Housing, Neighborhoods and Health Disparities
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.
In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.
We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.
In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.
The findings indicate, first, that spatial context measures such as proximity to the nearest ghetto decrease mental health and increase the prevalence of obesity and modify the effects of living in low-poverty immediate neighborhoods. Second, spatial inequality contributes in important ways to explaining gender differences in youth psychological distress, depression symptoms, and involvement in risky and delinquent behavior. Third, spatial trajectories of different racial and ethnic groups exhibit important disparities that align with existing urban segregation patterns. Moreover, spatial proximity and similarity between any two neighborhoods on multiple structural dimensions significantly constrain residential mobility patterns, which indicates the importance of the general network context within which neighborhoods are embedded that incorporates, but transcends, spatial interdependencies.
Several important questions about the neighborhood and spatial context aspect of housing remain critical to ask in our quest to understand and act on the constellation of factors shaping health outcomes:
a) How do different spatially salient markers (such as nearby presence of crime hotspots; community health centers; daycare) interact with the neighborhood context in shaping health outcomes, employment, and health care;
b) What are the health effects of the diversity of population in the community, the level of integration, social cohesion, and interaction across socioeconomic and racial/ethnic barriers in contrast to the effects of persistent segregation and social exclusion;
c) What is the role of spatially ordered socioeconomic inequality on mental health and youth risky and delinquent behavior and other behavioral problems;
d) What are the health implications of the spatial distribution of population, organizational resources, and jobs: how are groups differentially distributed across space relative to the distribution of jobs? How does the neighborhood context of the workplace interact with the role of the neighborhood of residence in shaping individuals’ well-being and access to information and resources that are directly or indirectly related to health;
e) To what extent does the spatial context of daily activities overlap or not with how we normally think about neighborhoods (the area immediately surrounding one's address of residence); and
f) To what extent moving low income families to high quality neighborhoods increases or decreases their access to health related resources and critical social networks and jobs? Social exclusion may be as powerful as absence of resources.
The importance of addressing these big questions is underscored by the constant sobering reminders that housing inequalities to this day still remain closely enmeshed with health inequalities and these gaps have not changed much since the early 70s. The positive side of this sad historical trend is that targeted interventions at the neighborhood level that are successful in improving health outcomes would lead even more effectively to decreasing health disparities.
Indeed, much work remains to be done in the New Year and the years to come in addressing these questions. I am, however, tremendously encouraged by the constructive dialogue between U.S. Housing and Urban Development and the Robert Wood Johnson Foundation and their increasing attention to these issues as reflected most recently in a December 15 Roll Call article called “Housing and Health Care Go Hand in Hand.”