By Rachel Cernansky
A recent American Heart Association study analyzing census tract data and heart failure rates among middle-aged white and African-American individuals has found that heart failure is more prevalent in neighborhoods with greater concentrations of poverty compared with neighborhoods with mixed income levels.
In other words, it’s not just a person’s individual behavior, genetics and socioeconomic status that determines health risks. “Neighborhood factors”—including educational, environmental, health care and occupational resources—also play a significant role.
“We know from prior literature that people with lower income levels, and people who have lower educational attainment, have higher risk of heart failure and other cardiovascular diseases,” said study author and Vanderbilt University Medical Center research fellow Elvis Akwo, MD, MS.
What the new study suggests, he explained, is that “if you live in a neighborhood where you have all these adverse metrics of socioeconomic status, then regardless of what your income level is, you are at higher risk of developing heart failure.”
One goal of Akwo’s and colleagues’ research going forward is to expand the findings beyond heart failure, which he sees as a proxy for the link between high-poverty neighborhoods and health in general. “That will create more solid evidence that to improve human health, we have to understand what’s happening in the neighborhood,” he said.
Ultimately, Akwo would like this work to lead to interventions to reduce heart failure and other diseases. That could mean allocating more money to publicly funded facilities to improve services, policy changes at the state or federal level, public health campaigns along the lines of smoking cessation programs, or any combination of interventions.
Shanae Gutierrez, a health education specialist at the Pueblo-based Southeastern Colorado Area Health Education Center who grew up in the city’s East Side neighborhood, is not surprised by the findings.
In Pueblo's East Side, about 33 percent of people live in poverty, according to census data, compared with 25 percent in Pueblo as a whole and 11 percent statewide. Public transportation is weak, grocery options are scarce, and there aren’t a lot of jobs nearby.
“The [effect of] stress alone on heart failure is really high,” Gutierrez says, pointing to common stress factors: People may not be exercising, or letting their kids play in or walk to the park, because they don’t feel safe outside; many grandparents are raising their grandchildren.
Gutierrez lives in a different part of Pueblo now, and moved her elderly mother out of the East Side neighborhood because Gutierrez didn’t feel she was safe there. But Gutierrez still feels a connection to and is involved in the neighborhood, including by attending community meetings.
“I want better for my community where I grew up and came from. There are plenty of us that are going back and attending these meetings, trying to do better and volunteer,” she said.
“Although I felt like I needed to move my mother out of the neighborhood, I will never give up on the community I came from.”