Moving poor women to lower-poverty neighborhoods improves their health

>>Jens Ludwig: Starting in the early
1990s, the U.S. Department of Housing and Urban Development sponsored our
Residential Mobility Demonstration, a randomized experiment,
called “Moving to Opportunity.” So MTO operated in five U.S. cities, Baltimore,
Boston, Chicago, Los Angeles, and New York. Women with children living in very disadvantaged
public housing neighborhoods were invited to participate in the program. Families voluntarily joined
and signed up for MTO and then were randomly assigned
in different mobility groups. One group was given no residential
mobility assistance under MTO and other families were randomly assigned
to receive the opportunity to move to less economically disadvantaged
neighborhoods using a housing voucher. Ten to fifteen years after baseline what we
find is that something like seventeen percent of the women in the control group are extremely
obese and about twenty percent of the women in the control group have diabetes. The chance to move from a high poverty to
a low poverty neighborhood through moving to opportunity reduces the rate of
extreme obesity and diabetes for women in the study sample by about one-fifth. Previous researchers have looked at
this question of neighborhood effects on health outcomes and have
raised four candidate explanations for why neighborhoods might
affect obesity and diabetes. One is diet; that is, access to healthy
foods might vary across neighborhoods. The second type of explanation is opportunities for physical activity might
vary across neighborhoods. This could be opportunities for actual exercise,
like differential access to parks and gyms. It could also be more mundane
things, like just having sidewalks in the neighborhood or neighborhood safety. Some of these neighborhoods that families are
living in are just not safe to walk around in. The third kind of explanation that people
have focused on is the possibility that access to medical care might vary across
communities, and a final sort of explanation is that psychological stress,
levels of psychological stress, might systematically differ
across neighborhoods, for reasons like neighborhood safety. There’s growing concern within the medical
community that stress might change diet, might change exercise patterns,
and might affect metabolism. We spend a huge amount on healthcare
in the United States every year. I think one of the things that our study raises
is the possibility that over the long-term, well-targeted interventions at improving
neighborhood environments might be cost-effective compliments to medical
care in reducing obesity and diabetes. [Silence]  

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