Poor neighborhoods may contribute to poor health

People who move from a poor neighborhood to a better-off one could end up thinner and healthier than those who stay behind, according to an urban housing experiment that tracked low-income residents in five major cities for 10 to 15 years.

The research, set up by the U.S. Department of Housing and Urban Development, shows that health is closely linked to the environments people live in — and that social policies to change those environments or move people away from blighted areas could be a key tactic in fighting the “diabesity” epidemic.

The study released Wednesday by the New England Journal of Medicine took advantage of a 1990s social experiment approved by Congress primarily to track the changes in income, education and employment of people given the opportunity to move out of low-income housing in Los Angeles, Baltimore, Chicago, New York and Boston. At least 40% of the residents at the start of the study made less money than the federal poverty threshold.

Researchers soon realized that the project could allow them to study residents’ changes in health as well, said study coauthor Dr. Robert Whitaker, a pediatrician at Temple University in Philadelphia.

Between 1994 and 1998, the researchers randomly divided 4,498 women with children who made less than the federal poverty level into three groups. A third were given a voucher that would pay for a portion of their rent, so long as they moved to a much better-off area in which no more than 10% of residents had incomes below the poverty level. They were provided with counseling to help them make the move.


Another third were offered traditional vouchers, which would subsidize housing regardless of location. The final third served as the control group and did not receive vouchers.

Ten to 15 years later, researchers measured the women’s height, weight and blood sugar. They found that rates of extreme obesity among women given vouchers to move to less impoverished neighborhoods were about 19% lower than those who stayed in the low-income neighborhoods, and rates of diabetes were about 22% lower.

“This is one of the first studies to show that where you live — the circumstances of your neighborhood, the social characteristics of the people around you — all these things may play a role in your own health,” said Dr. Harlan Krumholz, a cardiologist at the Yale School of Medicine who was not involved in the study. “Your health is not just what happens to you, but is influenced by all of those around you and the environment. … Some environments are toxic to health.”

One only has to visit one of these housing projects to grasp that toxicity, said study lead author Jens Ludwig, a public policy professor at the University of Chicago.

On one visit to Baltimore, he recalled, “we walk into the elevator and it’s like a tin can. It’s just metal everywhere, meant to reduce graffiti — unsuccessfully.” Obscene and graphic language were scrawled across the walls, he said.

“It smelled like a urinal … and in walks this mom with this incredibly sweet 6- or 7-year-old girl, and you think, this is the environment these poor moms have to raise their children in,” Ludwig said.

Experts have yet to identify for sure what aspects of such environments make them so damaging to health — but they do have ideas, as well as suggestions for improvement, said Dr. Michael Rodriguez, a UCLA professor of family medicine who was not involved in the study. Among them: safer ways for schoolchildren to walk home, better and safer public spaces, a focus on crime reduction, and incentives to bring healthful grocery options to low-income areas.

“The next step would probably be to intervene by altering neighborhoods rather than moving people out of neighborhoods,” Whitaker said. “Now that we have seen experimentally that people who are placed in very different neighborhoods do better, the question is, how we can address the quality of the neighborhoods … without necessarily having [residents] move?”

The nation’s overall obesity rates doubled between 1980 and 2000, according to the Centers for Disease Control and Prevention, and newly diagnosed cases of diabetes have more than tripled since 1980.

Poorer and minority populations have especially high rates of obesity and diabetes, and some obesity experts have blamed that fact on the unhealthful environments they live in: Low-income urban areas are often described as “food deserts,” full of fast-food joints and few healthful grocery options, and high crime rates deter outdoor activity.