Why Living in a Poor Neighborhood Can Change Your Biology The sheer stress of an environment contributes to obesity and diabetes.

By Andrew Curry in Nautilus

It was the most ambitious social experiment ever conducted by the United States Department of Housing and Urban Development. And one of the most surprising.

In 1994, HUD randomly assigned 4,600 poor, mostly African-American families in Baltimore, Boston, Chicago, Los Angeles, and New York to one of three groups. One group received housing vouchers intended to help them move to low-poverty neighborhoods. Another group received vouchers without geographic restrictions. A final control group didn’t receive vouchers at all.

Called “Moving to Opportunity,” the study was designed to answer a question that had divided social scientists and policymakers for decades: Did getting people off of welfare and other forms of social assistance depend on changing their social context?

More than a decade later, the researchers found that a lot of things hadn’t changed. Many people offered housing vouchers didn’t move. The people who did move to better neighborhoods didn’t change their diets or daily lifestyles. Their kids showed no improvement in reading or math scores. And moving didn’t make people any more or less economically self-sufficient, the question the study was designed to answer.

But as the experiment went on, researchers began encountering anecdotal evidence that surprised them. The people who moved out of poor neighborhoods were healthier. When they went back and measured the differences between people who got vouchers and people who didn’t, the results were remarkable: The people who got vouchers to move to low-poverty neighborhoods had significantly lower rates of obesity and Type 2 diabetes.

Robert Whitaker, a pediatrician and public-health expert at Temple University, co-authored a report on the HUD study for the New England Journal of Medicine in 2011. “By dint of the design, the cause of the difference in diabetes and obesity was the voucher and the move to a less-distressed neighborhood,” Whitaker says. “The amazing thing is that the cause of the difference in obesity and diabetes was the move.”

How could this be? Ethnic disparities in diabetes and obesity—Hispanics and blacks in the U.S. are up to 45 percent more likely to be obese than whites, and nearly twice as likely to have Type 2 diabetes—have long been blamed on diet, access to health care, and even the lack of good grocery stores in America’s poorest neighborhoods. Genes, too, have long been suspected to play a role.

But the HUD study, and subsequent research, have shown that something more than race, individual behavior, or genetics is taking a toll on the health of people who live in poor neighborhoods: stress.

When study participants moved to low-poverty neighborhoods, they reported feeling safer, less depressed, and less anxious—in other words, less stressed. “Somehow, our social environment is getting under people’s skin and causing a cascade of things to occur in the body,” says Rebecca Hasson, director of the Childhood Disparities Research Laboratory at the University of Michigan. “Ethnic minorities are exposed to a lot more stressors. Is that related to their elevated diabetes risk?”

To understand how stress affects health, it’s important to know that one hormone, cortisol, plays an outsize role. In an emergency, cortisol provides a jolt to the body’s systems that floods it with energy. “That generalized response releases energy substrates to the muscles, so you can fight or run away,” says Hasson. “Usually that’s in response to a physical stressor, like a bear chasing you.” In the effort to escape the bear, the body burns off the blood sugar that cortisol helped release, coming down tired and shaky but safe. (If you manage to escape, of course.)

If cortisol was reserved for bear attacks, we’d have no problems. But you don’t need a bear to unleash cortisol. The perception of stress alone is enough to trigger a flood of the hormone.

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