Your Neighborhood Can Impact Your Health
Written by Faith Anderson on October 24, 2011
Study Shows that Environment Can Significantly Affect Health
The apparent improvements in health associated with low-poverty areas are comparable to the typical outcomes seen with programs that encourage healthy eating or exercise, or that provide medications to people with diabetes, reports Jens Ludwig, Ph.D., the lead author of the study and a professor of social service administration, law, and public policy at the University of Chicago. “For this program, health improvements were not the primary goal,” Ludwig says. “But the fact that we’re seeing effects in the ballpark of what you’d get with very direct, targeted interventions designed for weight loss, for example, [is] pretty striking.”
According to Ludwig, there are a number of factors that could contribute to better health in low-poverty areas, including better access to healthy foods, lower levels of psychological stress, and a safer environment more conducive to outdoor exercise. “The move changed a bunch of things at one time for these families, so it’s hard to tease out exactly what made a big difference for them,” Ludwig says. “But all of these things seem like plausible explanations.” As Troy Blanchard, Ph.D., an associate professor of sociology at Louisiana State University who studies health and obesity in poor rural areas points out, the findings draw attention to an often-ignored aspect of the obesity and diabetes epidemics. “Oftentimes, research really focuses on people’s decisions, and what they do wrong, and how they are at fault, essentially, for being obese or having a disease or a poor diet,” Blanchard says. “This provides evidence that it’s not just the individual’s decisions, but…also the environment – the neighborhood – that really does matter.”
A Call for Public Health Programs that Target Obesity and Diabetes in Poor Neighborhoods
Although research indicating that neighborhoods can have an impact on health is not new, this particular study represents the first time researchers have been able to compare moving out of a neighborhood with staying behind, much in the same way that new drugs are compared to placebos in drug trials. The relocation program, called Moving to Opportunity, began in 1994 when the U.S. Department of Housing and Urban Development joined with local housing authorities to recruit low-income families living in public housing in cities like Baltimore, New York, Los Angeles and Chicago, some of which moved into areas with a low-poverty rate, and some of which stayed behind. Between 2008 and 2010, the study authors followed up with 3,186 women who participated in the Moving to Opportunity program, and calculated each woman’s body mass index (BMI) and tested their blood for a type of protein that indicates average long-term levels of blood sugar.
Of the women who stayed in their original areas, 20% had blood-sugar levels consistent with diabetes and 18% had a BMI of at least 40, which is the unofficial cutoff point for morbid obesity. In comparison, only 16% of the women who moved to low-poverty neighborhoods had diabetes and just 14% were morbidly obese. “We went in wondering to what degree a real randomized experiment would confirm – or not confirm – what a lot of people already believed,” Ludwig says. “The most surprising thing was not that it did confirm the belief, but the significant size of the effect.” Although the study has some limitations and certainly doesn’t claim that moving from a high- to low-poverty area guarantees weight loss or protection from diabetes, researchers can conclude that public health programs that target obesity and diabetes in high-poverty neighborhoods “could generate substantial social benefits.” This message “shows that being active in your community and working to make safer, healthier environments can really affect the health of the people who live there,” says Blanchard, who was not involved in the study. “Not everyone can move our of their neighborhood, but maybe there’s a chance to improve what’s there.”