Neighborhood & Environment Programs & Support - What's Working & Trending? SDoH Series, Part 3

Following the Healthy People 2030 model, this article series focuses on the 6 aspects of social determinants of health, including food insecurity, economic stability, neighborhood and the physical environment, education, community, social support, and healthcare access. Here we'll discuss the impact of one's neighborhood on health and wellbeing with examples of national and regional programs that are making a positive impact.

How do neighborhoods impact health?

Imagine a neighborhood without sidewalks. Or a neighborhood park that seems abandoned or appears unsafe. In this scenario, the drinking water may contain contaminants, and the air is thick and hazy with exhaust fume pollution from a nearby freeway. There is extensive concrete and scarce trees, which means the area gets especially hot and uncomfortable during summer months. There is just one convenience store with packaged food products and several fast-food restaurants. In this neighborhood, transportation may be a challenge to those who don't own a car.

Now, envision another neighborhood. The air is clean and several well-lit, treed parks with walking and bike paths are convenient to one's home. Close by, several grocery stores with plentiful fresh fruits and vegetables as well as a weekend farmer's market mean the kitchen is regularly stocked. There are good public schools and public transportation and a pharmacy that offers vaccinations.

When comparing these scenarios, it's easy to see why public health experts have long said that your ZIP code may be the most telling indicator of your health—and even your lifespan. One's address reflects the daily living conditions that can create or reduce opportunities to make healthy choices.

Uneven access to safe, healthy neighborhoods

In the US, many people live in places with high rates of violence, unsafe air or water and other health or safety risks, says Healthy People 2030, a government initiative to improve health and safety through data-driven objectives.

People from racial and ethnic minority groups as well as people with low incomes are more likely to live in places with these health and safety risks, Healthy People notes. Addressing the social determinants of health (SDoH), or the nonmedical factors that influence health outcomes, on a neighborhood level is vital to improving wellbeing and increasing equity.

An increased focus on SDoH

Throughout the country, there is an increased awareness of the role one's neighborhood plays in creating health gaps. The COVID-19 pandemic—and the social inequities it lay bare—only heightened the importance of understanding and addressing these root causes of health gaps.

“Collectively, we should recognize the possibilities of this moment and seize the opportunity to support population health and health equity," wrote authors of a recent viewpoint article in The Lancet Regional Health -Americas.

Transportation access impacts health

Reliable access to safe and adequate transportation can have a big impact on a community's health. That's because transportation access can affect how or even if people can travel to work, school, and healthcare appointments. Each year, 3.6 million people forego medical care because they lack transportation says the American Hospital Association (AHA) in a briefing examining transportation's impact on health.

The AHA offers innovative examples of health systems that are acknowledging this interaction and working to improve patients' transportation access. These include:

• CalvertHealth Medical Center's Mobile Health Center in Southern Maryland, which provides primary and preventive care services to residents with transportation challenges
• Denver Health Medical Center's collaboration with Lyft to order rides for patients in need to and from the hospital
• Southern Vermont-based Grace Cottage Family Health & Hospital partnership with Green Mountain RSVP in a volunteer, neighbor-to-neighbor driver program.
• Central Kentucky's Taylor Regional Hospital's hospitality van service for patients

Aging presents distinct challenges

Older adults are deeply affected by the places in which they live. From access to prescription medications to affordable housing, one's environment can greatly impact the ability to age in place, a term used for residing in one's home. According to AARP, nearly 90% of adults over age 65 prefer to age in place.

The ability to do so, however, may be limited by neighborhood characteristics and offerings. For example, chronic health conditions might require ongoing medical appointments, a challenge if driving oneself is no longer an option. The transition away from driving can be especially challenging for older adults in rural communities with little affordable public transportation options.

The built environment can also influence whether an older adult can access healthy food options and stay active. Safety and walkability of neighborhoods can present additional risk and challenges on the aging body.

Assessing older adults' needs

Understanding the distinct SDoH that impact older adults' health was part of the goal of the Aging Hub of the 100 Million Healthier Lives, a collaborative that brought together wide-ranging agencies to promote health and wellbeing. The group created an assessment that could be used to better understand what influences respondents' physical and mental health. Measuring these factors is key in applying resources to services and programs that address these needs.

Senior centers and other organizations have used the resulting toolkit to gauge whether services are meeting community needs. For example, the Baltimore County Department on Aging used thousands of assessment findings to make changes at 20 senior centers. They were able to identify places with low scores in socializing and exercise opportunities and add more options in those locations.

Addressing gaps for rural residents

Transportation challenges aren't limited to older adults, especially in areas without widespread affordable public transportation. Rural residents who don't own a vehicle often are especially impacted by transportation hurdles, explains The Rural Health Information Hub. Among the innovative ways to reach people where they live, the Hub offers examples including:

• Carpool and Ride Share Programs: Vanpooling programs typically include a van, resources for starting a vanpool, and help with recruitment efforts.
• Volunteer Models: Programs such as The Vernon County Volunteer Driver Program provides door-to-door services to county residents. Another example: The New Freedom Transportation Program in Wisconsin, which uses volunteer drivers to provide rides to the elderly and people with disabilities.

Increasing access to green spaces in neighborhoods

Another key aspect of one's neighborhood that can influence health is the prevalence or scarcity of urban green spaces. Along with providing an outdoor space for physical activity and fresh air, green spaces reduce the impact of heat-islands, which are urban areas that experience higher temperatures than surrounding areas.

Proximity to safe, well-appointed parks can also improve a community's sense of social cohesion, resulting in mental health wellbeing as well, findings documented in the International Journal of Environmental Research and Public Health. More green spaces are also associated with mental restoration, reduced stress and better air quality.

Efforts to increase green space include:

• A local effort reclaimed a contaminated urban corridor and created Unity Park in Richmond, California.
• Numerous communities across the county are creating digital heatmaps in an effort to document—and ultimately address—which areas experience heat islands.
• A local nonprofit is improving the tree canopy by harvesting rainwater in Tucson, AZ.

Housing instability impacts health

From trouble paying the rent to overcrowding and moving often, housing instability can impact one's physical and mental health. In the US overall, 37.1 million households were cost burdened as of 2019, with 17.6 million households severely cost burdened, a description that refers to spending more than 30% of income on housing.

Persons living in historically marginalized communities are more likely to be cost burdened, describes a report from the Joint Center for Housing Studies of Harvard University.

Understanding the role of racist policies

The practice of red-lining, or racist housing policies that blocked Black and other communities of color from accessing mortgages, is just one example of discriminatory housing practices, points out the Urban Institute in a 2023 report. A wide range of discriminatory practices have contributed to the Black/White housing ownership gap as well as persistent obstacles to stable housing, such as evictions.

Other practices that harmed historically marginalized communities include:

• Housing discrimination ordinances and racial covenants, which restricted Black persons and other historically marginalized groups from living in certain neighborhoods
• Racial steering, or directing Black home buyers or renters toward some neighborhoods and away from others

Addressing this racist legacy isn't as simple as focusing housing resources on formerly red-lined areas. Many of the people most harmed by these discriminatory policies no longer live in the same places.

How can we improve housing stability to impact health?

The COVID-19 pandemic increased support of housing stability policies among US adults, especially among people who acknowledged racial inequities in housing, according to the findings published in the American Journal of Preventative Medicine.

In 2022, the Biden Administration announced a series of specific actions and steps designed to address the country's housing shortages and “ease the burden of housing costs."

More broadly, The Brookings Institute outlines 3 key measures to direct policymakers and housing advocates in improving housing stability.

1. Increasing the amount of long-term affordable rental housing
2. Protecting existing affordable housing from physical deterioration
3. Supporting affordable housing projects that faced financial obstacles during the pandemic

Environmental factors impact a neighborhood's health

Environmental factors, such as air pollution and uneven access to healthy drinking water, too often plague historically marginalized communities. There have been some noteworthy efforts to address environmental hazards that arise from shuttered industrial or manufacturing sites that may still release contaminants, places known as “brownfields."

• Growing Change is a North Carolina program that turned a former prison into a sustainable farm and community resource center.
• The New Hampshire Department of Environmental Services addressed poor water quality in private wells by identifying and addressing the barriers that kept users from testing and improving water quality.
• A Mississippi project addressed environmental barriers to health, including former gas station storage tanks that were leaking at the site of a family medical clinic.
• The Biden Administration has prioritized replacing lead pipes as part of the Infrastructure Law, an effort to ensure families and children aren't exposed to the toxin through drinking water.

Focusing on intersecting factors in neighborhoods

The SDoH that impact someone's neighborhood overlap with a myriad of other factors, making the impact of geography hard to study in isolation. For example, the relationship between food insecurity and housing instability are “highly correlated," points out researchers in the Journal of the Academy of Nutrition and Dietetics. Similarly, researchers have investigated the association between neighborhood residential instability and access to healthcare.

A growing recognition of the interconnectivity of SDoH has spurred more collaborations between public health and community development efforts, explains a report from Build Healthy Places Network: “As community development has placed more emphasis on people and as the health sector has increasingly recognized the importance of places, the commonalties across these sectors have become clearer."

A "one-stop shop" approach to SDoH

An example of addressing these commonalities comes from a Maryland effort to improve child wellbeing by focusing on multiple SDoH: incarceration, employment, nutrition, and housing. A Health Affairs report also describes how some states used coronavirus-related relief funds to address multiple social needs in “one stop shop" approach.

As more attention is dedicated to SDoH, successful interventions may rely on understanding the interconnectivity of various variables, say researchers who published these findings in JAMA Network Open.

RTI Health Advance can guide you

RTI Health Advance can help you understand the impact of programs designed to address SDoH, and the complex interaction between factors such as environment, food, transportation and healthcare access. Our experts are well versed in the latest research and evidence-based practices and can help you develop innovative, effective, and measurable interventions and strategies to address SDoH and improve health equity.