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The Inextricable Link Between Neighborhoods and Health

By Steven H. Woolf, M.D., M.P.H.; Emily Zimmerman, Ph.D.; Sarah Simon, M.S., Virginia Commonwealth University,
Center on Society and Health


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Communities influence health in many ways. For example, living near a supermarket has been linked with lower rates of obesity, whereas living closer to small convenience stores has been linked with higher rates of both obesity and smoking.

In New Orleans, a person born in the city’s Lakeview neighborhood has a life expectancy that is a stunning 25 years longer than one born near Iberville, just a few miles down Interstate 10.

In Washington, DC, residents of one neighborhood near Metro’s Red Line can expect to live 7 years fewer than those who live only a few stops further away.

These striking differences in life expectancy show up repeatedly in communities across the nation, bringing into sharp relief the inextricable connection between the health of a community and the health of its residents.

To better understand the connection between neighborhood health and life expectancy, the Virginia Commonwealth University (VCU) Center on Society and Health created a new series of maps for the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America. By displaying life expectancy alongside common landmarks such as subway stops and highway exits, these maps illustrate the vastly different health outcomes experienced by Americans living just a few miles apart.

The maps, which depict life expectancy data for neighborhoods in the metropolitan areas of New Orleans; Washington, DC; and Kansas City, Missouri as well as the San Joaquin Valley in California, were developed using vital statistics obtained from state and local health agencies and the U.S. Centers for Disease Control and Prevention. VCU researchers, along with colleagues nationwide, used these data to calculate how long a newborn could expect to live based on population counts and death rates for the geographic area in which they were born.

As with any complex issue, no single explanation exists for these dramatic differences in health outcomes and life expectancy. A growing body of evidence suggests that these disparities are only partly attributable to differences in health behaviors, such as smoking or physical inactivity, or to differences in access to quality health care. Although these factors are important determinants of health, the maps reveal that certain neighborhood and community conditions also strongly influence residents’ health outcomes.

Important place-based factors include access to safe and affordable housing, supermarkets that sell healthy food, and places to play and exercise. In addition, access to life-enhancing opportunities — a community’s proximity to jobs and quality educational institutions — positively affects residents’ health, whereas exposure to violence and chronic stress (and the negative coping behaviors that result, such as alcohol consumption) has a harmful effect. Addressing these complex issues of health and life expectancy requires multilayered solutions that improve access to good jobs and education, strengthen neighborhoods, and foster community development initiatives. Uncovering these solutions also requires a deep understanding of how social factors such as income, education, and race or ethnicity interact.

Uncovering these interactions and solutions is a major focus of the RWJF Commission, which was created in 2008 to look at ways to improve health outside of the doctor’s office. In 2009, the Commission issued a set of influential recommendations for improving the health of all Americans. Since then, RWJF, its Commissioners, and many national organizations have embarked on a multiyear effort to convey that improving America’s health requires leadership and action from every sector — especially those not traditionally associated with public health, such as education, transportation, community development, and business.

One notable and direct result of this outreach is a series of Healthy Communities meetings held by the Federal Reserve Bank of San Francisco and other regional Federal Reserve banks in partnership with RWJF and others. The meetings were designed to encourage discussion about the ways that cross-sector and place-based approaches to revitalizing low-income communities can also improve health. An independent survey by Wilder Research and the Federal Reserve Bank of Minneapolis found that two-thirds of Healthy Communities conference attendees believe that they are successfully increasing collaboration between local community development and health organizations.

The Foundation reconvened the RWJF Commission this year to evaluate the progress it has made since 2009 and identify new actions to pursue. The life expectancy maps were created as part of the Commission’s current focus on improving health in early childhood and creating healthier communities. As David Erickson from the Federal Reserve Bank of San Francisco told the Commission in June, “Since the 1970s, [the community development] industry has developed millions of new units of housing, new storefronts, schools, clinics and community facilities. On the whole, these efforts have generated significant, if largely unmeasured, health benefits. Much more could be done, however, with better coordination among community developers and the health sector.”

The Commission’s forthcoming recommendations, which will be released in January 2014, will provide specific steps on how to make these connections stronger. For more information about the Commission and its upcoming recommendations, visit www.rwjf.org/goto/commission.