In collaboration with the John D. and
Catherine T. MacArthur Foundation’s How
Housing Matters Initiative, Spotlight
on Poverty and Opportunity will be running a series of commentaries for the
next two months exploring the relationship between housing and three topics:
health, economic opportunity, and education. Please be sure to read Michael
Stegman’s “An Introductory Note” to learn more.
This commentary is the first installment in
the series, which is entitled “How Housing Matters to Families and Communities.”
of the most striking features of urban life in America today is the degree to
which our neighborhoods are so starkly segregated by race, ethnicity, and
economic status. Two of us work or live in Hyde Park on Chicago’s south side. The
neighborhood is home to the University of Chicago and formerly President Barack
than one in five Hyde Park residents are poor. Right across Cottage Grove
Avenue to the west is Washington Park, a neighborhood where 98 percent of
residents are black and 52 percent are poor.
as striking is the correlation between neighborhood segregation and life
outcomes—including health. The overall mortality rate in Washington Park is
about 1.5 times that in Hyde Park.
sorts of disparities across neighborhoods have generated long-standing concern
that poor families living in high-poverty neighborhoods might be
“doubly-disadvantaged”—both poor and living in a high-poverty environment that
may be harmful to their health. This is an important consideration for
policymakers, because social policy - including housing policy - helps shape the
geography of poverty in America.
are several common hypotheses for how neighborhood or residence affects health,
including differential access to grocery stores that sell healthy foods, opportunities
for physical activity, or availability of medical treatment. Neighborhoods
could also vary in their social norms around health-related behaviors, or in the
psychological stress arising from rates of crime and violence. Some research
even suggests that the physical appeal or aesthetic of a neighborhood may also
influence health and well-being.
there has been no shortage of theories, empirically isolating the causal
effects of neighborhood environments on health has been challenging for social
scientists and medical researchers because most families have at least some
degree of choice over where they live.
average, people in Hyde Park have better health than people in Washington Park.
Is that due just to differences in the characteristics of people living in the two
areas, including individual attributes that are hard to measure? Or is at least
part of the difference in average health outcomes we see between places like
Hyde Park and Washington Park also due to something about the neighborhood
recently published a paper in the New England Journal of
Medicine that provides the first test from a real randomized experiment
of how social and physical environments affect health outcomes. Drawing on data
from the U.S. Department of Housing and Urban Development’s (HUD) Moving to
Opportunity (MTO) experiment, we found that providing low-income women the opportunity
to move from high-poverty to lower-poverty urban neighborhoods was associated
with about a one-fifth reduction in rates of extreme obesity and diabetes.
study suggests that, over the long term, investments in improving neighborhood
environments may be an important complement to medical care when it comes to
preventing obesity and diabetes and improving the health outcomes of poor
also found that environmental influences on health are big. In comparing the
MTO impacts to those from other studies, it is important to keep in mind that
most clinical trials in medicine usually enroll study samples that are more
socioeconomically advantaged than that of MTO, and that different studies often
use slightly different outcome measures. With those qualifications in mind, we
saw health effects in MTO that are comparable in size to the long-term impact on
diabetes that can result from targeted lifestyle interventions or from
providing people with medication that can prevent the onset of diabetes. This suggests
that investments in improving neighborhood environments may be an important
complement to medical care when it comes to preventing obesity and diabetes and
improving the health outcomes of poor families.
our research could help policymakers utilize housing policy to improve life for
low-income Americans, it may also shed some light on why the prevalence of
obesity and diabetes has more than doubled in the U.S. since about 1980. Over
this same time period, the likelihood that poor Americans live in economically
disadvantaged neighborhoods has also increased. We’re not yet certain how well our
findings generalize to other populations, but these results suggest the
possibility that the growing exposure of Americans to distressed neighborhoods
could be one reason why obesity and diabetes have been on the rise in the US.
They may even help explain an even more unsettling phenomenon—the disparity in
obesity and diabetes rates that we see in America between minorities and
whites, given that minorities are more likely than whites to live in
and racial segregation is something visible to people who live in America’s
urban areas every day. What’s less visible is the long-term health toll of such
segregation. We’re hopeful our research is an important first step in helping
inform policy decisions in housing and social policy more generally that can help
America’s “doubly-disadvantaged” poor.
To print a PDF version of this document, click here.
Greg J. Duncan is
a distinguished professor in the department of education at the University of
Lindau is an associate professor of obstetrics, gynecology, and
medicine-geriatrics at the University of Chicago.
Jens Ludwig is
the McCormick Foundation Professor of Social Service Administration, Law, and
Public Policy in the School of Social Service Administration and the Harris
School and director of the University of Chicago Crime Lab at the University of
is professor of public health and pediatrics at Temple University.