Heal the Sickest Neighborhoods First

Where you live affects your health and life expectancy. A report released in September by the Trust for America's Health and the Robert Wood Johnson Foundation projects that obesity rates in 13 States will be over 60% by 2030. These are state-wide rates, so the rates for poor neighborhoods within those states will be ever more shocking.The least walkable neighborhoods (sprawling suburbs, lacking sidewalks and public transit, absence of nearby healthy food and shops, etc) frequently have the highest levels of obesity and related illnesses. Carcinogenic airborne pollutants are often highest in poor neighborhoods close to industry or highways. Fragmented, sprawling neighborhoods often lack a place-based community, increasing likelihood of poor health, depression, social anxiety syndrome among children, early death among seniors, and absence of community controls to prevent violence and crime. These unhealthy environmental factors are often combined in the poorest neighborhoods.

It is high time for us to put to good use the technical mapping data that identify by census tract where the greatest levels of physical and social ill health exist, and to finally apply life-rescue operations for neighborhoods most in need.

Numerous studies indicate a strong correlation between ill health and neighborhood environmental factors. A recent Canadian study linked diabetes, neighborhood unwalkability and poverty. Unwalkable Neighborhoods, Poverty, and the Risk of Diabetes Among Recent Immigrants to Canada Compared With Long-Term Residents demonstrated that lack of walkability was a strong predictor of diabetes incidence, independent of age and area income. However, this was particularly strong among recent immigrants living in low-income areas. Recent immigrants living in low-income/low walkability areas were three times more likely to develop diabetes than those living in high-income/high walkability areas.

Investigating the 750 deaths that occurred in Chicago over a 5 day period during the 1995 heatwave, Eric Klinenberg discovered that not only were these deaths predominantly the elderly poor, but that they were the elderly poor living isolated lives in physically fragmented, unsafe neighborhoods. There was no continuous urban fabric, thus no life on the street, no neighbors, no stores or services within walking distance. Face-to-face social networks and any sense of community were virtually impossible. Thus, it is not simply a matter of poverty, but poverty combined with isolation that kills.

The Joint Center for Political and Economic Studies’ July 2012 report, Place Matters for Health in Cook County:  Ensuring Opportunities for Good Health for All, found a similar correlation between residential location and health.  The environmental element they focused on was availability of healthy food. “Residents in census tracts and municipalities with the lowest level of access to supermarkets have an average life expectancy that is more than 12 years shorter … as well as double the risk of premature death … than residents in areas with the highest access.” Moreover, due to racial and class segregation,  census tracts with “the lowest life expectancy tend to have a higher percentage of people of color and low-income residents”.

The Center produces up to 10 reports per year, addressing important correlations between environmental factors, economic conditions, and racial and ethnic health inequalities. Their September 2012 report on Bernalillo County, N.M., identified similar strong correlations. Among their findings:

  • Life expectancy in the county varies by more than 22 years across census tracts…
  • Nonwhite and low-income census tracts, such as those in the downtown area, face a higher concentration of environmental health hazards such as air pollution and toxic industrial wastes than do whiter and higher- income census tracts; and life expectancy is an average of 5.2 years shorter in census tracts with the greatest concentration of environmental hazards.

In New Orleans, the Center found that life expectancy in the poorest zip code in the city is 25.5 years lower than life expectancy in the zip code with the least amount of poverty.

These health problems cluster in the poorest neighborhoods, diminishing opportunities for individuals to lift themselves out of the vicious cycle. The fact is, there has been a long-standing negligence on the part of planners and elected officials to maintaining fundamental conditions to assure health and well-being.

If we want to make the greatest improvements in our nation’s health with the limited resources available it is imperative that we prioritize the most unhealthy neighborhoods – and these are the poorest neighborhoods. Our poor, and our youth are our greatest undeveloped resources. Preventing a 60% obesity rate and the associated social and health care costs, and strengthening social life and community efficacy to reduce physical and social health problems is in the best interests of national security.