Low-income women with children who moved from high-poverty to lower-poverty neighborhoods experienced notable long-term improvements in aspects of their health; namely, reductions in diabetes and extreme obesity, according to a new study by researchers at the University of Chicago and partner institutions.
The New England Journal of Medicine recently published the study in a special article, "Neighborhoods, Obesity and Diabetes -- A Randomized Social Experiment." Lead author for the collaboration was Jens Ludwig, the McCormick Foundation Professor of Social Service Administration, Law and Public Policy at University of Chicago.
Ludwig and a team of scholars from around the country studied 4,498 women and children who lived in public housing in distressed census tracts and who enrolled in a residential mobility program called Moving to Opportunity (MTO) between 1994 and 1998. The U.S. Department of Housing and Urban Development operated MTO in five United States cities--Baltimore, Boston, Chicago, Los Angeles and New York.
Through the MTO program, families could volunteer to participate in a random lottery. Based on the lottery outcome, some volunteers received a rent voucher to move into a higher income census tract and were given counseling for moving. Other families either received a traditional voucher with no requirements regarding their housing location choice or retained routine support available in public housing.
During 2008-2010, the study collected information on families which had enrolled in the program 10 to 15 years earlier. The research team directly measured the heights and weights of MTO participants, and it also collected blood samples to test for diabetes.
At the time of follow-up, the rates of both morbid obesity and diabetes for the women who moved to the higher income census tracts were about one fifth lower than in the other two groups of women. In those groups, 17 percent of the women were morbidly obese with a body mass index at or above 40, and 20 percent had diabetes.
"These findings provide strong evidence that the environments in low-income neighborhoods can contribute to poor health," said Ludwig.
The research team included another University of Chicago faculty member, Stacy Tessler Lindau, associate professor in obstetrics and gynecology, who is also an expert in urban health. "Obesity and diabetes are among the biggest health problems facing our country, and they are preventable. But preventing these conditions through interventions that target individual behavioral change has proven very difficult," she said.
"This study shows that where a woman lives with her children may, in part, determine whether she develops serious, costly, life-shortening diseases like diabetes and extreme obesity. Giving a low-income woman the opportunity to move with her children to a less impoverished neighborhood appears to lower her risk of diabetes and extreme obesity," said Tessler Lindau.
Disadvantaged community environments that contribute to extreme obesity and diabetes could help explain the increase over time in these health problems. The study's findings could also help explain disparities in obesity and diabetes prevalence across race and ethnic lines in the United States.
"The increase in U.S. residential segregation according to income in recent decades suggests that a larger portion of the population is being exposed to distressed neighborhood environments," they write in the paper. "Minorities are also more likely than whites to live in distressed areas."
"These results highlight the great importance of learning more about what specific aspects of the social or physical environment reduce the risk of diabetes and obesity; for example, greater access to grocery stores, more opportunities for physical activity or feelings of greater safety and reduced psychological stress," said Ludwig.
"Given that diabetes and obesity are associated with a large number of health complications and higher cost for medical care, the findings from this study suggest that improving the environments of low-income urban neighborhoods might improve the duration and quality of life for the residents and lower health care expenditures," said Robert Whitaker another study co-author and professor of Public Health and Pediatrics at Temple University, who is an expert on obesity and diabetes.
The study was supported by HUD, the National Science Foundation (NSF), the National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, the National Institute of Mental Health, the National Institute on Aging, the Institute of Education Services at the U.S. Department of Education, the John D. and Catherine T. MacArthur Foundation, the Smith Richardson Foundation, the Spencer Foundation, the Annie E. Casey Foundation, the Bill and Melinda Gates Foundation, the Russell Sage Foundation and the Robert Wood Johnson Foundation.
"NSF's Social and Economic Sciences Division (SES) welcomes opportunities to provide support for research which delivers high impact jointly with other agencies," said SES Division Director Rachel Croson. "This study demonstrates how basic social and economic science research can contribute to improving the health of women and children in major U.S. cities. It makes evident that personal, individual outcomes are tied in with the social and economic environments in which people reside."
Joining Ludwig, Lindau and Whitaker in writing the paper were Lisa Sanbonmatsu, National Bureau of Economic Research; Lisa Gennetian, Brookings Institution; Emma Adam and Thomas McDade, Northwestern University; Greg Duncan, University of California, Irvine; Lawrence Katz, Harvard University; Ronald Kessler, Harvard Medical School and Jeffrey Kling, Congressional Budget Office.
- Jens Ludwig, Lisa Sanbonmatsu, Lisa Gennetian, Emma Adam, Greg J. Duncan, Lawrence F. Katz, Ronald C. Kessler, Jeffrey R. Kling, Stacy Tessler Lindau, Robert C. Whitaker, Thomas W. McDade. Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment. New England Journal of Medicine, 2011; 365 (16): 1509 DOI: 10.1056/NEJMsa1103216
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