Week 6 Homework

Week 6 Homework

by Biftu Mengesha -

           Housing policies are not usually intended to be a health policy however can hold significant health implications, especially when factoring in things such as zoning laws which have the potential to radically change the health of a neighborhood secondary to limited access to grocery stores, medical care and other important health mediators. Evaluating policies such as these are informative and important in that societal constructs can have significant impacts on the health of particular population(s), whether positive or negative, and knowing these impacts adds or subtracts from the value of the social policy; they provide information on how to create an impetus for change in policy if needed.

           Particularly with housing policies, minority and low-income populations are the most affected (although in June 2015 the Supreme Court ruled it unconstitutional to have disparate impacts among different racial/ethnic/socioeconomic groups with zoning practices, as well as other sales and rental practices, by businesses and housing companies in the way housing and business planning is undertaken and they supported the 1968 Fair Housing Act). Outcomes that are likely most affected are: diet-related (poor access to health foods leading to obesity and its related comorbidities as well as malnutrition), activity-related (decreased physical activity because of neighborhood violence, inadequate parks), access-related (number of board-certified medical providers in the area, number of medical and surgical specialists in the area), environmental-toxin related (proximity to major factories with toxic emissions, rates of disease related to these exposures, proximity to clean drinking water).

          Perhaps a descriptive study evaluating the differences in health outcomes of particular neighborhoods in two different cities that have two different approaches to zoning would appropriately evaluate housing policies. I would choose a city known for poor practices (i.e. Chicago) and a city with better-than-average practices. The above outcomes could be compared between matched neighborhoods (matched by socioeconomic and ethnic characteristics) in the two cities to evaluate for differences in these health outcomes with regard to differing zoning and housing policies and practices. Challenges to this type of design is controlling for other external factors that can contribute to these health outcomes as well as distinguishing between those neighborhoods that were manufactured by these policies and those that were created by social behavior of the people within them (although, the latter is much less likely to naturally occur in the current observed pattern). If the inference of the association between zoning practices and poor health outcomes is in fact true, then the biggest challenge would be to implement legislature and social policy to rectify these negative impacts, and would require a large budget to restructure the compositions of neighborhoods that are negatively affected by these zoning  and housing practices. 

Re: Week 6 Homework

by Maria Glymour -

Housing policies, and zoning laws in particular, are a great example of major social policies that probably have large impacts on health, but are rarely evaluated as health policies.  I like the numerous mechanisms you note- many of these would presumably be related to segregation in particular.  

The challenge, as you note, is developing a rigorous design to demonstrate which aspects of policy we might change to improve health.  A case study describing the differences between two cities can be compelling to motivate ideas and suggest hypotheses, but it will rarely be convincing about the impact of specific, modifiable policies, for exactly the reason you note: there may be many other reasons that, Chicago differs from, say, "WiseZoningVille", that are not necessarily due to zoning practices.  This is partly so difficult because we are not just asking about the effects of one person's house, but about the effects of a whole neighborhood, or the policies prevailing in a whole city. Thus, the effective unit of analysis is a city or a metro area, and it is difficult to have enough data.  Often the most rigorous designs rely on changes in exposure within a unit of analysis (e.g., someone goes from unexposed to exposed, does their outcome value change in tandem?).  In this case, we would need cities that changed their zoning laws, and to evaluate the health of their residents before and after those changes.  But since the zoning laws may take years or decades to impact health, it is really tough to build a convincing case.  

Some of the most convincing examples rely on natural experiments, e.g., the city build a new transport and this meant two neighborhoods previously isolated were now connected - what did that do to the health of residents? But few studies have really explored this type of natural experiment carefully.

Maria