Health in changing neighborhoods: A study of the relationship between gentrification and self-rated health in the state of California

The US faces persistent racial and socioeconomic health disparities. Poor and minority—and in particular black—populations experience disproportionately high rates of mortality (Franks et al., 2003), chronic disease (Cooper et al., 2000), and serious mental illness (Evans et al., 2016). Efforts to better understand these disparities suggest that they are perpetuated by social injustices (Braveman et al., 2011), including the downstream effects of discriminatory policy (Krieger et al., 2011), income inequality (Wilkinson and Pickett, 2009), and racism (Hudson et al., 2013). Predictable geographic patterning of health inequality suggests neighborhoods are important health-differentiating urban environments (Sampson, 2003). The “neighborhood effect” has become a model for coalescing multiscale biological, psychological, and social processes by which places embody and replicate the social conditions leading to health disparities (Curtis, 2004; Izenberg and Fullilove, 2016; Sampson, 2012). The emerging awareness of this relationship between place and health has reignited interest in leveraging neighborhood improvements for health equity and understanding how urban political and social processes affect health. One such process stands out for being hotly-debated among urban policymakers, yet poorly-understood by practitioners of public health: gentrification. Gentrification is often characterized as the influx of investment capital and wealthier residents into previously-disinvested neighborhoods (Smith, 2007). Many have argued that gentrification involves state-led initiatives and incentives, and should accordingly be viewed as a form of policy (Lees et al., 2008). Threatening increased housing costs and displacement for some and promising substantial capital gains for others, gentrification is a contentious topic. It is made more so by the fact that even when defined (as above) in socioeconomic terms, gentrification is intimately bound up with racial segregation and inequality, at least in the US, where it is frequently cast as a threat to minority communities. When viewed through the neighborhood-effects lens, the potential impact of gentrification reaches beyond the physical displacement of low-income renters. Longtime residents of gentrifying neighborhoods may experience profound change and alienation, the breakdown of informal place-based networks of exchange, the loss of gathering spaces and institutions, symbolic manifestations of socioeconomic inequality, and the increased racialization of the public space (Freeman, 2006; Shmool et al., 2015; Werth and Marienthal, 2016). Lower income residents may face difficulty affording food and other necessities, or find themselves in overcrowded housing stock (Phillips et al., 2014). Renewed infrastructure, reduced community violence, access to improved schools, parks, and other community resources, or the cleanup of ecological hazards may bring benefits as well. Available data suggest that associations between gentrification and health vary among different groups—particularly when comparing black populations to white. A 2014 study in New York City reported a correlation between gentrification and pre-term birth among black populations, with the inverse true for whites (Huynh and Maroko, 2014). A more recent study in Philadelphia found that that self-rated health was worse among blacks in gentrifying neighborhoods, though this appeared to primarily be true in gentrifying neighborhoods experiencing increases in the black population, rather than those with an increasing relative percentage of white residents (Gibbons and Barton, 2016). Other findings have suggested that gentrification serves to further stratify public health risks along sociodemographic lines (Abel and White, 2011). Not all studies have reported negative effects of gentrification, with recent evidence from Montreal, Quebec pointing to an association between gentrification and collective efficacy (Steinmetz-Wood et al., 2017), a community factor often associated with positive health and social outcomes (Sampson, 2012). Notwithstanding these investigations, or the breadth of theoretical links, empirical research on the relationship between gentrification and health remains sparse. With an eye toward gentrification’s potential role in health inequalities, the goal of this study was to examine the association between gentrification and self-reported health, independent of individual-level confounders. Self-rated health is a well-established predictor of morbidity and mortality (Idler and Benyamini, 1997) that has been linked to a number of community-level factors potentially related to gentrification, such as social cohesion (Kim and Kawachi, 2006). We also sought to determine if associations are modified by several indicators of vulnerability (lower household income, ethnic minority status, tenancy, and longer duration of neighborhood residence). In secondary analyses, we examined four three-way interactions: 1) race, housing tenure, and gentrification, 2) race, income, and gentrification, 3) race, neighborhood residential duration, and gentrification, and 4) housing tenure, neighborhood residential duration, and gentrification. We also conducted a sensitivity analysis for respondents living in California’s four largest metropolitan areas, given that large urban areas are generally where gentrification is felt to be most widespread and where policy discussions surrounding gentrification are most active.