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From High to Lower Poverty

Disadvantaged community environments contribute to extreme obesity, diabetes

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October 21, 2011 | by Hilary Hurd Anyaso

EVANSTON, Ill. --- Low-income women with children who move from high-poverty to lower-poverty neighborhoods experience notable long-term improvements in some aspects of their health, namely reductions in diabetes and extreme obesity, according to a new study.

“The study underscores the important role that social and physical environments play in shaping the health of residents of disadvantaged urban neighborhoods,” said Thomas W. McDade, professor of anthropology and Institute for Policy Research (IPR) faculty fellow at Northwestern University.

McDade and Emma Adam, associate professor in the School of Education and Social Policy and IPR faculty fellow at Northwestern, are among the study’s co-authors.

The study was the first to employ a randomized experimental design -- akin to a randomized clinical trial used to test the efficacy of new drugs -- to learn about the connections between neighborhood poverty and health. The study was published Oct. 20 in the New England Journal of Medicine in a special article, “Neighborhoods, Obesity and Diabetes -- A Randomized Social Experiment.”

“The randomized experimental design of the study is a major strength and increases our confidence in concluding that improving the quality of the environments in which people live decreases their risk of diabetes and extreme obesity,” McDade said.

For the study, lead author Jens Ludwig, the McCormick Foundation Professor of Social Service Administration, Law and Public Policy at the University of Chicago, and a team of scholars from around the country studied 4,498 poor women and children, who from 1994 to 1998, enrolled in a residential mobility program called “Moving to Opportunity For Fair Housing” (MTO). The U.S. Department of Housing and Urban Development operated MTO in five cities --  Baltimore, Boston, Chicago, Los Angeles and New York.

The MTO program enrolled low-income families with children living in distressed public housing. Families volunteered for the experiment, and based on the results of a random lottery, were offered the chance to use a housing voucher subsidy to move into a lower-poverty community. Other families were randomly assigned to a control group that received no special assistance under the program.

The study collected information from 2008 to 2010 on families who had enrolled in the program 10 to 15 years before. 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, 17 percent of the women in the study’s control group were morbidly obese (body mass index at or above 40), and 20 percent had diabetes. However, in the group of women who were offered housing vouchers to move to lower-poverty neighborhoods, the rates of morbid obesity and diabetes were both about one-fifth lower than in the control group. “These findings provide strong evidence that the environments in low-income neighborhoods can contribute to poor health,” said Ludwig.

The study’s findings that disadvantaged community environments 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 magnitude of the effects of the experiment are striking, and are comparable in size to the effects on diabetes we see from targeted lifestyle interventions or from providing people with medication to prevent the onset of diabetes,” McDade said.

In the paper, the authors write that 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, and that minorities are also more likely than whites to live in distressed areas.

The study was supported by HUD, the National Science Foundation, 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.

The study’s co-authors, along with Ludwig, Adam and McDade, are Stacy Tessler Lindau (University of Chicago); Lisa Sanbonmatsu (National Bureau of Economic Research); Lisa Gennetian (Brookings Institution); Greg Duncan (University of California, Irvine); Lawrence Katz (Harvard University); Ronald Kessler (Harvard Medical School); Jeffrey Kling (Congressional Budget Office); and Robert Whitaker (Temple University).