Poor neighborhoods bad for women’s health: Study

By Dr. Ananya Mandal, MDOct 20 2011

A new study shows that a woman’s physical health can be seriously affected by their place of residence.

In the 1990’s the federal government offered thousands of poor women in big-city public housing a chance to live in more affluent neighborhoods. A decade later, the women who relocated had lower rates of diabetes and extreme obesity — differences that are being hailed as compelling evidence that neighborhood can determine health. Initially researchers aimed at looking whether moving impoverished families to more prosperous areas could improve employment or schooling. But according to a study released Wednesday, the most interesting effect may have been on the women's physical condition.

Results showed that 16 percent of the women who moved had diabetes, compared with about 20 percent of women who stayed in public housing. And about 14 percent of those who left the projects were extremely obese, compared with nearly 18 percent of the other women.

“This study proves that concentrated poverty is not only bad policy, it's bad for your health,” Shaun Donovan, secretary of the Department of Housing and Urban Development. “It's not enough to simply move families into different neighborhoods,” Donovan said. Instead, new ways must be found to help families “break the cycle of poverty that can quite literally make them sick.”

The study's good design “provides a basis to infer cause and effect” between poverty and bad health, said Dr. Robert Califf, a noted Duke University cardiologist who is leading a massive study on neighborhoods and health outcomes. The research was led by Jens Ludwig, a University of Chicago professor of public policy. It was published in Wednesday's New England Journal of Medicine.

The experiment started as a $70 million HUD project in Baltimore, Boston, Chicago, Los Angeles and New York. It morphed into a health study after a variety of other government agencies and private foundations pitched in with an additional $17 million more. “In terms of scale, it's not soon or ever to be repeated,” said Dr. Robert Whitaker, a Temple University pediatrician who was a study co-author.

The study however has some notable flaws. Because it did not start out looking at health, the women's medical condition and weight were not checked at the outset. The researchers believe the women in the different groups were about the same, because they matched up on more than 50 other indicators, such as age, race, employment and education. But that is an assumption. Also, only about half the women offered a chance to move to a more prosperous zip code did so. And many who did move left after a year.

The authors listed four theories why the results stood so. Firstly the availability of healthier food is worse in lower-income neighborhoods. Then opportunities for physical exercise are scarcer, and fear of crime can make people afraid to jog or play in parks. Also there may be fewer doctors' offices and other medical services and finally the long-term stress of living in such an environment may alter the hormones that control weight.