How Neighborhoods Influence Health: Lessons to be learned from the application of political ecology

Abstract

AIM

This paper articulates how political ecology can be a useful tool for asking fundamental questions and applying relevant methods to investigate structures that impact relationship between neighborhood and health. Through a narrative analysis, we identify how political ecology can develop our future agendas for neighborhood-health research as it relates to social, political, environmental, and economic structures. Political ecology makes clear the connection between political economy and neighborhood by highlighting the historical and structural processes that produce and maintain social inequality, which affect health and well-being. These concepts encourage researchers to examine how people construct neighborhood and health in different ways that, in turn, can influence different health outcomes and, thus, efforts to address solutions.

Introduction

"… there's the air quality, you have some of the highest rates of asthma in the state [of California], they're right there in West Oakland, so you have the particulate matter coming from the trucks in West Oakland, and so these advocacy groups were really instrumental in forcing the truckers to go to cleaner diesel-type vehicles, and it became a statewide thing but that really got started in West Oakland."

"… when you talk to people in the community the first thing they will tell you is there's two different schools of thought about how you address gun violence. A lot of folks, especially if you're above [live above interstate highway] 580 will tell you, you need more police, if you have more cops then everything will stop. A lot of people below 580 will tell you we need more programs and services and we need jobs. And so the council is trying to balance those two requests…"

"And then the last one is the whole job things, right, that's your ultimate prevention… this is just me anecdotally, in 2000, 2004, 2005, 2006 when the economy was doing really well, the amount of crime and the amount of drug-dealing went down. Why? Because people were working. I was driving with a friend of mine on 71st. Street and East 14th Street and pointed out a spot and said 'that used to be the biggest dealing spot right there!' and I said 'but there ain't nobody out there!' She says, 'exactly, they all got jobs!' Came back 4 years later, economy had tanked, she says 'aw look, the boys are back!' So even though there are those who say there's no direct correlation, I say the majority of folks wanna work. I've been in meetings, and the first thing people say is 'I wanna job, I don't wanna go back'."

The District Councilmember from Oakland, California, United States, who was interviewed as a part of a preliminary study on neighborhood health in Oakland,¹ explains a multiplicity of struggles to respond to social and environmental degradation and its link to the health and well-being of neighborhood residents. This is not a unique story, but one that is repeated in urban environments across the United States. Many people are looking for a place to live that is affordable, safe, and accessible to necessary amenities like work, school, grocery stores, and public transportation. At the same time, people desire a home that has access to nature, such as parks, and gardens, a neighborhood that is both socially and environmentally healthful.

This paper aims to highlight the ways the theoretical perspective of political ecology² can be useful in expanding work on neighborhood and health. Specifically, political ecology helps us understand how everyday life experiences are situated, and constructed by structural forces. These forces directly and indirectly impact neighborhood social and physical environments influencing the health of residents. And, in turn, the health of residents affects their abilities to mobilize, to gather together and use existing or get new resources to address and change the structural forces at work. We articulate how the social science framework of political ecology can expand health researchers' conceptualizations of mechanisms that make neighborhood characteristics important for health. Political ecology argues that because neighborhood environments are the products of historical, social, political, and environmental processes, the effects of those environments on our health cannot be transformed without addressing the underlying structural processes that gave rise to and sustain those neighborhoods. Political ecology offers such an opportunity because it provides a theoretical context to question the impacts of power, race, and class on how individual health is created or degraded.

A growing body of research documents associations between neighborhood physical or built environments and health outcomes (e.g. green space and its benefits (Wolch et al., 2014). Social characteristics of neighborhoods, such as collective efficacy (Sampson et al., 2002, Sampson and Raudenbush, 2004), have also been investigated with similar findings with respect to health behaviors and health status (Diez Roux, 2007, Diez Roux, 2008, Auchincloss et al., 2008, Black and Macinko, 2008, Chaix, 2009). While for the sake of brevity we confine our discussion mainly to considerations of the physical or built aspects of neighborhood, we are very mindful that our discussion has a wider significance. Thus, whenever we use the term “neighborhood environment,” we are referring to both the physical and social characteristics of that space. So far, these epidemiologic investigations have proceeded without a “system of hypotheses” that describes the mechanisms involved in the neighborhood-health relationship (O'Campo, 2003). Without clear articulations of theory, there is a lack of direction regarding how to examine the complex relationship between neighborhood and health (Macintyre and Ellaway, 2000, Macintyre and Ellaway, 2003, Frohlich et al., 2001, Sampson et al., 2002, O'Campo, 2003, Cummins et al., 2007). The inability to discern mechanisms from (primarily) cross-sectional research hampers the translation of these results into health policy because any such intervention will be based on insufficient understanding of the underlying causal processes at work. As research on neighborhood-health effects continues, we argue for renewed attention to under-explored mechanisms and processes that connect places to health. We need a robust framework that theorizes how neighborhoods are socially and historically constructed; this will enable us to think about the health effects of such wide-ranging phenomena as segregation and racism, economic exclusion and mass incarceration, to name a few. All of these social structures are disproportionately spatially patterned. A full understanding of neighborhood-health connections must be able to theorize the causal pathways through which such phenomena become geographically concentrated and unevenly distributed. These complex and historically rooted ills impact the well-being of residents today in part because they shape the ecology of the place they call home. In this paper we present one theoretical framework that deepens neighborhood-health research: We offer neighborhood political ecology as a useful frame to examine some of the under-explored impacts of the neighborhood on health. By neighborhood political ecology we refer to the varied components of the places people live, including the social, cultural, economic, political and environmental history and present engagements. Neighborhood political ecology therefore takes an interdisciplinary and multi-sided approach to examining neighborhoods, especially as they intersect with health.

To explore the role of theory in general and political ecology specifically, we have organized this paper into four sections. First, we present an overview of concepts that support our arguments as they relate to health in neighborhoods. Second, we introduce political ecology as a useful theoretical lens to view gaps in neighborhood-health research, and show how political ecology offers alternative concepts through which to advance understanding of the complex ways place affects health. Neighborhoods have been typically characterized in the neighborhood-health literature in two ways: One focuses on the demographic composition (people) in the neighborhood as an influence on the other factors (e.g. living among a high concentration low-income households or unemployed residents). The other examines the influence of the physical or built environment (e.g. green space, parks, food stores) on residents and their health. Third, we detail those mechanisms generally examined in current neighborhood and health research, and point to significant gaps that impinge on addressing structural change. Finally, the choice of a particular theoretical framework influences the framing of the research question, and vice versa. We present neighborhood political ecology as a framework that can guide neighborhood-health research by linking health outcomes to sources of economic, political, and ecological inequality.

We aim to be clear and concise in these explanations; however, we are cognizant that the meaning of any given concept is often debated within fields, and across disciplinary boundaries. We hope our discussion of the value of neighborhood political ecology serves to illustrate how theoretical concepts and processes can provoke attention to under-investigated questions that target structural inequality and disparities in policy-oriented and practice-based solutions in neighborhood-health research. We begin by outlining some central concepts and debates in social theory that we feel are particularly useful and then place those ideas in a political ecology perspective.