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Neighborhoods
and Health
Edited by
ICHIRO KAWACHI
LISA F. BERKMAN
1
2003
1
Oxford New York
Auckland Bangkok Buenos Aires Cape Town Chennai
Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata
Kuala Lumpur Madrid Melbourne Mexico City Mumbai
Nairobi São Paulo Shanghai Taipei Tokyo Toronto
Copyright © 2003 by Oxford University Press, Inc.
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York, 10016
http://www.oup-usa.org
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press
Library of Congress Cataloging-in-Publication Data
Neighborhoods and health /
edited by Ichiro Kawachi, Lisa F. Berkman.
p. ; cm. Includes bibliographical references and index.
ISBN 0-19-513838-4 (cloth)
1. Community health services. 2. Health services accessibility.
3. Medical care—Social aspects. 4. Medical care—Utilization.
I. Kawachi, Ichiro. II. Berkman, Lisa F.
[DNLM: 1. Health Services Accessibility. 2. Community Health Services.
3. Socioeconomic Factors.
W 76 N397 2003] RA427 .N454 2003 362.1⬘2—dc21 2002029287
987654321
Printed in the United States of America
on acid-free paper
Preface
The search for the effects of neighborhoods on health has moved much
closer to the center stage of the public health and social sciences research
agenda. Researchers have long suspected that where one lives makes a
difference to health in addition to who one is. Almost everyone now un-
derstands that smoking cigarettes, eating fast foods, and being sedentary
can compromise longevity and chances of good health, but can a person’s
ability to maintain a healthy lifestyle be affected by the smoking habits
of other people living in proximity to them, or by access to local grocery
stores selling fresh fruit and vegetables, or by the existence of safe parks
and recreational spaces in their communities? In other words, can certain
social and physical characteristics of residential neighborhoods make a
difference to a person’s well-being, over and above an individual’s in-
tentions and actions to maintain healthy habits? The answer to that ques-
tion requires new ways of thinking about the determinants of health as
well as new analytical methods to test these ideas. If the characteristics
of neighborhoods make a difference to health beyond the characteristics
of the individuals who live in them, then policy-makers should take heed
of the new opportunities to develop health promotion interventions di-
rected at places as well as people.
There are clear signals to indicate that researchers in public health
and allied social sciences are converging on the search for place-based in-
fluences on health. Even a cursory search of the major professional jour-
nals in public health reveals dozens of relevant studies published just in
the past few years. Research funding bodies, including the U.S. National
Institutes of Health, have assigned priority to the search for neighbor-
hood effects, especially in the context of explaining social inequalities in
health. Even so, despite the interest in this subject, we are unaware of any
comprehensive text that surveys the theoretical and methodological chal-
lenges involved in conducting research in this area.
This book was conceived as a response to that vacuum. We have
gathered together contributions from leading international investigators
on neighborhoods and health. The contributors represent the diversity of
disciplines that have advanced theory, methodology, and empirical evi-
v
vi PREFACE
dence in this field of research. Gathered together in this volume are state-
of-the-art reflections from social epidemiologists, sociologists, demogra-
phers, statisticians, clinicians, and medical geographers.
The book is organized into four parts. The first two chapters provide
an overview of research on neighborhoods and health. These chapters lay
out the historical motivation behind focusing on neighborhood contexts
as determinants of population and individual health. They summarize the
major conceptual and theoretical issues that have emerged over two
decades of research on neighborhoods and health.
Part I (Chapters 3–8) deals with the methodological complexities of
undertaking neighborhood research. The chapters focus on the meaning
and interpretation of ecological data (including a discussion of the eco-
logical fallacy—Chapter 3), the analytical potential of multilevel statisti-
cal methodology (Chapter 4), the emerging science of “ecometrics” (Chap-
ter 5), and the contributions of sociological theory to characterizing
neighborhood contexts (Chapter 6). Chapters 7 and 8 introduce the tech-
niques of geocoding and the construction of area-level indexes of socio-
economic position and deprivation, from U.S. and U.K. perspectives,
respectively.
The chapters in Part II showcase the empirical evidence linking neigh-
borhood conditions to health outcomes: infectious disease (Chapter 9), in-
fant health (Chapter 10), and asthma (Chapter 11). These examples were
singled out on the basis of their promise for demonstrating the utility of
extending etiological hypotheses to the ecological level. Examples of other
health outcomes, such as total mortality, cardiovascular disease, and func-
tional limitations in old age, are brought up elsewhere in the volume.
The final section tackles some of the major cross-cutting themes in
contemporary neighborhood research. Chapter 12 describes the mea-
surement and health consequences of residential segregation by race and
class. Chapter 13 extends the theme of an earlier chapter (6) by focusing
on neighborhood context as the basis of social interactions. Chapter 14 is
an extended reflection on the interaction between neighborhood research
and aging. Finally, Chapter 15 discusses the relevance of studying neigh-
borhoods for social policy.
We feel confident that the material presented in this volume will
prove useful to a broad audience, ranging from those who are just be-
ginning to wet their feet in this field of inquiry to experienced practi-
tioners. In addition to providing guidance on methodology and practice,
the authors introduce alternative models of neighborhood effects on
health (e.g., Chapters 2 and 14) as well as detailed examples of commu-
nity interventions to improve population health outcomes (e.g., Chapter
11). The potential influence of neighborhood conditions on health is de-
Preface vii
scribed throughout the life course, from birth and infancy to old age. If
the chapters that follow inspire researchers and policy-makers to move
the field ahead by refining the methodology, adding to new evidence, or
devising novel policy approaches to improve the health of populations,
then we will have accomplished our goal in organizing this book.
Boston, Massachusetts I. K.
L. F. B.
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Contents
Contributors, xi
1. Introduction, 1
Ichiro Kawachi and Lisa F. Berkman
2. Neighborhoods and Health: An Overview, 20
Sally Macintyre and Anne Ellaway
PART I METHODOLOGICAL AND CONCEPTUAL APPROACHES
TO STUDYING NEIGHBORHOOD EFFECTS ON HEALTH
3. The Examination of Neighborhood Effects on Health: Conceptual
and Methodological Issues Related to the Presence of Multiple
Levels of Prganization, 45
Ana V. Diez-Roux
4. Multilevel Methods for Public Health Research, 65
S.V. Subramanian, Kelvyn Jones, and Craig Duncan
5. The Quantitative Assessment of Neighborhood Social
Environments, 112
Stephen W. Raudenbush
6. Neighborhood-Level Context and Health:
Lessons from Sociology, 132
Robert J. Sampson
7. Geocoding and Measurement of Neighborhood Socioeconomic
Position: A U.S. Perspective, 147
Nancy Krieger, Sally Zierler, Joseph W. Hogan, Pamela Waterman,
Jarvis Chen, Kerry Lemieux, and Annie Gjelsvik
8. Area-Based Deprivation Measures: A U.K. Perspective, 179
David Gordon
ix
x CONTENTS
PART II NEIGHBORHOODS AND HEALTH OUTCOMES
9. Neighborhoods and Infectious Diseases, 211
Mindy Thompson Fullilove
10. Infant Health: Race, Risk, and Residence, 223
James W. Collins, Jr. and Nancy Fisher Schulte
11. Putting Asthma into Context: Community Influences on Risk,
Behavior, and Intervention, 233
Rosalind J. Wright and Edwin B. Fischer
PART III THE CONTOURS OF NEIGHBORHOOD
EFFECTS ON HEALTH
12. Residential Segregation and Health, 265
Dolores Acevedo-Garcia and Kimberly A. Lochner
13. Neighborhoods and Networks: The Construction of Safe Places and
Bridges, 288
Lisa F. Berkman and Cheryl Clark
14. Neighborhoods, Aging, and Functional Limitations, 303
Thomas A. Glass and Jennifer L. Balfour
15. Neighborhoods, Health Research, and Its Relevance to
Public Policy, 335
Jody Heymann and Aron Fischer
Index, 349
Contributors
DOLORES ACEVEDO-GARCIA, JAMES W. COLLINS, JR, MD
PHD, MPA-URP Division of Neonatology
Department of Health and Social Children’s Memorial Hospital
Behavior Chicago, Illinois
Harvard School of Public Health
Boston, Massachusetts
ANA V. DIEZ-ROUX, MD, PHD
Division of General Medicine
JENNIFER L. BALFOUR, PHD, Columbia College of Physicians and
MPH Surgeons
Department of Epidemiology and the Division of Epidemiology
Center for Social Epidemiology and Joseph P. Mailman School of Public
Population Health Health
University of Michigan Columbia University
Ann Arbor, Michigan New York, New York
LISA F. BERKMAN, PHD
Harvard Center for Society and Health CRAIG DUNCAN, PHD
Department of Health and Social Population Estimates Office
Behavior Office for National Statistics
Harvard School of Public Health Southampton, U.K.
Boston Massachusetts
ANNE ELLAWAY, PHD
JARVIS CHEN, SCD MRC, Social and Public Health Sciences
Department of Health and Social Unit
Behavior University of Glasgow
Harvard School of Public Health Glasgow, Scotland
Boston Massachusetts
CHERYL CLARK, MS ARON FISCHER, BA
Department of Health and Social Department of Health and Social
Behavior Behavior
Harvard School of Public Health Harvard School of Public Health
Boston, Massachusetts Boston, Massachusetts
xi
xii CONTRIBUTORS
EDWIN B. FISHER, PHD ICHIRO KAWACHI, MD, PHD
Department of Psychology Harvard Center for Society and Health
Washington University Department of Health and Social
Division of Health Behavior Research Behavior
Departments of Medicine and Pediatrics Harvard School of Public Health
Washington University School of Boston, Massachusetts
Medicine
St. Louis, Missouri
KELVYN JONES, PHD
Department of Geography
MINDY THOMPSON FULLILOVE, University of Bristol
MD Bristol, U.K.
The Community Research Group
New York Psychiatric Institute
New York, New York NANCY KRIEGER, PH.D.
Department of Health and Social
Behavior
ANNIE GJELSVIK, MS Harvard School of Public Health
Department of Community Health Boston, Massachusetts
Brown University
Providence, R.I.
KERRY LEMIEUX, MS
Department of Health and Social
THOMAS A. GLASS, PHD Behavior
Department of Epidemiology and the Harvard School of Public Health
Center on Aging and Health Boston, Massachusetts
Johns Hopkins Bloomberg School of
Hygiene and Public Health
Baltimore, Maryland
KIMBERLY A. LOCHNER, SCD
The Robert Wood Johnson Foundation
Princeton, New Jersey
DAVID GORDON, PHD
Head of the Centre for the Study of
SALLY MACINTYRE, PHD
Poverty and Social Justice
MRC, Social and Public Health Sciences
School for Policy Studies
Unit
University of Bristol
University of Glasgow
Bristol, U.K.
Glasgow, Scotland
JODY HEYMANN, MD, PHD STEPHEN W. RAUDENBUSH, PHD
Department of Health and Social
School of Education
Behavior
University of Michigan
Harvard School of Public Health
Ann Arbor, Michigan
Boston, Massachusetts
JOSEPH W. HOGAN ROBERT J. SAMPSON, PHD
Center for Statistical Sciences Department of Sociology
Brown University University of Chicago
Providence, Rhode Island Chicago, Illinois
Contributors xiii
NANCY FISHER SCHULTE, BS ROSALIND J. WRIGHT, MD, MPH
Division of Neonatology Department of Pulmonary and Critical
Children’s Memorial Hospital Care Medicine
Chicago, Illinois Beth Israel Deaconess Medical Center
Harvard Medical School
S. V. SUBRAMANIAN, PHD Channing Laboratory
Department of Health and Social Behavior Brigham & Women’s Hospital
Harvard School of Public Health Boston, Massachusetts
Boston, Massachusetts
PAMELA WATERMAN, MPH SALLY ZIERLER, PHD
Department of Health and Social Behavior Department of Community Health
Harvard School of Public Health Brown University
Boston, Massachusetts Providence, Rhode Island
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Neighborhoods and Health
