities are more frequently observed in wealthier areas. For luxury housing, the average

nearest neighbor result showed significant clustering, and the mean center indicates the majority

are located in West Austin. Since I used data of homes sold within the past year, these clusters

could indicate areas where new luxury housing is being built, particularly areas just west of

Mopac which had the greatest amount of homes sold. With these results, I concluded that our

study further supports the spatial economic inequalities observed within many US cities.

Limitations to this study included the lack of evaluating travel time to facilities, facility

size, and response time. While our study was on a broader qualitative scale and simultaneously

utilized multiple quantitative metrics, future studies could further qualitatively evaluate the

effects of limited access. Lastly, it would be valuable to have access to further studies assessing

luxury housing and elaborating on how the quantity and distribution affects home values in a city



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