Demons of density: Do higher-density environments put people at greater risk of contagious disease?
This paper studies the relationship between density and COVID during three distinct waves of the pandemic in New York City. Unlike prior work, this paper's analysis uses individual Medicaid claims records, which include a rich array of demographic characteristics and pre-existing medical conditions and cover a near universe of low-income New Yorkers. In brief, the results suggest that living in higher density neighborhoods did not heighten the risk of COVID hospitalization.
Not a New Story: Place‐ and Race‐Based Disparities in COVID‐19 and Influenza Hospitalizations among Medicaid‐Insured Adults in New York City
For all that is unprecedented about COVID-19, the race-based health disparities in the pandemic's early days are sadly familiar. In this study, the authors compare the geographic and racial/ethnic disparities during the first three waves of the COVID-19 pandemic (first wave: January 1–April 30, 2020; second wave: May 1–August 31, 2020; third wave: September 1–December 31, 2020) to the 2016 and 2017 influenza seasons using New York State Medicaid claims data. Ultimately, the study concludes that while geographic and racial/ethnic disparities evident during the first wave of the pandemic were similar to those of previous waves of influenza, the later waves of COVID-19 hospitalizations reflected far less severe disparities. This is one of the first papers to examine how the characteristics of patients hospitalized with COVID-19 changed over the course of 2020, and in turn demonstrates how COVID-19-related racial/ethnic disparities decreased over time.
Gentrification and the Health of Legacy Residents
This health policy brief reviews research about gentrification and its effects on the health of long-term, or legacy, residents, with a focus on renters, exploring gentrification's effects on residential mobility, neighborhood environments, and the health and well-being of both neighborhood stayers and movers. Given the
robust evidence that neighborhoods and residential mobility affect health, there is good reason to believe that gentrification would shape the health of residents.
Renovating Subsidized Housing: The Impact On Tenants’ Health
Many public and subsidized housing developments in the US are aging and in need of significant repairs. Some observers worry that their poor condition threatens the health of residents. This study evaluated a recent renovation of public housing that was undertaken through the transfer of six housing developments from the New York City Housing Authority to a public-private partnership. It examined whether the renovation and transfer to private managers led to improvements in tenants’ health over three years, as measured by Medicaid claims. While it did not find significant improvements in individual health outcomes, it found significant relative improvements in overall disease burden when measured using an index of housing-sensitive conditions.
Gentrification And The Health Of Low-Income Children In New York City
Although the pace of gentrification has accelerated in cities across the US, little is known about the health consequences of growing up in gentrifying neighborhoods. This study used New York State Medicaid claims data to track a cohort of low-income children born in the period 2006–08 for the nine years between January 2009 and December 2017. It compared the 2017 health outcomes of children who started out in low-income neighborhoods that gentrified in the period 2009–15 with those of children who started out in other low-income neighborhoods, controlling for individual child demographic characteristics, baseline neighborhood characteristics, and preexisting trends in neighborhood socioeconomic status.
A Pilot Community Health Worker Program in Subsidized Housing: The Health + Housing Project
We examine the implementation of a community health worker (CHW) program in subsidized housing, describe needs identified and priorities set by residents, and summarize participant-reported outcomes.
Black and Latino Segregation and Socioeconomic Outcomes
Latinos seem to be inheriting the segregated urban structures experienced by African Americans and, to a similar extent, the diminished social and economic outcomes associated with segregation. This brief examines the relationships between metropolitan segregation levels and socioeconomic outcomes for Latinos and African Americans and explores mechanisms to explain these relationships. It finds that in more segregated metropolitan areas, both native-born Latinos and African Americans are significantly less likely compared with whites to graduate from high school and college, are more likely than whites to be neither working nor in school. Additionally, higher levels of segregation are associated with dramatic reductions in earnings for both African Americans and Latinos relative to whites. The research brief summarizes the findings of the article, Desvinculado y Desigual: Is Segregation Harmful to Latinos? (PDF), which was published in the July 2015 edition of The Annals of the American Academy of Political and Social Science. See the press release or read the key findings.
Housing, Neighborhoods, and Children’s Health
In theory, improving low-income families’ housing and neighborhoods could also improve their children’s health, through any number of mechanisms. For example, less exposure to environmental toxins could prevent diseases such as asthma; a safer, less violent neighborhood could improve health by reducing the chances of injury and death, and by easing the burden of stress; and a more walkable neighborhood with better playgrounds could encourage children to exercise, making them less likely to become obese. Yet although neighborhood improvement policies generally achieve their immediate goals— investments in playgrounds create playgrounds, for example—Ingrid Gould Ellen and Sherry Glied find that many of these policies don’t show a strong effect on poor children’s health. One problem is that neighborhood improvements may price low-income families out of the very neighborhoods that have been improved, as new amenities draw more affluent families, causing rents and home prices to rise. Policy makers, say Ellen and Glied, should carefully consider how neighborhood improvements may affect affordability, a calculus that is likely to favor policies with clear and substantial benefits for low-income children, such as those that reduce neighborhood violence. Housing subsidies can help families either cope with rising costs or move to more affluent neighborhoods. Unfortunately, demonstration programs that help families move to better neighborhoods have had only limited effects on children’s health, possibly because such transitions can be stressful. And because subsidies go to relatively few low-income families, the presence of subsidies may itself drive up housing costs, placing an extra burden on the majority of families that don’t receive them. Ellen and Glied suggest that policy makers consider whether granting smaller subsidies to more families would be a more effective way to use these funds.
Accessibility of America’s Housing Stock: Analysis of the 2011 American Housing Survey (AHS)
The American Housing Survey (AHS) is the most comprehensive national housing survey in the United States. Since 2009, AHS has included six core disability questions used in the American Community Survey. The questions address hearing, visual, cognitive, ambulatory, self-care, and independent living difficulties for each household member. For 2011, AHS added a topical module on accessibility. The module asked about the presence of accessibility features in housing units, including wheelchair accessibility features, and whether the accessibility features were used or not. Together, these data provide an unprecedented opportunity to examine the accessibility of the U.S. housing stock and to ask whether people with disabilities reside in accessible homes.
In this report, the authors present summary measures of housing accessibility based on the 2011 AHS. To develop these summary measures, they examined United States (U.S.) and international standards and regulations regarding housing accessibility, reviewed the relevant literature, and conducted interviews with a set of disability and housing design experts. These interviews are further described in appendix A. Based on these summary measures, the authors describe how accessibility varies by housing market characteristics as well as resident characteristics such as age, disability status, and income. They also present evidence on the relationship between the need for and availability of accessible housing units, taking affordability of accessible units into account.
Race and Neighborhoods in the 21st Century
This research brief explores the state of racial segregation in American neighborhoods, and the connection between segregation and gaps in neighborhood conditions. Based on a working paper that analyzed U.S. segregation patterns between the years 1980 and 2010, the research finds that minority groups and whites continue to live in separate and highly unequal neighborhoods. Black and Hispanic households tend to live in neighborhoods with higher poverty rates, fewer college-educated neighbors, lower-performing schools, and higher violent crime rates. Moreover, these differences in neighborhood conditions are amplified in more segregated metropolitan areas. View the working paper, press release, and other resources here.