Summary: The neighborhood where you live can shape your heart and brain health, new research and community experience suggest.
Source: American Heart Association
Liz Harris refuses to let obstacles stop her from walking. Three mornings a week she descends three flights of stairs and heads to Anacostia Park, a 10-minute walk from her home. If friends aren’t available she walks alone, though they often worry for her safety.
“The community is known for crime, and you don’t feel comfortable walking alone,” said Harris, 72, who lives in southeastern Washington, D.C.’s Ward 8. She also cites unleashed dogs in the park, poorly maintained sidewalks and heavy traffic that worsen air quality as barriers to getting regular exercise.
“For the most part, the neighborhood isn’t conducive to getting exercise, especially for women,” she added.
Harris persists because, despite the challenges, the area also faces high rates of obesity, heart disease and cognitive decline, according to the DC Health Matters Collaborative, a coalition of hospitals and community health centers. A 2018 regional report highlighted additional disparities in the neighborhood, including higher infant mortality, child poverty, unemployment, older housing and longer commutes.
“We’re always at the lowest indicators,” said Mustafa Abdul-Salaam, a longtime community activist in Ward 8. “We die 15 years earlier than Ward 3 (in northwest Washington). That says it all.”
A substantial body of research shows that the conditions in which people live, work, learn and play—known as social determinants of health—have a direct effect on cardiovascular health and, by extension, brain health. Neighborhood factors include housing stability, access to affordable, healthy food, reliable transportation and health care, opportunities for safe physical activity, and levels of pollution and noise.
Lack of public safety, social disorder and exposure to violent crime have also been linked to higher stroke risk, which can lead to cognitive decline. “All of those factors coming together increase a person’s vulnerability to cardiovascular disease, especially in poorer neighborhoods,” said Mustafa Hussein, assistant professor at the Joseph J. Zilber School of Public Health at the University of Wisconsin–Milwaukee.
Hussein led a 2017 study published in the American Journal of Epidemiology that found people with low socioeconomic status were about 60% more likely to experience a heart attack or stroke than those with higher socioeconomic status, with roughly one-third of that extra risk attributable to neighborhood conditions. Other research published in Stroke suggests that living with three or more adverse social determinants can make someone nearly 2.5 times more likely to have a stroke. A 2020 report in the journal Circulation: Cardiovascular Quality and Outcomes noted that simply living in aging public housing raises heart disease risk. In its 2019 prevention guidelines, the American Heart Association, together with the American College of Cardiology, described social inequities as strong determinants of cardiovascular risk—comparable in impact to medications and lifestyle changes.
Abdul-Salaam observes these effects firsthand in Ward 8. The neighborhood has abundant green space and natural beauty—assets that support health—but lacks consistent access to affordable, healthy groceries and is burdened by heavy commercial and commuter traffic. That traffic makes walking less safe and increases noise and pollution.
Groups such as the National Complete Streets Coalition promote redesigning roads to be safer and more accessible for pedestrians, cyclists and people who use assistive devices, as well as improving access to public transportation. Solutions include continuous sidewalks, protected bike lanes, wider shoulders, dedicated bus lanes and more accessible transit stops. A 2020 American Heart Association policy statement emphasized that such infrastructure changes are essential to increase physical activity across ages, incomes, abilities and racial or ethnic groups.
To date, 35 state governments and the District of Columbia have adopted Complete Streets policies. In Washington, these changes have led to improvements in some areas of Ward 8—raised crosswalks and dedicated bike paths among them—but residents say far more investment is required for the neighborhood to thrive.
Abdul-Salaam is helping lead a community planning process in Ward 8 that connects residents with government, business and health leaders to find collaborative solutions. He is recruiting and training residents to map neighborhood assets and deficits using GPS-enabled apps so the community can identify what to add or remove.
Dr. Tiffany Powell-Wiley, chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute, emphasizes that resident involvement is essential and often overlooked. Too frequently, upgrades in under-resourced communities happen without the input of local residents and can lead to displacement as areas become more attractive and more expensive.
“There needs to be an element of racial equity in the work that’s happening,” she said. “If a new policy is coming into place around community development, we need to ensure that different racial and ethnic populations are benefiting equally.”
Powell-Wiley also stresses practical, culturally appropriate strategies that individuals and small groups can adopt while broader structural changes are pursued. She collaborates with residents like Harris to study and implement approaches that increase physical activity and support heart health among Black women living in resource-limited neighborhoods. “There are ways to use the resources you do have,” she said. Building social networks—walking in groups, for instance—can enhance both safety and participation.
Still, Hussein warns that lifestyle-focused recommendations alone are insufficient if underlying structural challenges remain unaddressed. “The whole idea of lifestyle choices as something everyone can tap into is misleading when that choice is constrained by what is available to people,” he said. “This is where policy solutions or investments into these neighborhoods to make up for historical disinvestment become so important.”
About this environmental neuroscience research news
Source: American Heart Association
Contact: Laura Williamson – American Heart Association
Image: The image is in the public domain