– By Loretta Okonkwo:
Social and economic conditions of neighborhoods have been linked with mortality, morbidity, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease, as well as with mental health, injuries, violence and other important health indicators.
Physical and social environments in neighborhoods can be overtly hazardous for example, polluted or crime-infested. They also can severely limit the choices and resources available to individuals. For example, an individual’s ability and motivation to exercise and avoid smoking and excessive drinking can be constrained by living in a neighborhood that lacks safe areas for exercise, where intensive tobacco and alcohol advertising targets poorer and minority youth and liquor stores are plentiful, and where healthy role models are scarce. By the same token, aspects of neighborhood environments such as the presence of walkways and playgrounds, after-school physical activity programs for children and youth, and availability of affordable nutritious food can promote health by encouraging healthy behaviors and making it easier to adopt and maintain them. Similarly, people are more likely to receive recommended medical care if facilities are accessible in their neighbourhood, either because they are located nearby or because safe, convenient transportation is available
Social and economic conditions in neighborhoods can also influence health by affecting access to employment opportunities and public resources including efficient transportation, an effective police force, and good schools. Strong ties and trust among people within neighborhoods have been associated with better health.
Not all neighborhoods enjoy these opportunities and resources equally, however, and access to neighborhoods with health-promoting conditions varies by a household’s economic and social resources; housing discrimination has limited the ability of many to live in health-promoting neighborhoods. The concentration of substandard housing in less-advantaged neighborhoods further compounds ethnic lines as well as socioeconomic disparities in health.
Improving the social and physical environments in neighborhoods can be one of the most important contributions to improving the health of populations.
The concept of “place” is very important to health. Just as conditions in our homes affect our health, the places surrounding our homes also have a relationship with our health. Research shows that even after accounting for other differences, the characteristics of a neighborhood can be proven to impact the health of its residents.
These characteristics are usually divided into three categories: physical, social, and service. The physical environment is composed of the “built environment” constructed by people, as well as the natural environment such as open fields or waterways. The social environment is the result of individual behavior and the quality of relationships between people. The service environment includes resources for education, employment, transportation, health care, food, and recreation.
Not surprisingly, poor neighborhood conditions have been linked to higher rates of mortality, disability, chronic diseases and their risk factors, mental health issues, injuries, and violence. Besides having immediate, short-term effects on health and our ability to make healthy choices, neighborhoods also have longer-term effects. Accumulated stress, poor environmental quality, and limited resources wear down our health over the years and make us more likely to die from a number of diseases.
Poorer neighborhoods frequently lack well-maintained parks, sporting facilities, and walking or jogging trails. This is especially problematic when you consider that half of the preventable deaths are related to behaviors such as poor diet and lack of physical activity. The existence of litter, vandalism, scrawls, and crime is also an obstacle to physical activity, as are traffic and noise on the streets.
Neighborhoods can influence health in many ways. First and perhaps most obvious is through the physical characteristics of neighborhoods. Health can be adversely affected by poor air and water quality or proximity to facilities that produce or store hazardous substances; by substandard housing conditions exposing residents to lead paint, mold, dust or pest infestation; by lack of access to nutritious foods and safe places to exercise combined with concentrated exposure and ready access to fast food outlets and liquor stores; and by adverse traffic conditions.
Health can also be shaped by the social environments of neighborhoods that is, by characteristics of the social relationships among their residents, including the degree of mutual trust and feelings of connectedness among neighbors. Residents of supportive neighborhoods may be more likely to work together to achieve common goals e.g., cleaner and safer public spaces, healthy behaviors and good schools, to exchange information e.g., regarding childcare, jobs and other resources that affect health, and to maintain informal social controls e.g., discouraging crime or other undesirable behaviors such as smoking or alcohol use among youths, drunkenness, littering and scrawls, all of which can directly or indirectly influence health. Children in more supportive neighborhoods are more likely to receive guidance from multiple adults and less likely to engage in health damaging behaviors like smoking, drinking, drug use or gang involvement.
The availability of services and opportunities in neighborhoods is another general pathway through which neighborhoods can influence health. Where we live is highly correlated with the quality of schools, transportation and other municipal services, health care services and employment opportunities to which we have access. Health care can influence health in relatively direct ways. Education, employment opportunities and other services influence health more indirectly, such as by providing the means to achieve an adequate standard of living now and in the future. Differences across neighborhoods in education and employment opportunities can create and reinforce social disadvantage that translates into worse health, creating health disparities along both socioeconomic and ethnic lines.
Just as conditions in our homes affect our health, the places surrounding our homes also have a relationship with our health. Neighborhood condition is a vital determinant of health. Positive health behaviors, physical and mental health are supported and promoted in safe neighborhoods.