Institute For The Future

Investing in Local Communities to Improve Health

The New England Journal of Medicine has a fascinating study examining the effects of a low-income housing program impacted participants' health--the results of which suggest that, at least in many instances, improving the local neighborhoods where people live does far more to improve health than trying to tackle health problems on a case-by-case basis.

 

The study, led by University of Chicago Law Professor Jens Ludwig, looked at how health outcomes changed over time among people who moved out of high poverty neighborhoods, compared with those who didn't move. Time's Healthland blog concisely summarizes their findings:

 

"The results suggest that over the long term, investments in improving neighborhood environments might be an important complement to medical care when it comes to preventing obesity and diabetes," says study author Jens Ludwig, a professor of public policy at University of Chicago

The HUD program, called Moving to Opportunity (MTO), wasn't originally focused on tracking people's health. It was designed to study the effect of the residential milieu on employment, income and education in families with children living in cities with a 40% or greater poverty rate. But Ludwig and his team were curious about how the rise in poverty in the U.S. has also mirrored the increase in obesity and diabetes and wondered, Could neighborhood and social factors influence health outcomes?

The current study, published in the New England Journal of Medicine, is the first to conduct a social experiment that allowed the comparison of such outcomes in families — in this case, low-income single mothers and their children living in public housing — who were randomly assigned to live in different economic environments. Families who volunteered to join MTO entered a lottery, which randomly put them in one of three groups: those who received vouchers to move to a less disadvantaged neighborhood (with a poverty rate of less than 10%), those who got vouchers to live wherever they chose, and those who did not receive any vouchers or additional assistance.

Because of the randomized design of the program, scientists knew they could track and correlate changes in living circumstances to later health outcomes like obesity or diabetes. Most of the families — who were from Baltimore, Boston, Chicago, Los Angeles and New York — were followed for an average of 12 years, during which they answered survey questions about their neighborhood, jobs and health.

Among the 4,498 single moms who volunteered for the program, those who were assigned to move to lower-poverty areas were 19% less likely to have a BMI of 40 or higher, the cutoff for morbid obesity, and 22% less likely to have glucose levels typical of diabetes, compared with those who stayed in public housing.

 

In other words, moving from an impoverished to a relatively healthier neighborhood lowered health risks by about one fifth--as effective as many medical interventions. What's also notable is that just providing a housing voucher--helping one family without doing much for the community--doesn't seem to measurably improve health.

 

Shared environmental and social health problems, in other words, get better through efforts to improve shared local conditions.

 

Beyond simply pinpointing scales of action--our social structures and environments--their study, at least by implication, opens up a much broader set of opportunities for local communities to act collaboratively to improve their health, such as improving access to parks, grocery stores, and otherwise acting through local communities to improve health that have the potential to be a lot cheaper, and a lot more effective, than a lot of traditional biomedical interventions.

 

(For a great review of some of the research on the effects of poverty on health, check out this recent blog post from biological anthropologist Patrick Clarkin.)