Danya E. Keene

“Weathering” HOPE VI: The Importance of Evaluating the Population Health Impact of Public Housing Demolition and Displacement

HOPE VI has funded the demolition of public housing developments across the United States and created in their place mixed-income communities that are often inaccessible to the majority of former tenants. This recent uprooting of low-income, urban, and predominantly African American communities raises concern about the health impacts of the HOPE VI program for a population that already shoulders an enormous burden of excess morbidity and mortality. In this paper, we rely on existing literature about HOPE VI relocation to evaluate the program from the perspective of weathering—a biosocial process hypothesized by Geronimus to underlie early health deterioration and excess mortality observed among African Americans. Relying on the weathering framework, we consider the effects of HOPE VI relocation on the material context of urban poverty, autonomous institutions that are health protective, and on the broader discourse surrounding urban poverty. We conclude that relocated HOPE VI residents have experienced few improvements to the living conditions and economic realities that are likely sources of stress and illness among this population. Additionally, we find that relocated residents must contend with these material realities, without the health-protective, community-based social resources that they often rely on in public housing. Finally, we conclude that by disregarding the significance of health-protective autonomous institutions and by obscuring the structural context that gave rise to racially segregated public housing projects, the discourse surrounding HOPE VI is likely to reinforce health-demoting stereotypes of low-income urban African American communities. Given the potential for urban and housing policies to negatively affect the health of an already vulnerable population, we argue that a health-equity perspective is a critical component of future policy conversations.

Community-Based Support among African American Public Housing Residents

Recent shifts from federally owned public housing toward tenant-based housing assistance in the form of vouchers raise important questions about the health and wellbeing of rent-assisted households. In particular, little is known about how these shifts in housing policy will affect access to critical sources of community-based social support among those who receive rent assistance. Using the Survey of Income and Program Participation, we estimate the relationship between residence in a federally owned public housing project and the reported presence of social support among a nationally representative sample of blacks who receive rent assistance. We find that in comparison to other rent-assisted households, public housing residents are significantly more likely to report that people in their neighborhood count on each other, watch each other’s children, and have access to help from a family nearby. We also find that these measures of community-situated social support are associated with reduced odds of school expulsion among children and food insecurity among adults. In conclusion, we find evidence suggesting that public housing communities contain social resources that are important to the wellbeing of their residents and are less accessible to other rent-assisted households.

Spatial stigma and health inequality

A large body of literature has considered the way that places contribute to the health of their residents. The bulk of this research has considered the numerous risks and resources that are contained within the bounded spaces of neighborhoods and communities. Only recently have scholars begun to consider how these material and social conditions interact with the symbolic dimensions of place to further affect health. In this conceptual paper, we draw on a broad literature in order to develop a conceptual framework that connects negative representations of place, or spatial stigmas, to health. We argue that spatial stigma can affect health through three primary pathways: (1) access to material resources; (2) processes of stress and coping; and (3) processes related to identity formation and identity management. Our model suggests that spatial stigma is likely an important and understudied mechanism through which disadvantaged places contribute to multiple physical and mental health outcomes. Furthermore, by considering the larger sociocultural meanings that surround marginalized places, the concept of spatial stigma introduces new considerations for the development of effective policies to address geographic health inequality.

Length of residence and social integration: the contingent effects of neighborhood poverty.

Given the well-established benefits of social integration for physical and mental health, studies have begun to explore how access to social ties and social support may be shaped by the residential context in which people live. As a critical health exposure, social integration may be one important mechanism by which places affect health. This paper brings together research on two previously studied contextual determinants of social integration. Specifically, we use multi-level data from the Chicago Community Adult Health Survey to investigate the relationships between an individuals length of residence and measures of social integration. We then investigate the extent to which these relationships are moderated by neighborhood poverty. We find that the relationship between length of residence and some measures of social integration are stronger in poor neighborhoods than in more affluent ones.

Fragile health and fragile wealth: mortgage strain among African American homeowners.

Several recent studies identify illness and disability as contributors to mortgage strain, suggesting that the disproportionate burden of poor health that African Americans experience may be an important source of housing fragility in this population. In order to understand how poor health plays out in the lived experiences of African-American homeowners and contributes to mortgage strain, we present an analysis of 28 in-depth interviews conducted with middle and working-class African-American homeowners at risk of losing their homes. Our interviews show how racial inequalities in health, which result from an ongoing history of racial discrimination, intersect with other racially stratified sources of housing fragility to put homeowners at risk of foreclosure. Many participants in this study were long-term homeowners who experienced mortgage strain as result of a health-related event that triggered the collapse of a fragile household budget. Like many middle and working-class African Americans, participants experienced poor health and disability at relatively young ages. Additionally, they often lacked access to personal and public safety nets that could buffer the consequences of illness. Understanding how poor health contributes to mortgage strain among African-American homeowners provides important insight into the downstream consequences of health inequalities. Furthermore, understanding the processes through which illness can act as a financial shock has important policy implications.

A difference-in-differences study of the effects of a new abandoned building remediation strategy on safety

Vacant and abandoned buildings pose significant challenges to the health and safety of communities. In 2011 the City of Philadelphia began enforcing a Doors and Windows Ordinance that required property owners of abandoned buildings to install working doors and windows in all structural openings or face significant fines. We tested the effects of the new ordinance on the occurrence of crime surrounding abandoned buildings from January 2011 to April 2013 using a difference-in-differences approach. We used Poisson regression models to compare differences in pre- and post-treatment measures of crime for buildings that were remediated as a result of the ordinance (n = 676) or permitted for renovation (n = 241), and randomly-matched control buildings that were not remediated (n = 676) or permitted for renovation (n = 964), while also controlling for sociodemographic and other confounders measured around each building. Building remediations were significantly associated with citywide reductions in overall crimes, total assaults, gun assaults and nuisance crimes (p <0.001). Building remediations were also significantly associated with reductions in violent gun crimes in one city section (p <0.01). At the same time, some significant increases were seen in narcotics sales and possession and property crimes around remediated buildings (p <0.001). Building renovation permits were significantly associated with reductions in all crime classifications across multiple city sections (p <0.001). We found no significant spatial displacement effects. Doors and windows remediation offers a relatively low-cost method of reducing certain crimes in and around abandoned buildings. Cities with an abundance of decaying and abandoned housing stock might consider some form of this structural change to their built environments as one strategy to enhance public safety.

Getting sick and falling behind: health and the risk of mortgage default and home foreclosure

Background An emerging literature shows that mortgage strain can lead to poor health outcomes, but less work has focused on whether and how health shocks influence mortgage distress. We examine the link between changes in health status and default/foreclosure risk among older middle-aged adults. Method We used National Longitudinal Study of Youth 1979 data and multivariate logistic regression models to examine the relationship between changes in health limitations and chronic conditions across survey waves and risk of mortgage default and foreclosure. Results We found that changes in health limitations and chronic conditions increased the risk of default and foreclosure between 2007 and 2010. These associations were partially mediated by changes in family income and loss of health insurance. Conclusions From a policy perspective, the strong link between the onset of illness and foreclosure suggests a need to re-examine the safety-nets that are available to individuals who become ill or disabled.

Spatial Stigma and Health in Postindustrial Detroit.

An emerging body of research suggests that those who reside in socially and economically marginalized places may be marked by a stigma of place, referred to as spatial stigma, which influences their sense of self, their daily experiences, and their relations with outsiders. Researchers conducted 60 semistructured interviews at partnering community-based organizations during summer 2011 with African American and Latina/o, structurally disadvantaged youth of diverse gender and sexual identities who were between 18 and 26 years of age residing in Detroit, Michigan. The disadvantaged structural conditions and dilapidated built environment were common themes in participants’ narratives. Beyond these descriptions, participants’ framings and expressions of their experiences in and perceptions of these spaces alluded to reputational qualities of their city and particular areas of their city that appear related to spatial stigma. Young Detroit residents articulated the ways that they experience and navigate the symbolic degradation of their city.

You Can't Just Walk Down the Street and Meet Someone: The Intersection of Social-Sexual Networking Technology, Stigma, and Health Among Gay and Bisexual Men in the Small City.

Social–sexual networking technologies have been reported to yield both psychosocial benefits and sexual risks for gay and bisexual men, yet little research has explored how technology interacts with the social–geographical environment to shape the health of gay and bisexual men in the relatively understudied environment of small cities. This article draws on 29 semistructured interviews examining the use of social–sexual networking technologies among racially diverse gay and bisexual men in two small cities. Questions probed participants’ use of technology to meet sexual partners, engagement in the gay community, and the role of virtual and nonvirtual spaces in relation to health. Findings suggest that social networking technologies can help men navigate the challenges of small cities, including small and insular gay communities, lack of dedicated gay spaces, and sexual minority stigma. However, participants also describe declines in gay community visibility and cohesion, which they attribute to technology use. The article concludes by discussing the intersections of virtual and physical space in small cities as sites for the production of health and illness.

‘The big ole gay express’: sexual minority stigma, mobility and health in the small city

Abstract Recent research has examined how gay and bisexual men experience and navigate the variations in sexual minority stigma that exist across geographic contexts, with implications for their health. We extend this literature on stigma, mobility, and health by considering the unique and understudied setting of the small city. Drawing on semi-structured interviews (n = 29) conducted in two small US cities (New Haven and Hartford), we find that these small cities serve as both destinations and points of departure for gay and bisexual men in the context of stigma. New Haven and Hartford attracted gay and bisexual men from surrounding suburbs where sexual minority stigma was more prevalent and where there were fewer spaces and opportunities for gay life. Conversely, participants noted that these small cities did not contain the same identity affirming communities as urban gay enclaves, thus motivating movement from small cities to larger ones. Our data suggest these forms of mobility may mitigate stigma, but may also produce sexual health risks, thus drawing attention to small cities as uniquely important sites for HIV prevention. Furthermore, our analysis contributes to an understanding of how place, stigma and mobility can intersect to generate spatially distinct experiences of stigmatised identities and related health consequences.