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This research furthers the discussion about inequalities in community health by addressing childhood lead exposure for the St. Louis, Missouri metropolitan area. Aligning with an environmental justice approach, this research addressed structural determinants of health. The purpose of this research was to evaluate how racism determines the spaces where people live and the health consequences to which people are exposed. The broad approach confronted racism as a public health concern. Residential segregation was used as a proxy for racism and lead exposure as a consequence of living in a racially stratified society. Results indicated that spaces with higher proportions of blacks and Hispanics were associated with increased cases of elevated blood lead levels (BLL), while spaces with higher proportions of whites were associated with decreased elevated BLL.