It's a Beautiful Day in This Neighborhood: Mr. Rogers Had It Right

One of the reasons that retail health clinics have been so successful is that they are located in neighborhoods. Their convenience makes them an attractive venue for nearby patients to seek health care. Two recent studies indicate that retail health care providers would be wise to understand their surrounding neighborhoods and advocate for improvements in those neighborhoods to improve patient health.

The first study, conducted by researchers from the University of Southern California in Los Angeles, California, looks at perceptions of neighborhood disorder and cohesion. It indicates that less cohesive neighborhoods are host to residents with greater cardiometabolic risk, a risk that persists over subsequent years.

This study, published in the journalSocial Science & Medicine, found that factors predictive of neighborhood disorder including street trash, vacant buildings, crime, and vandalism have considerably more influence on health than we tend to believe. Residents of such neighborhoods often feel threatened in subtle ways, and fear leads to negative psychological risk factors, poor self-reported health, and increased incidence of chronic health conditions. These neighborhoods are also more likely to have fewer places where residents can congregate and develop relationships.

Conversely, cohesive neighborhoods often encourage reciprocity among group members and are associated with better self-reported health.

The researchers reported that lower levels of cohesion significantly increased cardiometabolic risk, which persisted over 4 years. In part, they attributed the increased risk to a decreased likelihood of exercise and increased anxiety levels.

A second study, conducted by researchers at the Center for Outcomes Research and Education in Portland, Oregon, looked at neighborhood characteristics, but in this case, they conducted a twin study. They acknowledged previous work that shows that neighborhood environment affects mental health profoundly. However, to reduce confounding factors, they looked at 3738 same-sex twin pairs.

Their results showed that socioeconomically-deprived neighborhoods tend to be associated with greater depression. In twin sets where 1 twin was depressed and the other was not, the magnitude of association between neighborhood deprivation and depression was significant. This association persisted even when the twins had similar incomes and when their residential stability was approximately the same.

These studies shed light on the importance of good, secure, safe neighborhoods. It adds to the growing body of literature that tells us that social determinants of health are probably as important as, or even more important than, our interventions. Health care practitioners need to lobby to improve neighborhoods across the nation.

References

Cohen-Cline H, Beresford SAA, Barrington WE, et al. Associations between neighbourhood characteristics and depression: a twin study. J Epidemiol Community Health.2017 Dec 22. pii: jech-2017-209453. doi: 10.1136/jech-2017-209453. [Epub ahead of print]

Robinette JW, Charles ST, Gruenewald TL. Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk.Soc Sci Med.2017 Dec 18;198:70-76. doi: 10.1016/j.socscimed.2017.12.025. [Epub ahead of print]