For quite some time, social scientists have noted people living in impoverished, racially segregated neighborhoods are more likely to be obese and diabetic than people from integrated, less impoverished neighborhoods (even after adjusting for known predispositions for obesity and diabetes).

Is it the neighborhood that makes people fat and obese? Perhaps poor and segregated neighborhoods—lacking grocery stores and safe streets to exercise on, to start—doom people to obesity and diabetes? Or is it the other way: The sort of person who would be lazy and inept enough to live in a poor and segregated neighborhood lazy and inept enough to be doomed to obesity and diabetes.

A study recently published in the New England Journal of Medicine randomized a few hundred people living in poor, segregated neighborhoods in the United States to receive no housing help, a housing voucher to move and live anywhere they want, or a voucher limited to neighborhoods with low levels of poverty.

Ten years later, the people randomized with vouchers for less impoverished neighborhoods had (statistically significantly) much lower rates of obesity and diabetes as compared to those randomized to receive no voucher to move. Compared to people who received unrestricted vouchers, there was a (statistically insignificant) reduced rates of both obesity and diabetes.

It’s the neighborhood.

More amazingly, if you think about this sort of voucher system as a medical treatment—like dialysis or insulin—it’s pretty damn cost effective. Only about twenty people needed to move in order to prevent one case of diabetes or obesity. Makes one wish we didn’t give up on the War on Poverty.

Jonathan Golob is an actual doctor.

20 replies on “Is It The Neighborhood?”

  1. Moving 20 people to a higher cost of living to save one case of diabetes/obesity is cost effective? Sounds like an issue of ‘keeping up with the joneses’ so I think a better solution would be moving a family of skinny models into the poorer neighborhoods.

  3. I’m guessing a lack of grocery stores is the single biggest factor. I’ve got to walk over a mile to get anything other than fast food/junk food. Not gonna happen when you don’t have a car.

  6. @4 – So it obviously makes perfect sense that we just take that number divide by 20 and buy $39,000 homes in less impoverished neighborhood to save society one fat person. I’m not saying the study isn’t interesting but pulling some absurd “social program” out our asses because of it is classic liberal arrogance.

  7. Doctor,
    Danny periodically posts a youtube video of Rob Tisinai who cites a flimsy old survey from Denver as “proof” that homosexuals do not molest underage males.
    As Slog’s only functioning-brain endowed contributor could you explain to Danny that the survey in question is not a scientific study and does not ‘prove’ what he and Rob so desperately want it to?
    Thanks

  8. Echoing #5, what is the solution? Move all poor people out of poor neighborhoods? Won’t that make at least some of the neighborhoods they move into poor by default? What are you going to do to prevent middle class flight from those now majority-poor neighborhoods?

  9. @8 What he’s arguing for is gentrification. See, by importing the “right kind” of neighborhood – one with sidewalks, bike lanes, Trader Joe’s, etc… – it is just as good, and a lot cheaper, than exporting people.

  12. I’m going to bring this up next time Dominic Holden and Cienna Madrid start arguing that cleaning up graffiti, or making people feel safe to walk down the street or take their kids to the park is an attack on what makes cities “great” or some bullshit crackpipe distortion of Jane Jacbos that gets passed around the Stranger newsroom like the clap.

  13. @12 ‘broken window’ is a real thing. I dint know why any one would fight against it. I run a business in SoDo and clean up any kind of mess right away. The people who don’t soon get more and more garbage. It’s not about building new things but maintaining those that exist. I’d love to see programs that help communities get grocery stores in their areas.

  14. I’m more interested in the results of giving people a voucher to live anywhere. Did many of those people end up choosing to stay in poor neighborhoods? Why? Familiarity? Community? Access to resources such as drug treatment programs that might be more concentrated in poor neighborhoods? On the surface it seems that if you give poor families choices, they choose badly. But if you choose for them, they do well. I think we’d understand poverty and obesity better if we dug past that paternalistic surface impression.

  17. If I had fast food options all over the place on the Hill, I’d probably weight 15 pounds more. My most convenient options happen to include Madison Market and it’s wonderful veggie deli-counter options. So I’m likely to eat 1/2 a pound of collard greens and some bbq tofu when I’m lazy. But if I had an Ezels nearby…. needless to say I would eat less tofu.

  18. Many poor people make poor choices because they are poorly educated and do not grow up around people who model healthy behavior. Schools in poor districts are never as good as schools in better-off districts. Maps that correlate particular health problems such as diabetes, heart disease, obesity and etc.with zip code will always show greater levels of morbidity in low income areas on local, county, state and national levels. Preventive interventions are always cheaper but the right and libertarians always vote against funding neighborhood clinics and youth programs. I just don’t get it. Who doesn’t want a healthier, better educated, more productive general population?

  19. Interesting stuff. To be clear, it’s probably the people in the neighborhood – we are social creatures and take cues about acceptable diet, body type, and activities from our peers.

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