In my last blog post I mentioned the five categories of Social Determinants of Health (SDoH) that have been identified by Healthy People 2030. They are: 1) our neighborhoods and built environments, 2) health and health care, 3) social and community context, 4) education, and 5) economic stability.1 Today I want to talk about our neighborhoods and built environments, and the impacts – both good and bad – they can have on our health outcomes.1
According to the Centers for Disease Control (CDC), a built environment includes “all of the physical parts of where we live and work.” This includes things like houses, roads, parks and other open spaces (or lack thereof), and infrastructure.2 Think about where you live right now – does your neighborhood have sidewalks or a bike path? Is there a park or playground nearby? Is the air often polluted because of nearby construction? How close are you to the highway, or to a grocery store? How far would you have to drive to go on a hike?
Where you live, and what surrounds you, matters. Historically, minority groups have been more likely to live in disadvantaged neighborhoods as a result of “historical racism in housing practices” and have suffered for it.3,4 According to the Robert Wood Johnson Foundation, “neighborhood differences can create and reinforce social disadvantages that contribute to health disparities along socioeconomic, racial or ethnic lines, given disproportionate access to resources and exposures to conditions that are harmful to health.”4
Take for instance, Elyria Swansea, one of Denver’s oldest neighborhood situated in a heavily industrialized part of the city; considered by some to be located in one of the most polluted zip codes in the nation. According to a 2017 study by ATTOM Data Solutions, the 80216 zip code ranked highest in the “10 highest total Environmental Hazard Housing Risk Index.”5 It is home to the Purina Dog Chow Plant, Suncor Oil Refinery, two superfund sites, and the I-70 expansion project currently underway, all of which contribute to the poor living conditions in the area.6,7
A 2014 Health Impact Assessment found that the top five health concerns impacting Elyria Swansea residents were: environmental quality, connectivity and mobility, access to goods and services, community safety, and mental wellbeing.8 It also found that residents, who are largely Hispanic, “suffer from some of the highest rates of cardiovascular disease, diabetes, obesity and asthma in the City.”7 In Elyria Swansea, the rate of asthma hospitalizations was 1,113.12 per 100,000 people.9 Now compare that to a wealthier and better situated neighborhood like Washington Park West, whose residents are not impacted by highways, constant construction, and environmental pollutants. The rates of asthma hospitalizations in this part of Denver were less than one quarter of the rate in Elyria Swansea; the difference is alarming.9
So many factors play into our overall health, and where we live is a big one. Being armed with this knowledge is critical for implementing targeted and effective interventions and ensuring that our members receive the right resources and support.