Helping the Doubly-Disadvantaged: The Role of Neighborhoods in Health
One of the most striking features of urban life in America today is the degree to which our neighborhoods are so starkly segregated by race, ethnicity, and economic status. Two of us work or live in Hyde Park on Chicago’s south side. The neighborhood is home to the University of Chicago and formerly President Barack Obama.
Just under half of all Hyde Park residents are white and around 17 percent are poor. Right across Cottage Grove Avenue to the west is Washington Park, a neighborhood where 98 percent of residents are black and 52 percent are poor.
Just as striking is the correlation between neighborhood segregation and life outcomes—including health. The overall mortality rate in Washington Park is about 1.5 times that in Hyde Park.
These sorts of disparities across neighborhoods have generated the long-standing concern that poor families living in high-poverty neighborhoods might be “doubly-disadvantaged”—both poor and living in an environment that may be harmful to their health.
This is an important consideration for policymakers, because social policy – including housing policy – has profound impacts on the geography of poverty. If we’re going to make better choices around low-income housing, it’s critical that we take these worrying trends into account.
There are several common hypotheses for how neighborhood or residence affects health, including differential access to grocery stores that sell healthy foods, opportunities for physical activity, or availability of medical treatment. Neighborhoods could also vary in their social norms around health-related behaviors, or in the psychological stress arising from rates of crime and violence. Some research even suggests that the physical appeal or aesthetic of a neighborhood may also influence health and well-being.
Despite a lot of theories, empirically isolating the causal effects of neighborhood environments on health has been challenging for social scientists and medical researchers because most families have at least some degree of choice over where they live.
On average, people in Hyde Park have better health than people in Washington Park. Is that due just to differences in the characteristics of people living in the two areas, including individual attributes that are hard to measure? Or is part of that difference also the neighborhood environments themselves?
We recently published a paper in the New England Journal of Medicine that provided what we believe is the first test of how social and physical environments affect health outcomes. Drawing on data from the U.S. Department of Housing and Urban Development’s (HUD) Moving to Opportunity (MTO) experiment, we found that providing low-income women the opportunity to move from high-poverty to lower-poverty urban neighborhoods was associated with about a one-fifth reduction in rates of extreme obesity and diabetes.
Our study suggests that, over the long term, investments in improving neighborhood environments may be an important complement to medical care when it comes to preventing obesity and diabetes and improving the health outcomes of poor families.
We also found that environmental influences on health are big. With some important qualifications, we saw health effects comparable in size to the long-term impact on diabetes that usually results from targeted lifestyle interventions or from providing people with medication that can prevent the onset of diabetes. This raises the exciting possibility that living environments could play as profound a role on health as medical intervention.
While our research could help policymakers utilize housing policy to improve life for low-income Americans, it may also shed some light on why the prevalence of obesity and diabetes has doubled in the U.S. since about 1980. Over this same time period, the likelihood that poor Americans live in economically disadvantaged neighborhoods has also increased.
We’re not yet certain how well our findings generalize to other populations, but these results suggest the possibility that the growing exposure of Americans to distressed neighborhoods could be one reason why obesity and diabetes have been on the rise in the US. They may even help explain an even more unsettling phenomenon—the sharp uptick in obesity and diabetes rates among minorities, who are more likely than whites to live in high-poverty areas.
Economic and racial segregation is something visible to people who live in America’s urban areas every day. What’s less visible is the long-term health toll of such segregation. We’re hopeful our research is an important first step in making choices in housing and social policy that could begin to help America’s “doubly-disadvantaged” poor.
Greg J. Duncan is a distinguished professor in the department of education at the University of California, Irvine.
Stacy Tessler Lindau is an associate professor of obstetrics, gynecology, and medicine-geriatrics at the University of Chicago.
Jens Ludwig is the McCormick Foundation Professor of Social Service Administration, Law, and Public Policy in the School of Social Service Administration and the Harris School and director of the University of Chicago Crime Lab at the University of Chicago.
Robert Whitaker is professor of public health and pediatrics at Temple University.