For Health and Well-being, Place Matters

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Unhealthy Cities by Kevin Fitzpatrick and Mark LaGory

FAYETTEVILLE, Ark. – Place matters when it comes to health, according to University of Arkansas sociologist Kevin Fitzpatrick.

“When trying to understand a person’s health and well-being, we believe that their zip code may be just as important a number to their physical health as their blood pressure or glucose level,” Fitzpatrick said.

In Unhealthy Cities: Poverty, Race, and Place in America, Fitzpatrick and co-author Mark LaGory of the University of Alabama at Birmingham drew from the social sciences and public health fields to examine the role that place and policy play in the health of Americans, particularly for those people living in high-poverty urban neighborhoods.

In urban areas, a single zip code digit can make a big difference in life expectancy. Given the continued social segregation of the United States, the researchers wrote, “Where we live in the metropolis is a function of the interrelationship between race and class, with residential location accentuating just how disparate some groups are.”

More than 9 million people live in more than 3,000 high-poverty neighborhoods in the United States. Low-income African Americans in particular are disproportionately isolated in high-risk neighborhoods, and the researchers wrote, “Some parts of the city seemed to be designed to make people sick.”

For example, over the years studies have established a relationship between a concentration of fast-food restaurants in poor, predominantly minority neighborhoods and health problems among the residents of those neighborhoods. These same neighborhoods may not have even a single grocery store offering fresh, nutritious food or safe places to exercise.

Fitzpatrick cited a simple but critical element that affects the health of people in a community: the square footage of green versus concrete in the neighborhood. The green he is talking about can be a safe place to walk and a place where children can play games or an urban community garden that can feed hundreds of families.

As one effective response, the researchers use the example of a collaborative program in the Los Angeles School District, which serves more than 730,000 students, two-thirds of whom are eligible for free or reduced lunch. Working with teachers, health professionals, parents and students, the district cleared schools of unhealthy foods and improved the nutritional value and variety of food in the school meals. The program led to improved health systemwide, with fewer health problems reported to school nurses at all grade levels and more participation in physical education.

There were visible changes in the community, too, with more funding for neighborhood farmers’ markets and the fresh fruits and vegetables they offer. The schools continue to play a role in the health of students and their communities by targeting problems such as obesity, sedentary lifestyle and poor nutrition.

“This is what I see Michelle Obama talking about make happen at the grass-roots level. Educating kids about gardening, cooking and eating well has the potential to be a model to provide schools and communities with a best practices approach to addressing unhealthy lifestyles,” Fitzpatrick said.

In the conclusion to Unhealthy Cities, Fitzpatrick and LaGory note that cities in the United States have become increasing unhealthy over the past 50 years.

“Without a comprehensive place-based strategy to address the health needs of the at-risk, underserved, and unprotected in the urban core,” they wrote, “America will continue to be a society plagued by the contradiction of great wealth and mediocre health.”

Fitzpatrick is a professor of sociology and Jones Chair in Community in the J. William Fulbright College of Arts and Sciences at the University of Arkansas. Unhealthy Cities is published by Routledge.