Neighbors Matter
What about problems like drug use or obesity? Are these problems just a matter of bad decision-making, which can’t be repaired by bringing access to preventive services to someone’s home? An abundance of research suggests that the quality of a neighborhood truly matters for these problems: a recent New England Journal of Medicine study showed that when people are randomized to live in low-income housing in a low-income neighborhood, versus similar housing in a higher-income neighborhood, the latter group reduced their rates of obesity in spite of having the same socio-demographic characteristics as the former group (possibly because of easier access to grocery stores and safe parks to exercise in). The same trends appear to apply to substance abuse as well; a neighborhood’s influence on health includes the likelihood of becoming a drunk or getting addicted to drugs.
Source: Sanjay Basu blog post, “Should Doctors Make House Calls?“
Interesting. But even if true, we can’t all have the same neighbors.
Hillary Clinton wrote the book, It Takes a Village [to raise a child]. Maybe some busybody can write a book titled… It Takes a Neighborhood [to prevent obesity]. I would like to write a book It Takes Some Willpower and a Gym Membership [to prevent obesity].
The solution to obesity isn’t sprinkling low-income housing in neighborhoods that are far more affluent than the low-income residents can afford to live in. This sounds similar to other misguided policy proposals that purport a whole host of benefits from injecting poor people into affluent areas. In the 1990s, advocates wanted to force the Dallas Housing Authority to build low-income housing units in high-income areas of North Dallas.
There were three groups: one group assigned to public housing–one wonders what the human subjects ethics board was doing–one group given a traditional housing voucher, and one group given a housing voucher but only allowed to use it if they located in a census tract with less than 10% of the residents below the federal poverty level.
Differences in BMI were fairly minor. At “10 to 15 years of follow-up,” the census tract group had a percentage of people with BMI of 35 or more that was 35.5 percent. The census tract percentage was 4.6 percentage points less than that. The percentage of people with BMI of 40 or more in the control group was 17.7 percent, the census tract percentage was 3.4 percentage points lower.
Only 48 percent of the people assigned to use the census tract vouchers used them.
This is not evidence that those who would have experts dictate who lives where in the name of public health.
Oops. Typo in post above. Should read ‘At “10 to 15 years of follow-up,” the control group had a percentage of people with BMI of…’
@Buster.
You know home owner associations and property owners in those affluent areas had something to say about that. It was a total recipe for disaster.