Why Health Depends Partly on Where People Live

Poor people are unhealthier not only because of their lower incomes, but also as a result of where they live.
by | April 13, 2015
Poor neighborhoods across America often lack parks, playgrounds and access to grocery stores. (Wikimedia Commons/Ingfbruno)

A striking divide exists in the health of people at the top of the economic ladder and those near the bottom.

Wealthier people tend to experience diseases or illnesses less frequently, have better access to care and live longer than those who are poor. Part of this is due to the mere fact that the more affluent can afford to pay for superior care or hold jobs providing better health benefits. But, to a certain extent, a person's health also depends on the neighborhood where he or she lives.

An Urban Institute report published Monday explores the link between economic well-being and health with an analysis of how income-related policies may advance health outcomes.

Part of the report highlights a range of community factors preventing people from living healthier lives. For one, residents of poorer neighborhoods are more likely to live in food deserts, turning to fast food restaurants and convenience stores because grocery stores aren't close by. Such communities are also typically hindered by greater levels of air and water pollution, particularly if major roadways run through them. Advertisers, too, often target low-income neighborhoods for tobacco, alcohol and unhealthy food products, the report notes.

A community’s built environment further plays a role in improving or limiting one’s health. Results from the 2011 National Survey of Children’s Health (NSCH), shown below, illustrate the prevalence of neighborhood amenities that help kids lead healthy lifestyles. About 63 percent of children in the most affluent households lived in neighborhoods with parks, recreation centers, sidewalks and libraries, compared to 45 percent for those living in poverty. Households below the federal poverty level were similarly three times more likely to lack all four amenities than families in the top income bracket.

Additionally, socialization by other adults outside an immediate family shape children’s perceptions of acceptable behaviors that potentially carry short or long-term health consequences. In the same way, peers and community social networks also influence young people, wrote researchers Ingrid Gould Ellen and Margery Austin Turner.

Neighborhood characteristics don’t affect all segments of the population equally, though. Most research suggests children are particularly vulnerable to unhealthy living settings.

Years of life expectancy after age 25

Along with neighborhood-level characteristics, a significant part of disparity has to do with low-income patients simply not being able to pay for the same level of care. This further extends, according to the Urban Institute report, to one’s ability to pay for nutritional meals, recreational opportunities and programs promoting lifestyle changes, such as smoking cessation and drug treatment programs.

But multiple studies have found that neighborhood-level factors still influence health conditions, even after accounting for income and other individual and household variables. One study of Alameda County, California, for example, linked poor social environment factors to higher mortality risks. Individuals living in "low social environments" were found to have a greater risk of death over an 11-year period after taking into account individual income, education, race and various health measures.

It’s true that the causal link between income and health goes in both directions. Disabled people, for example, have few opportunities to earn higher incomes. For the most part, though, it’s greater income that affords people better health and not the other way around, said Lisa Dubay, an Urban Institute senior fellow who co-authored the report.

And Dubay pointed out that it’s not just poor families whose incomes pay a role in limiting health. The relationship extends across the socioeconomic spectrum; middle class people experience more frequent health issues than those with higher incomes. This fact is further reflected in NSCH data, which shows how reported overall child health status improves each step up the income ladder.

Although evidence linking income to health outcomes is strong, health benefits rarely surface in policy debates surrounding income-related policies. “The relationship is not talked about as much as it could be,” Dubay said.

Studies have found, for example, that the Earned Income Tax Credit has had positive effects on infant health. Recent research also suggests that Social Security benefits play a role in pushing down mortality rates among older adults.

“Both conservative and progressive strategies -- from policies that enable small businesses to thrive and take on new workers to policies that provide tax credits and sick leave to working parents -- are really health policies,” the report states.

State Level Children's Health Survey Data

Select a state below to view health data depicting disparities among children.