Improving Health by Investing in Communities

A primer on the connections between community development and health.

When it comes to health, your ZIP code may be more important than your genetic code.

Where you live matters for your health. Case in point: babies born in the Iberville neighborhood of New Orleans can expect to live to age 55. Just a few miles to the north, along I-10, it’s a very different story where babies born to mothers near the Naverre neighborhood have a life expectancy of 80 years.

That’s a 25-year difference in life expectancy for babies born just a few miles apart.

New Orleans, for all its history and unique characteristics, is not alone in having stark health differences from one neighborhood to the next.

In the nation’s capital region, babies born to mothers in Maryland’s Montgomery County and Virginia’s Arlington and Fairfax Counties can expect to live six to seven years longer than babies born to mothers in Washington, DC—just a few metro stops away.

This pattern repeats across the U.S. on multiple health measures.

[View the full collection of life expectancy and health maps]

What Makes One Community Healthier — or Less Healthy — than Another?

Neighborhood characteristics can influence health in many ways.

What is it about the places we live, learn, work and play that can have such a dramatic impact on how long and how well we live? And why are some communities so much healthier—or less healthy—than others? The answer lies in a cluster of factors that, together, have an enormous impact:

Image credit: Investing in What Works for America’s Communities (
  • Some communities are unsafe for children to play outside and lack parks and sidewalks for physical activity.
  • Fast food chains and convenience stores selling unhealthy food may outnumber supermarkets that sell fresh produce or restaurants with nutritious food.
  • Access to primary care doctors and good hospitals may be limited.
  • Good jobs may be scarce in neighborhoods with struggling economies; employment provides wages and benefits that are important to health.
  • Communities with weak tax bases cannot support high quality schools; education is critically important to health.
  • Unsafe or unhealthy housing can expose residents to allergens, outdoor air pollution, or other hazards.
  • Public transit may be inadequate to connect residents to good jobs, health care, and services.
  • Residential segregation and features that isolate communities (e.g., highways) can damage social cohesion, stifle economic growth, and perpetuate cycles of poverty.
All of these factors can have a tremendous impact on people’s opportunity to live a healthy and rewarding life.

What are the Potential Solutions? How Does Community Development Fit In?

To improve health, we need to improve opportunities to be healthy.

When we build and revitalize communities, we need to consider health.

This means spurring the integration of health, finance, urban planning and community development, investing in innovation, and replicating what works. It also means thinking about the impacts of housing policy, education policy, food policy, and economic policy on health.

This is particularly important in low-income communities.

Nearly a fifth of all Americans live in low-income neighborhoods where job opportunities are scarce, access to safe housing and nutritious food is poor, and pollution and crime are prevalent. These factors have a tremendous impact on health.

That’s where community development comes into play.

What is community development? The community development sector — a network of nonprofit service providers, real estate developers, financial institutions, foundation and government — leverages public and private dollars to transform impoverished neighborhoods into economically viable and healthy communities. Community development works locally to meet the needs of residents by planning and building roads, child care centers, schools, grocery stores, community health clinics and affordable housing: the same community characteristics that shape health.

The community development industry spends about $150 billion annually to improve low- and moderate-income communities. Similarly, the health sector spends a tremendous amount of money to improve lives — more than $2.7 trillion each year and one sixth of our national economy.

Yet still, for the first time in history, the United States is raising a generation of children who may live shorter and sicker lives than their parents.

For 50 years, the community development industry has worked to transform low-income neighborhoods. The public health sector works in many of these same neighborhoods, but too they work together too infrequently. Better alignment of these fields can improve health outcomes in the places that need it the most.

Last January, the Robert Wood Johnson Foundation Commission to Build a Healthier America—a bipartisan groups of experts from across a broad range of sectors—called for a seismic shift in how we approach health, including the integration of health into community development.

Almost a year later, there’s growing awareness and support for action.

Toolbox: Reshaping Our Communities for Better Health

There’s a growing focus on improving health from outside the health sector, including community development.

The health care sector alone cannot bear sole responsibility for the country’s health. For that reason, we need to break down conventional
silos that separate health from education, transportation, community planning, and other areas of decision-making and engage in true cross-sector collaboration. Here are some resources to get started:

County Health Rankings

RWJF Commission to Build a Healthier America

Build Healthy Places Network

Healthy Communities initiatives

Health Impact Project

Conversations about Health at the 2014 National Interagency Community Reinvestment Conference

Health Affairs issues on community development and health:
November 2011 and November 2014.

Success Stories

There are examples of success hiding in plain sight.

Here are just a few examples of bright spots around the country showing how community development investments can improve health:

Atlanta’s East Lake neighborhood was once known for its high rates of poverty and crime —both linked to poor health — is the model for Purpose Built Communities. Combining mixed-income housing and other neighborhood improvements with cradle-to-college education helped increase the employment rate from 13 to 70 percent. The neighborhood’s Drew Charter School moved from last to 4th place among 69 Atlanta public schools, and violent crime dropped by 90 percent. Similar projects are in progress in Indianapolis, Galveston and New Orleans.

In Texas, Neighborhood Centers, Inc. provides residents with child care services, credit unions, job counseling, health centers, charter elementary schools, immigration services, and community centers. Serving more than 400,000 people each year, Neighborhood Centers has connected people to more than 65,000 jobs since 2008 and has returned more than $5 million to the community in increased wages. Increased income is linked to better health.

ReFresh is the first development in the nation to house healthy and fresh
food retail options under the same roof with a broad range of organizations and programs designed to promote positive health outcomes and healthy behaviors. The development, which has taken over an old grocery building in the city left vacant following Hurricane Katrina, combines direct services and goods with education, training and outreach.

At Educare, every aspect of the learning environment is focused on providing a healthy and supportive place that will have a long-term impact on the children and their families.

Renovations to the Booth Memorial Childcare Center in Oakland, Calif., improved the health of the children and employees, and helped the center to deliver better services for the community while achieving more financial stability.

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