NEIGHBORHOODS AND HEALTH: AN INTRODUCTION
The neighborhoods where we live, work, shop, and socialize can influence our health outcomes and health behaviors. In this chapter, we will discuss evidence suggesting that neighborhoods can influence a wide range of health outcomes and health behaviors. Here, as Duncan and Kawachi do in their recent textbook on the topic, we defined “neighborhoods” as “geographical places that can have social and cultural meaning to residents and nonresidents alike and are subdivisions of large places” (p. 1).1 The purpose of the current chapter is to provide an overview of select methodological and substantive areas in the field of neighborhoods and health research.
We suspect that neighborhoods emerged as an important area of interest for population health research and policies because historical and contemporary research focused on individual-level factors does not fully explain population health outcomes and health disparities. With that said, the field of neighborhoods and health has been in existence for many decades. Louis Rene Villermé, for example, created maps that showed socioeconomic disparities by neighborhood and mortality in Paris as early as 1830. Another one of the earliest (and oft-discussed) investigations of neighborhoods and health is that of John Snow. In 1854, Snow drew a dot map of cases of and deaths from cholera, which identified the source of cholera as the infamous Broad Street pump in the Soho neighborhood in London. This was antithetical to the predominant miasma theory of the time, which suggested that cholera was spread through “bad air.” The early research of Snow and Villermé demonstrates that neighborhood health has always been a critical, albeit under-researched area of public health. Not only do neighborhoods serve as the basis of daily life, but they also provide opportunities for important public health interventions. Snow’s findings helped foster the eventual consensus that infectious disease outbreaks are traceable, and must be targeted at their physical source. Furthermore, Villermé’s data on neighborhood—specific mortality rates provided a basis for understanding the syndemic nature of concurrent health outcomes. These historical examples are just two of many that predate the first textbook on the field, published in 2003.2 Since its publication, there has been an ever-growing number of studies in epidemiology and public health that focus on neighborhoods.
There is a wide range of neighborhood characteristics one can study, including two broad categories: the built environment and the social environment. The built environment includes all types of physical elements of neighborhood such as access to and attractiveness of destinations (such as parks and stores) and community design features. The location of the Broad Street pump would be an example of a built environment characteristic. The social environment—on the other hand—includes features such as spatial stigma, socioeconomic disadvantage, the social networks of neighbors who can provide social support, collective efficacy, and neighborhood safety.
When connecting built and social environmental characteristics of neighborhoods to health outcomes and health behaviors, ...