Making Neighborhoods Good for Your Health

Article, see p 504 Over the past 20 years there has been an emerging interest in the impact of neighborhoods on health. This growing trend is based on the increased recognition of the need to consider not only individual characteristics and behavior, but also the context in which individuals live when attempting to understand variance in health and disease across population groups after adjusting for individual factors.1 In an analysis of household income and mortality over a 15-year span in the United States, life expectancy for individuals in the lowest quartile of income varied substantially across local areas by up to 4.5 years.2 Some communities were clearly more successful at caring for their poorest citizens, and understanding the components that matter is a challenge for researchers and policy makers.Previous studies have used large data sets and linked these data to census-derived neighborhood variables by using individual zip codes to evaluate the importance of average household income, percent graduated from high school, and racial/ethnic composition as predictors of health outcomes or access to health care.3,4 Much of the focus of neighborhood research in chronic disease has been on cardiovascular disease, diabetes mellitus, and obesity, given that poor access to healthy foods and limited opportunities for physical activity are related to potentially health-relevant neighborhood physical and social environments.5,6 Measures of having green areas and parks, safe walking spaces such as maintained sidewalks, full-service food stores with fresh fruits and vegetables, recreational sites for sports and physical activity, and reasonable personal safety from crime have all been used to evaluate the quality of neighborhoods. These can be obtained from census data or, more recently, from geospatial data sets that incorporate satellite images. These measures may also be obtained by self-report from residents in response …