Neighbourhoods and Health Flashcards
what is a neighbourhood?
refers to a relatively small geographic area within a county, city, town, suburb surrounding a person’s residence
how do neighbourhoods influence health?
- the places people live directly and indirectly affect their health
–> factors like air pollution, school quality and job opportunities impact overall well-being
–> factors like walkability and access to alcohol/tobacco stores influence health behaviours
what is the relationship between neighbourhood and health?
features of a neighbourhood are associated with health-damaging or health-promoting behaviours among residents, impacting their overall health outcomes
how do health outcomes vary by neighbourhood? why?
- people living in adjacent or nearby neighbourhood within the same city can experience vastly different burden of disease and health outcomes
- this occurs because people living in wealthier or more developed areas often have better access to healthcare, healthier environments, and social services than those in low-income areas
how does one’s geographic location impact their life expectancy? why?
- life expectancy can differ by as much as 20 years depending on the neighbourhood
- life expectancy can vary across a city due to differences in access to healthcare, socioeconomic status, environmental factors, overall lifestyle choices
- leads to disparities in health outcomes across different neighbourhoods
what health outcomes are linked to social and economic disparities between neighborhoods?
there are higher rates of chronic diseases in lower-income areas:
- diabetes
- cardiovascular disease
- COPD
- asthma
- STIs
diseases rates can be up to 4x higher in certain neighbourhood than in others
how does the lifestyle of a child from a poor community differ from a child from a wealthy community?
wealthy:
- high-income neighbourhood = stronger school performance
- access to extracurriculars and sports
- strong parental involvement in life
poor:
- lower-income neighbourhood = struggling with school
- limited access to extracurriculars
- parent efforts to compensate for gaps in development
how do neighbourhoods influence health outcomes?
- social factors (e.g., social networks)
- economic factors (such as income and employment opportunities)
inequities in social and economic conditions lead to an unequal distribution of resources and health outcomes within neighbourhoods
what upstream factors contribute to disparities among neighbourhoods?
- residential segregation by socioeconomic status and race
- this segregation shapes access to resources, opportunities, and overall health outcomes
What is the most direct way neighbourhoods influence health?
the most obvious and direct way in which neighbourhoods can influence health is through their PHYSICAL CHARACTERISTICS
what are examples of neighbourhood physical environments?
- environmental exposures and hazardous substances
- availability of nutritious food
- natural green spaces and parks
- quality of housing
- services and resources
what are two main components of the physical environment?
1) built environment
2) service environment
what is the “built” environment?
refers to the physical characteristics of “man made” structures, such as buildings, streets and other features of a neighbourhood
examples of how the “built” environment impacts health
- living in close proximity to an area with high density of tobacco and alcohol retailers = increased alcohol consumption and smoking
- availability of food sources (full-service supermarkets) or unhealthy foods (fast-food) = poor diet and obesity
- less resources for exercise (parks, recreation centres) and walking = less physically active
what is the “service” environment?
- refers to the the accessibility and availability of essential services within their neighbourhood boundaries
- the physical availability of services in a neighbourhood have major effects on health
what are some examples of a neighborhood’s service environment?
- public transportation
- food stores and supermarkets
- parks and green spaces
- medical facilities and hospitals
- schools
- employment opportunities
how does the service environment in a neighbourhood impact health outcomes both directly and indirectly?
differential access to services between neighbourhoods contributes to health
inequities
- direct Impact = access to quality health care services directly influences health by providing medical treatment and preventive care.
- indirect Impact = access to good schools, transportation, and employment opportunities shapes education and income levels, enabling a higher standard of living and health-promoting behaviours
well-served neighbourhoods offer more opportunities for safety, social support, and reduced environmental risks, contributing to better long-term health outcomes.
what are examples of neighbourhood social environments?
- safety and violence
- social connection and cohesion
- local institutions
- norms
how does a neighbourhoods social environment influence health?
- individual’s access to social support, sense of safety, and positive relationships impacts health behaviours
- the quality and strength of social relationships between residents, significantly impacts people’s health
- feelings of mutual trust and connectedness among residents contribute to the overall health of the community
what are the benefits of “close knit” communities?
- more likely to work together to achieve common goals that can directly or indirectly impact health (e.g. cleaner green spaces)
- more likely to exchange information regarding childcare, job opportunities
- greater chance of working together to uphold informal controls to reduce crime or health-damaging behaviours (e.g. smoking, alcohol, littering)
- more willing to intervene for the public good = less crimes
- children are more likely to receive guidance from multiple adults and less likely to engage in health-damaging behaviours (e.g. smoking, drugs, gang)
what are the consequences of “poorly knit” communities
poorly knit communities and more social disorder is has been linked to:
* feelings of isolation lead to anxiety and depression
* reduced sense of safety and more crime
* lack of collective action to address local issues
* lack of healthy role models
* negative health-related behaviours among residents
* poorer subjective wellbeing
what is the relationship between neighbourhood cohesion and crime?
there is an INVERSE relationship
- greater social cohesion = less crimes
- less social cohesion = more crimes
*may be due to a neighbourhoods social and economic advantage/disadvantage
how is neighbourhood safety linked to well-being?
- high crime neighbourhoods cause chronic stress and anxiety
- children in unsafe neighbourhoods experience higher levels of trauma
- fear of violence restricts outdoor activities and social cohesion
what were the results of the “Moving for Opportunity” study?
the Moving for Opportunity” study allowed families to move from high-poverty to low-poverty neighbourhoods
- found moving to high income had beneficial effects on health and social outcomes like:
–> higher rates of college attendance
–> higher earnings
–> reduced likelihood of single parenthood
- However, these positive effects were only true for those under 13 when they moved
- there were also paradoxical outcomes for lower-income individuals who moved to more advantaged neighbourhoods, as they may experience:
–> additional stressors (e.g., cost of living)
–> discrimination and differences by gender
–> pyschological effects of feeling inferior
What are the key findings of the “Moving for Opportunity” study?
- the study emphasized the potential effects of cumulative exposure over time to neighbourhood social and economic disadvantage (or advantage) on health, development, and opportunity
–> prolonged exposure to either disadvantaged or advantaged environments can significantly influence a child’s or adult’s future outcomes. - children under 13, especially very young children, may be particularly vulnerable to unhealthy conditions in neighbourhoods
–> these early-life exposures can have lasting consequences on health and well-being, affecting their development and opportunities later in life
in what ways are children vulnerable to neighbourhood effects?
- advantaged neighbourhood produce better health outcomes later in life
- disadvantaged neighbourhoods lead to worse health outcomes later in life
how do neighbourhoods impact health behaviours?
- access to parks and recreational facilites promotes physical activity and exercise
- prevalence of unhealthy food outlet poorly impacts diet and lead to obesity
- neighbourhood resources may increase risk of smoking and drinking
do people or places matter more for health in a neighbourhood?
- BOTH the neighbourhood environment and the individual characteristics of the residents influence health outcomes
- the physical features, social relationships, services, and opportunities within a neighbourhood can either enhance or constrain people’s exposures and options, which can have lasting consequences for their health and well-being.
what is the relationship between income and neighbourhood?
- poor U.S. families became more likely to live in disadvantaged neighbourhoods with concentrated poverty = worse health
- high-income families became more likely to live in advantaged neighbourhoods with concentrated affluence = better health
what is the relationship between the wealth of a neighbourhood and school performance?
- schools in wealthier neighbourhoods have higher test scores and perform better
- schools in poorer neighbourhoods have lower test scores, and perform more poorly
what groups of people are more likely to live in disadvantaged/poor neighbourhoods?
- individuals or households with incomes at or below the poverty lines
- African Americans, Indigenous and Latino/Hispanics
how does race/ethnic group affect where people live?
- the likelihood of living in a poor neighbourhood varies by a person’s race or ethnic group
- black people and latinos are more likely to live in economically disadvantaged neighbourhoods than White people of similar income
what was the role of Jim Crow laws?
- Jim Crow laws where enacted to deliberately and systemically constrain the rights and opportunities of black people
- Jim Crow laws reinforced racial segregation in all aspects of life, including residential location, schools, transportation, and other public services
how does systemic racism affect who lives in healthy neighbourhoods?
systemic/structural racism refers to systems, laws, and practices that create and maintain racial inequality, often without intentional discrimination
- Jim Crow laws and discriminatory lending practices systematically segregated Black people and other people of colour into disadvantaged neighbourhoods.
- these neighbourhoods often lack basic services, good schools, and job opportunities, contributing to poor health outcomes.
- racial segregation limits upward mobility, leaving people of colour in poor-quality housing with increased exposure to health risks (e.g., lead poisoning, asthma triggers).
examples of discriminatory policies limiting opportunities to live in health neighbourhoods
- redlining and discriminatory lending practices = banks considered the racial/ethnic composition and income level of neighbourhoods to determine mortgage risks, resulting in discrimination against communities of colour
- non-White borrowers were more likely to get high-cost mortgages, leading to higher foreclosure rates in their neighbourhoods
- zoning policies often place industries or commercial spaces (environmental hazards) near poorer neighbourhoods, which are typically home to people of colour.
- gentrification is when wealthier people move into poorer neighbourhoods, raising rents and pushing out low-income residents
what type of interventions would be best to reduce disparities among neighbourhoods?
- both physical and social characteristics of neighbourhoods can influence health directly (e.g., exposure to pollutants) and indirectly (e.g., shaping behaviours
- public health often focuses on individual choices, behaviours, or treatments, but this approach alone is not enough to improve health or reduce disparities
- improving health requires addressing the health-related opportunities and barriers within the places people live, not just individual actions
why is Toronto referred to as the “city of disparities”?
- toronto is becoming increasingly divided by income and socioeconomic status
- toronto is so polarized that is could be described as 3 geographically distinct “cities”
- no longer referred to as “city of neighbourhoods” –> “city of disparities”
- this three-city disparity did not exist before!!!
how does mortality relate to wealth in Toronto?
there may be a correlation between mortality rates and income distribution
- lower income areas of Toronto coincide with regions with higher mortality rates (U shape effect around Yonge street)
- in fact, life expectancy varies by almost 12 years across Toronto neighbourhoods
- may be due to access to health, housing quality, environmental factors, food security etc
what is the “U effect” in Toronto?
- the idea that wealthier communities are concentrated in central area along Yonge street
- poorer communities tend to be scattered along the outskirts in a U shape
what is the demographic distribution of low-income and high-income neighbourhood?
low income = $32,000 average
- 42% non-immigrants
- 40% established immigrants
17% recent immigrants
high income = $102,000 average
- 70% non-immigrants
- 23% established immigrants
- 8% recent immigrants
low-income neighbourhoods are increasingly dominated by visible minorities, while high-income areas have remained relatively white over the years
what are possible interventions to improve disparities among neighbourhoods?
- greater community development initiatives to promote inclusivity and relationships
- increase affordable housing in opportunity neighbourhoods
- reduce environmental hazards
- prioritize economic development by investing in physical and social environments
