Role of health in predicting moves to poor neighborhoods among Hurricane Katrina survivors

Abstract

Significance Although neighborhood outcomes and health may influence each other reciprocally, existing studies overwhelmingly focus on neighborhood effects on health. Health’s influence on neighborhood is largely viewed as a nuisance that may bias neighborhood effects estimates. However, if health shapes whether individuals attain better neighborhoods, understanding selection processes may advance both health and urban policy objectives. We follow a socially vulnerable cohort of Hurricane Katrina survivors from 2003–2010 and find that although health was not associated with neighborhood poverty before the disaster, those with pre-Katrina health problems ended up living in poorer neighborhoods years after the storm. Understanding whether and how poor health impedes poverty deconcentration efforts may help inform programs and policies designed to help low-income families move into—and stay in—higher opportunity neighborhoods.

Health Selection into Neighborhoods Among Families in the Moving to Opportunity Program

“…Our finding that health predicts neighborhood outcomes is in line with results from a previous natural experimental analysis of a cohort of Hurricane Katrina survivors with high postdisaster displacement rates (5). In that setting, predisaster health status differentiated neighborhood poverty exposure 4-5 years after the storm, such that persons in poorer health ended up in neighborhoods that were poorer by over 3 percentage points.…”

“…Possible explanations for this robust finding include the following: 1) associations are confounded, reflecting complex relationships among individual characteristics, neighborhood, and health; 2) neighborhood environments affect health; and 3) health status systematically sorts individuals into neighborhoods ("health selection"). Although all 3 explanations may operate simultaneously, academic literature on health and place is dominated by a unidirectional interest in neighborhood effects, while treating confounding and selection as nuisances (5).…”

“…Methodologists have noted difficulties associated with estimating neighborhood effects on health from observational data, often conceptualizing health-related selection into neighborhoods as one of many potential sources of bias (7,8) rather than as a substantively important process (5,9). Broadly, efforts to understand neighborhood effects on other dimensions of well-being suffer similar challenges (10).…”

Research on neighborhood effects on health in the United States: A systematic review of study characteristics

“…As such, neighborhood effect estimates were produced from observational analyses of trial participant data. We reviewed one study with a natural experimental design in which variation in neighborhood environment was reported to be exogenous (Arcaya et al, 2014). …”

“…However, with longitudinal data, frameworks that conceptualize health as an outcome and place as an exposure can be reversed to ask if health sorts individuals into neighborhoods. Earlier studies that adjusted for stated neighborhood preferences (Frank et al, 2007) to assess health-related selection effects are now joined by new empirical evidence supporting (M. C. Arcaya et al, 2014; Dunn et al, 2014) (Arcaya et al, 2015) and disputing (James et al, 2015) the idea that health is a meaningful neighborhood selection factor.…”