This section includes articles that provide conceptual frameworks for
understanding links between neighborhood factors and health, summarize
evidence on these links, and discuss implications for future research,
practice, and policy.
Most of the conceptual frameworks on neighborhoods
and health focus on the intersection of 1) neighborhood social relationships
and norms; 2)
community institutions and services; 3) direct environmental factors
(such as exposure to air pollution) and indirect environmental factors
that influence
behavior (such as access to healthy foods); and 4) broader structural
issues that affect the neighborhood. Several of the frameworks highlight
how these
factors may operate differently at different points in the life-course,
and how the effects of neighborhood factors accumulate to affect health
over time.
Some of the literature also describes methodological challenges in studying
links between neighborhoods and health, which include 1) distinguishing
between neighborhood and individual effects; 2) accurately measuring
neighborhood characteristics and health outcomes; 3) capturing nonlinear
effects; and
4) distinguishing association from causation.
Given the relationship between
neighborhoods and health, many of the authors discuss the need for intervening
to change environments to
improve health. These interventions, the authors suggest, could take
the form of neighborhood-level community development strategies,
comprehensive place-based strategies, and public policies.
The
California Campaign to Eliminate Racial and Ethnic Disparities in Health. Health for all: eliminating racial and ethnic health disparities. Washington
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Dannenberg AL, Jackson
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IG, Dillman K, Mijanovich T. Neighborhood effects
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2001;23:391-408.
Ellen,
IG, Turner MA. Does neighborhood matter? Assessing recent evidence. Housing
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Fitzpatrick K, LaGory M.
Unhealthy Places: The Ecology of Risk in the Urban
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N, Hochstein M. Life course health development: an integrated framework
for developing health policy and research. Milbank Quarterly.
2002;80:433-479.
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of Medicine. Neighborhood and community. In: Shonkoff J, Phillips DA, ed.
From neurons to neighborhoods: the science of early childhood development. Washington, DC: National Academy Press; 2000;328-336.
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of Medicine. Promoting health: intervention strategies from
social and behavioral
research. Washington, DC: National Academy Press; 2000.
Kaplan
GA. What is the role of the social environment in understanding inequalities
in health? Annals of the New York Academy of Sciences. 1999;896:116-120.
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S, Maciver S, Sooma A. Area, class, and health: should we be focusing on
places or people? Journal of Social Policy. 1993;22:213-234.
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JM, Williams-Russo P, Knickman, JR. The case for more active policy attention
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National
Research Council. Equality of opportunity and the importance of place:
summary of a workshop. Iannotta J, Ross I, ed. Washington, DC: National
Academy Press; 2002.
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Reducing health disparities through a focus on communities. Oakland: PolicyLink;
2002.
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IH, Syme SL. The social environment and health: a discussion of the epidemiologic
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