In a new scientific statement, to be published in a forthcoming 2020 issue of the journal Circulation: Cardiovascular Quality and Outcomes, a group of researchers looked at how health is affected by four dimensions of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment. “Housing is one of the most prominent social determinants of cardiovascular health,” says Mario Sims, PhD, the chair of the writing group for the scientific statement, the chief science officer of the Jackson Heart Study, and a professor in the department of medicine at the University of Mississippi Medical Center in Jackson. “The four categories we identified are a comprehensive window into the elements of housing and how those elements affect health.” The researchers noted that people who have difficulty finding permanent housing, move frequently, or feel pushed out of their homes by gentrification are more likely to suffer from hypertension, heart attacks, strokes, and heart failure. One study that Dr. Sims and his team drew attention to found that homeless adults experience 60 to 70 percent higher rates of cardiovascular events compared with the general population. Sims and his team said the risk of heart disease and stroke was also higher for people who had permanent homes but lived in buildings plagued by structural and engineering problems, like insufficient heat, poor ventilation, mold, or too much dampness. “In addition to those problems, the legacy of discrimination and where minorities could live meant they were in proximity to highways and factories, which spew air pollution,” says Sims. “It also meant less walkability in those neighborhoods and an absence of fresh, healthy food from greengrocers. Those all contribute to a higher incidence of cardiovascular risk factors, like obesity and diabetes.” RELATED: Lifetime Discrimination May Increase Risk of Hypertension
Structures and Policies Can Have a Negative Effect on Community Health
While gentrification often leads to an influx of new money followed by improved housing, as well as grocery stores, farmers markets, and healthy food options, Sims and his team found that the improving neighborhood actually had a negative health consequence for its longtime residents. In two studies that they reviewed, one from 2019 in SSM Population Health, and the other from 2016 in the Journal of Urban Health, African Americans in gentrifying neighborhoods reported higher levels of stress and worse health than African Americans in areas that were not gentrifying. “The economic benefit of gentrification drives up rents, and that can lead to stress and anxiety for people struggling to make ends meet,” says Sims. The psychological anguish of losing your home wreaked havoc on the health of minority communities during the foreclosure crisis that ran from 2007 to 2010. One study that Sims and his team included in their review, from BMC Public Health in 2019, found that Hispanic Americans in neighborhoods with high rates of foreclosure had higher blood pressure and higher cholesterol than Hispanics in areas that were less hard-hit. Another study in the statement, from a 2015 issue of the American Economic Journal, found a link between foreclosures and higher rates of heart attacks in middle-aged African American men. “This is very important work because it helps people understand the role of forces outside an individual’s control,” says James Johnson, PhD, a distinguished professor at the Kenan-Flagler Business School at the University of North Carolina in Chapel Hill. “We can’t just look at the stereotypical lens of diet and exercise in evaluating community health, but we have to look at the structures and policies that undergird pathways to health.” To that end, Sims would like to see additional research that looks at how interventions for families and neighborhoods affect health. “In this realm, we have a lot of studies about homelessness, but not a lot of research on the efficacy of interventions or best practices in housing,” he says. “The solutions are a considerable challenge though, since there are no quick fixes and entire systems need to be remodeled and redesigned.” Dr. Johnson echoed the sentiment that researchers need more data on how community health initiatives and fair-housing practices are affecting health outcomes. “To do that, we need to understand and address the discriminatory policies and barriers that created those conditions where people were forced into homes and neighborhoods that are harmful to their health,” he says. “Then we need to figure out innovative solutions that intertwine the various disciplines like medicine, business, and law, since these issues are all connected,” Johnson adds.
