By AMERICAN HEART ASSOCIATION NEWS
“Location, location, location” isn’t just an old real estate cliché. It’s also a major factor when it comes to heart health, according to an overview article published in the American Heart Association journal Circulation.
The article studied a growing body of literature on the relationship between neighborhoods and heart health and “the complex web of inter-related social, economic and physical factors that appear to influence health behaviors and cardiovascular risk.”
The article concluded that “where patients live may be an important contributor to the risk of developing cardiovascular disease.”
“ZIP code matters as much, if not more, than genetic code, at least for some people,” said Eduardo Sanchez, M.D., chief medical officer for prevention at the American Heart Association.
“Neighborhood characteristics make a difference,” he said. “Behavior factors like what you eat, how sedentary you are, and whether you smoke are all affected by social factors like the quality of your neighborhood and the income of your neighborhood … not just the income of the individual.”
Where you live “makes it easier or more difficult to adopt and especially maintain health behaviors like being physically active, consuming less calories, or consuming more fruits and vegetables,” said Ana Diez Roux, M.D., Ph.D, M.P.H., dean and professor of epidemiology at Drexel University. “The environment interacts with personal characteristics and can serve as a facilitator or impediment in subtle but very important ways.”
One of the biggest impediments to heart health is an inability for people to walk, bike and exercise in many lower-income neighborhoods, said Sanchez.
“Neighborhoods where there is some affluence are more likely to have sidewalks, trails, parks, and other amenities that some of us take for granted,” he said. “Lower-income neighborhoods have characteristics that make it harder to be physically active — characteristics like heavy traffic, poor lighting, and the higher likelihood of loose dogs running around that may keep children and others indoors.”
Living near busy streets can be unhealthy for other reasons, said Diez Roux. “Exposure to heavy traffic may also be linked to cardiovascular health through the effects of air pollution,” she said.
The article pointed out a link between poor heart health and neighborhoods where people experience racial segregation and discrimination.
“Predominantly poor and minority neighborhoods often have social and physical environments that are not conducive to cardiovascular health … and these difference arise because of economic factors, differences in power, and structural racism,” said Diez Roux.
The differences, she said, “in turn reinforce residential segregation, creating a vicious cycle that reinforces health disparities.”
Sanchez lauded the article for pointing out that cardiologists need to recognize the role that neighborhoods may play in their patients’ heart health.
“Context matters,” he said. “Understanding the context helps the clinician to think of other options, but also it keeps the clinician from blaming the patient.”
Unhealthy neighborhoods are often just a ZIP code or two away from healthy ones. According to a 2013 study by the Robert Wood Johnson Foundation, babies born to mothers in one New Orleans neighborhood have an average life expectancy of only 55, compared to a life expectancy of 80 for babies born to mothers who live just a few miles away.
“A moral and just society has to ask itself ‘Is that Ok?’ and the answer ought to be ‘No,’” said Sanchez. “From the perspective of the American Heart Association, we should all be thinking about policy changes that can mitigate those differences and asking ‘How can we create mixed income neighborhoods?’”
Diez Roux agreed and said she’d like to see research conducted on which policies are most effective at changing neighborhoods to improve cardiovascular health.
“Transportation policy, food access policy, and policies to reduce crime and create safe and welcoming public spaces are all health policies,” she said. “As a society, we need to recognize that if we want to reduce chronic diseases, we need to think broadly about the causes of these diseases. Medical care and screening, important as they are, won’t be enough.”