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date: 28 June 2017

Neighborhood Considerations and Social Determinants of Health and Risk

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.

Individuals who live in low income communities are at an increased risk for several health issues, such as obesity and obesity-related diseases like hypertension and diabetes; asthma; cancers; etc., compared to those who live in higher income communities. Contributing to these disparities are individual factors, such lower education, income, health literacy, health self-efficacy, social support, and a lack of health insurance and/or healthcare access. A combination of these individual-level factors and neighborhood-level constraints like a lack of transportation and primary healthcare options, can lead to a higher reliance on emergency medical services for health issues. Lower income neighborhoods often lack health enhancing resources. For example, they have fewer doctor’s offices, healthcare centers, health organizations, and gyms, and are often considered food deserts due to a lack of healthy food options. Where grocery stores are absent, convenience stores and fast food restaurants provide access to primarily unhealthy food options. When a grocery store is present, studies have shown a more prominent display of unhealthy products (e.g., cigarettes, cigarillos, and alcohol) and fewer/lower quality fruits and vegetables than found in higher income community stores. Additionally, unhealthy products like tobacco and fast food are marketed specifically to lower income communities through billboards and other point-of-purchase advertisements and incentives.

Factors of the built environment also contribute to health disparities. Aspects that encourage physical activity—sidewalks, trails, parks, and walking or biking paths—may be absent, unkempt, or unsafe. Vacant houses and lots become overgrown, attracting disease-carrying rodents and the illegal dumping of trash, and they can become the site of drug activity. It can be dangerous for children to walk past these houses on their way to school or if they were to play outside in their neighborhoods, increasing their stress levels and removing opportunity for physical activity. This type of urban blight also has an impact on the mental health of residents. There also tends to be a higher level of outdoor environmental toxins due to the increased presence of factories, transportation systems (e.g., trains, highways), nuclear power plants, and the like in lower income communities. A lack of green space and tree coverage leads to increased heat as the concrete gets hot in the summer, increasing emissions and smog levels. There are also increased levels of indoor environmental pollutants in the form of lead-based paint, asbestos, and cockroaches in lower income neighborhoods. To affect health outcomes, health communication interventions and messages need to take into account the neighborhood-level factors that contribute to health disparities.