You are where you live. A new study shows that low-income individuals who move to high-income neighborhoods have less obesity and better blood sugar control than individuals who stay in low-income neighborhoods. Past studies have shown that neighborhoods impact their residents’ health, but this is the first to show that changing from one kind of neighborhood to another can positively benefit an individual, even if most other things about that person’s life stay the same.
In the October 20th issue of the New England Journal of Medicine, Dr. Jens Ludwig, et al. published a paper on the health effects observed in the Department of Housing and Urban Development (HUD)’s Moving to Opportunity (MTO) demonstration project. MTO was a case-control study designed to measure the role that neighborhoods play in health. Participants in MTO were randomly selected Section 8 housing recipients in high-poverty neighborhoods in five major US cities. They were divided into three groups. The first group was given vouchers to allow them to move to a new neighborhood with a low level of poverty. The second group was given vouchers to allow them to move to a new neighborhood that was not necessarily different socioeconomically. The third group was not given vouchers. The health of individuals in all three groups was tracked over time.
Those participants who received vouchers to move to higher-income neighborhoods and chose to move were less likely to be obese and less likely to have uncontrolled diabetes than those who did not receive vouchers, even though the two groups were initially very similar. This is an important finding because it highlights the way that where one lives impacts one’s health and that moving can change that impact. Though the reductions in obesity and diabetes were small (around 2-3% overall), they were significant—few other interventions even come close. As Dr. Thomas W. McDade, a coauthor of the study notes, “The magnitude of the effects of the experiment are striking, and are comparable in size to the effects on diabetes we see from targeted lifestyle interventions or from providing people with medication to prevent the onset of diabetes.”
However, it’s important to keep in mind that the study is, at its most fundamental, a social experiment. HUD does not have the resources or ability to incentivize all Section 8 housing recipients in high-poverty neighborhoods to move to more healthful areas. Even if they did, there are not enough housing options for that to be a feasible option. So, if it cannot be widely implemented, why does this matter, other than to satisfy the curiosity of public health researchers and urban developers? This study opens the door to asking what it is that makes low-poverty neighborhoods that much healthier. Past studies have shown that some features of many low-poverty neighborhoods, like lower crime rates, better access to fresh fruits and vegetables, and parks may have positive effects on wellbeing. MTO is a chance to reexamine these factors and see if there are others, like transportation options and school quality, which might also play a role. Determining which of these are effective can help guide city planners in improving existing high-poverty neighborhoods to make them healthier, even if they do not become wealthier.
This study also makes a case for adding more mixed-income housing in low-poverty neighborhoods. While it is important to not abandon high-poverty neighborhoods (hence the role of city planners and ongoing urban improvement), incorporating more Section 8 housing into low-poverty areas may serve as a stop-gap. Ethically, financially, and logistically, it is not possible to clear out all high-poverty neighborhoods and relocate former residents to low-poverty neighborhoods in the name of public health, but providing individuals with options to live in more mixed-income areas may show a benefit.
Sources:
Anyaso, Hilary Hurd. “From High to Lower Poverty.” Northwestern University News Center. Accessed Nov. 7, 2011 http://www.northwestern.edu/newscenter/stories/2011/10/poverty-study-mcdade.html
Ludwig, Jens, et al. Neighborhoods, Obesity, and Diabetes—A Randomized Social Experiment. New England Journal of Medicine 2011; 365: 1509-1519. October 20, 2011.
Wheeler, Helen Rippier. "Berkeley's Housing Authority Administers Section 8, Public Housing." Accessed Nov. 7, 2011 http://www.berkeleydailyplanet.com/photos/05-14-04/5%253A14%2520rectangle.jpg
Wheeler, Helen Rippier. "Berkeley's Housing Authority Administers Section 8, Public Housing." Accessed Nov. 7, 2011 http://www.berkeleydailyplanet.com/photos/05-14-04/5%253A14%2520rectangle.jpg
Author:
Kira Newman is a second year MD/PhD student beginning the PhD portion of her education in epidemiology. Her research interests focus on the nexus between environment and health. Kira brings a broad background to translational research including primary research in historical epidemiology and practical epidemiology experiences at CDC and state levels. Biking, climbing, and scavenging free food are her passions.
