Where you live can help determine your health, studies say

Families see improvements after move to better neighborhoods, new research suggests

  • Joseph Walker, 12 doodles as his mother Nicole Davis helps Jamel Davis, 12, with homework at the family's home in Laurel. Nicole Davis says her family's health has improved since moving from West Baltimore.
Joseph Walker, 12 doodles as his mother Nicole Davis helps Jamel… (Karl Merton Ferron, Baltimore…)
November 18, 2011|By Andrea K. Walker, The Baltimore Sun

Sabrina Oliver looked forward to good schools and safer streets when she moved her family from her crime-ridden and trash-strewn West Baltimore neighborhood to the suburbs, but was surprised to discover another benefit as well — a dramatic improvement in their health.

The asthma that afflicted daughter Nyla, 9, and frequently kept her out of school just about disappeared when the family relocated to Parkville, and most recently to Orchard Beach, where there were no roaches and mice, and less dust because the houses were more modern. Although chronic depression had once mentally paralyzed Oliver — keeping her out of work and on disability — the 38-year-old no longer takes antidepressants and has a job sitting with severely ill patients at hospitals.

"I feel transformed," Oliver said. "I feel like I moved to a whole other world."

Sociologists and public health officials have long thought a ZIP code is at least as important as race, age and genetics in determining a person's health. Now, a growing body of more advanced research is bringing the issue to the forefront once again and opening up the debate about how the nation looks at health care.

In one recent study, researchers at the Johns Hopkins Bloomberg School of Public Health found racial disparities normally associated with hypertension, diabetes and obesity weren't as strong when they took into account where people lived.

The researchers looked at racially integrated, working-class neighborhoods, including in Southwest Baltimore, and found that blacks and whites had similar health outcomes. They also compared health outcomes in the neighborhoods to national health surveys. Across the country, blacks are more likely to suffer from hypertension, but when looking at the Baltimore neighborhood, the disparity declined by 29 percent. Blacks and whites in the neighborhood also showed similar odds of being obese.

The researchers attributed the difference to whites in the neighborhood having higher rates of disease than whites on average nationwide. "When whites are exposed to the health risks of a challenging urban environment, their health status is compromised similarly to that of blacks, who more commonly live in such communities," the researchers wrote.

"When people are living in a similar type of environment and they behave similarly, they tend to have similar health outcomes," said Thomas LaVeist, director of the Center for Health Disparities Solutions at Hopkins and lead author of the study, which was released last month in Health Affairs.

A different social experiment started by the U.S. Department of Housing and Urban Development in the 1990s is now also showing evidence that women in five cities, including Baltimore and Los Angeles, had a lower risk for diabetes and extreme obesity when they moved to better neighborhoods.

Under the program, HUD looked at the health impact a ZIP code played in the lives of 4,500 families, some who were given vouchers that allowed them to move out of neighborhoods with poverty rates of 40 percent or more. The other families stayed. Researchers revisited the families who moved over two years beginning in 2008, testing their blood levels, checking body mass index levels and having the families take a survey. They compared the results to a group of families who hadn't moved.

The study, published last month in the New England Journal of Medicine, found that the longer people lived in a lower-poverty neighborhood, the more their body mass index and diabetes symptoms improved.

People who stayed in the old neighborhoods had a prevalence rate of 18 percent for extreme obesity, while women who left were one-fifth less likely to suffer from extreme obesity. They were also one-fifth less likely to have diabetes than women who didn't move.

Jens Ludwig, a professor at the University of Chicago and lead author of the HUD study, said he hopes results like this will help the health industry see improving neighborhoods as a form of preventive care.

"The standard way we tend to do things is we have these low-income families living in these incredibly distressed neighborhoods, and we sit back and wait until someone comes to the doctor's office to say, 'I'm feeling bad, and have got this ailment and that ailment,'" Ludwig said. "People in the health system might think harder about intervention and preventive care by addressing the community-level risk factors that contribute to these adverse health outcomes."

Oliver was able to move to a better neighborhood under a federal program administered by the American Civil Liberties Union of Maryland that relocates low-income Baltimore families to what they call "opportunity neighborhoods" in the city or suburbs, where they have access to better schools and employment, less exposure to crime and more reliable transportation services. More than 1,500 families under the program have been moved from areas where the median income was $24,182 to neighborhoods with median incomes of $48,318.

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