Another study is adding to growing evidence that the condition of a neighborhood can have a significant impact on its residents' health.
The latest by the Joint Center for Political and Economic Studies and Equity Matters Inc. found that people living in Baltimore's lower-income neighborhoods had worse health outcomes than those in its more affluent areas.
Life expectancy varied by as much as 30 years between the city's poorest and wealthiest neighborhoods between 2005 and 2009, the study found. People lived longest in the greater Roland Park area in North Baltimore, 86.3 years, and shortest in Upton/Druid Heights, 56.7 years.
Because Baltimore has significant patterns of segregation, health disparities often align by race. For instance, in 2007 the premature death rate in Baltimore for blacks was 1.8 times higher than for whites.
Many characteristics of a neighborhood play a role in health outcomes, including access to medical care and healthful foods and exposure to violence and environmental hazards, the study found.
If residents don't have green space to walk and play, they may not get the physical activity they need, the study suggested. If there are no adequate grocery stores, they cannot buy fruits and vegetables. Exposure to lead, rodents and mold in the home can lead to asthma and other problems.
"Certain neighborhoods have burdens that are reflected in their health," said Michael Scott, president and co-founder of Equity Matters Inc., a Baltimore group that promotes health equity. "Certain neighborhoods have certain benefits and privileges and that is what their health looks like."
The roles race and neighborhoods play in health have become a focus of the health debate in recent years.
The Joint Center for Political and Economic Studies, a D.C.-based think tank that focuses on issues of concern in the African-American community, has studied health disparities in several cities over the years through its Place Matters program.
Maryland health officials are in the process of establishing enterprise zones to improve healthcare in the state's minority areas. The program will offer tax breaks and other incentives to doctors and community groups for working in these underserved areas. The zones come after a 2006 report found disparities in the state cost Medicare an extra $26 million annually.
The Baltimore City Health Department released a study last year that showed significant differences in social factors in neighborhoods that lead to health differences among residents. The city is using the data to try to tackle health problems neighborhood by neighborhood, including using zoning laws to reduce the number of liquor stores in poor neighborhoods.
The study by Equity Matters and the Joint Center for Economic Studies found that years of systematic discrimination, including redlining, that lead to segregated neighborhoods, have resulted in generations of African-Americans living in conditions that lead to bad health.
"Historically, people of color have been relegated to isolated and segregated communities that perpetuate cycles of hardship through poor schools, limited employment and housing opportunities, and lack of access to capital," the study's authors wrote. "Because of this, the extent to which an area is racially segregated can impact the health outcomes of its residents."
Like many other studies, the authors of the latest say a multifaceted approach to ending health disparities needs to be taken — bringing together residents, policy makers, the medical community and social services and advocacy groups.
The study recommends encouraging investment in poor communities and adopting land-use policies to increase the availability of affordable housing in poor neighborhoods. It also calls for keeping children in school and out of the criminal justice system by favoring peer mediation and school-based courts over expulsions and incarceration.
Education is a major factor in health outcomes, the study found. Neighborhoods with better-educated residents had fewer health problems, the study found. Fewer than 5 percent of residents in Cherry Hill, Sandtown-Winchester and other neighborhoods had college degrees. These neighborhoods also had many residents with poor health.
Scott said residents are the most important piece to improving health outcomes in a neighborhood and need to be involved in the process of improving their communities.
"The community should have a voice in housing and education and health care," Scott said. "They should be vocal and active and aware. That is the hallmark of a healthy community. That is because they feel empowered and have less chronic stress. It is important to have the right policies, but if the community isn't involved in making sure these policies come to life, they ultimately will not be healthy."
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