The New Health Dialogue

Image via bluekdesign. CC: BY-NC-SA

We've talked before on the blog about how where you live can have a huge effect on the kind of medical care you get. Unsurprisingly, it also affects how healthy you are to begin with.

A new study from the New England Journal of Medicine reports the results of a three-year randomized trial performed by the US Department of Housing and Urban Development (HUD). According to the study, people who live in lower-poverty areas are somewhat less likely to become obese or develop diabetes than those in higher-poverty areas.

The study was most notable for its methodology. The families in the study were all headed by women, with children under 18 in the household, and were drawn from public housing in cities across the country. Eligible families who applied were randomly selected to receive a standard housing voucher, a voucher that was only usable if they moved to a low-poverty area (a census tract with a poverty rate of 10 percent or lower), or no voucher. Because the families were drawn from comparable populations and randomly assigned vouchers for low-poverty areas or not, it's unlikely that the obesity effects of living in lower-poverty areas were the result of pre-exisitng motivation to leave their area or to stay fit.* That design allows the researchers to look at health differences based on where the participants in the study lived separately from the health effects of additional income from the voucher.

The study doesn't draw specific conclusions about why the people who moved to lower-poverty areas were less likely to be obese, but it notes several possibilities. People living in wealthier areas may feel safer and thus be more likely to exercise and spend time outdoors; they may be less stressed; they may have better access to healthy food choices; and they may see more healthy-weight people and be socially discouraged from becoming obese. All are probably true to some extent. This study provides an important window into those effects.

[A brief comment: Public health advocates drew some of their strongest justifications for anti-smoking regulations from the discovery of the negative health effects of secondhand smoke on non-smokers. This finding may be a first step toward demonstrating that obesity has similar negative health effects on healthy-weight people. Further study of those effects is critical to determining the gravity of our national obesity problem, and the ways that we should try to combat it.]

*The calculations of reduced obesity were based on having the opportunity to move, so families offered that voucher who didn't move were included in that group's obesity statistics.