Making Neighborhoods Good for Your Health
Authors: Adelaida M. Rosario, Eliseo J. Pérez-Stable
Journal: Circulation (2016)

ver 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 censusderived 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. 3,4Much 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. 5,6Measures 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 to a survey or generated from direct observation.The additional construct of social connectedness and networks is critical to evaluate as well.Given that place of residence is strongly associated with socioeconomic status and ethnicity, neighborhood characteristics have potential to be notable contributors to health disparities and to understanding why poor people in 1 city may live longer than those in another.As such, neighborhood-level interventions have the potential to significantly improve population health, and reduce health disparities in our Nation's communities, as well.In this issue of Circulation, Wing and colleagues 7 investigate the impact of neighborhood-level factors on the progression of subclinical atherosclerosis by assessing coronary artery calcium scores.The analysis used the MESA (Multi-Ethnic Study of Atherosclerosis) cohort that included a diverse sample of 5950 participants from 6 US cities, 51% white and 65% men.The association of changes in coronary artery calcium scores across 6 neighborhood factors was examined over a 12-year period in this ongoing study.Geographic information system-based measures were used in assessing neighborhood density of recreational facilities and healthy food Making Neighborhoods Good for Your Health