New Research Finds Health-Promoting Improvements Concentrated in More Advantaged U.S. Neighborhoods

Neighborhoods that are more walkable, with accessible public transportation, and amenities such as parks that promote physical and social activity are associated with better health.1 But new research suggests that more-advantaged neighborhoods receive more infrastructure improvements and new amenities, and reap more of the benefits—potentially exacerbating existing health disparities.2

A growing number of studies show that living in a disadvantaged neighborhood is associated with increased health risks for all residents, even for those who are not poor.The concentration of neighborhood improvement in more advantaged neighborhoods provides residents—who already have better health outcomes, on average, than those in less advantaged neighborhoods—with opportunities to become even healthier.

Understanding how constructed or “built” environments change over time can help policymakers, planners, and community organizations ensure that public and private investments are directed in ways that minimize health inequities.

A recent study finds that more advantaged neighborhoods tend to gain more private and retail amenities and services that may promote health and well-being than less advantaged neighborhoods. In this study, a team of researchers at the University of Michigan and University of North Carolina at Chapel Hill drew on data from regional governments and business listings to document neighborhood-level changes in land use and the number of social engagement destinations (such as entertainment, museums, political clubs, and religious locations), walking destinations (such as banks, post offices, drug stores, and groceries), and physical activity facilities (such as indoor gyms) between 2000 and 2010 in seven U.S. metropolitan areas (Los Angeles; Chicago; Baltimore; St. Paul, Minn.; Hinds County, Miss.; Forsyth County, N.C.; and New York City).4 They combined these data with data from the 2000 Census and the 2005-2009 American Community Survey to examine how neighborhood characteristics shaped the changing built environment.

They found that more advantaged neighborhoods in 2000—those with a larger share of non-Hispanic white residents and higher household incomes—and neighborhoods that became more advantaged between 2000 and 2010—those with a growing share of non-Hispanic white residents and rising household incomes—saw larger increases in destinations that promote social engagement, walking, and physical activity between 2000 and 2010 than other neighborhoods.

The authors suggest that these observed changes in neighborhoods may exacerbate existing disparities because “the benefits associated with positive change in the built environment would be experienced largely by people who already enjoy health advantages.”

Neighborhoods with older populations—more residents over age 65—in 2000 experienced decreases in destinations that promote walking and physical activity between 2000 and 2010. Declining availability of such amenities could be problematic for aging populations as combining walking with daily activities improves health and decreases social isolation.

However, neighborhoods with more population aging—that is the share of residents over age 65 increased—between 2000 and 2010—did have improvements in the built environment that promote walking, social engagement, and physical activity, which the authors found encouraging. “Age-friendly urban design will become critical for older people to successfully age in the community” rather than move to a more walkable neighborhood, they argue.

A second recent study finds that health-promoting neighborhood features, such as bike lanes, trails, and bus service, have increased in the past 25 years. Yet the neighborhoods with the largest increases tend to be more affluent, which could worsen health inequities, report a team of researchers at the Carolina Population Center and the University of North Carolina at Chapel Hill.5 Focusing this time on public infrastructure, the researchers combined decennial census and American Community Survey data with geospatial and city planning data to examine the spatial distribution of changes in the built environments of four U.S. cities (Birmingham, Ala.; Chicago; Minneapolis; and Oakland, Cal.) over 25 years (1985 to 2010) and how neighborhood characteristics shaped these infrastructure changes.

The researchers found that between 1985 and 2010, bike lanes, off-road trails, and bus service increased in the four U.S cities under study. However, the improvements in public infrastructure were not evenly distributed across the neighborhoods within cities. Neighborhoods that became poorer or had larger increases in residents who were unemployed saw fewer new off-road trails or bike lanes, while neighborhoods with large increases in median household income experienced more growth in bike lanes and bus service. These findings imply that improvements in public infrastructure that may promote healthy behaviors are more concentrated in affluent and economically stable neighborhoods.

The authors of both studies argue that more attention should be paid to ensuring that improvements in neighborhood infrastructure and amenities are developed and distributed in a way that improves health equitably. Strategies that aim to address existing health disparities include public incentives for developers to build more affordable housing in advantaged neighborhoods and for retail grocery stores to locate in “food deserts,” disadvantaged neighborhoods without access to fresh and affordable food.6


This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population research centers was highlighted in this article Carolina Population Center, University of Michigan, and the University of North Carolina at Chapel Hill.



  1. Mark Mather and Paola Scommegna, “How Neighborhoods Affect the Health and Well-Being of Older Americans,” Population Reference Bureau, Today’s Research on Aging 35 (Feb. 2017); Sallis et al., “Co-Benefits of Designing Communities for Active Living: An Exploration of Literature,” International Journal of Behavior Nutrition and Physical Activity 12, no. 1 (2015): 729-37; and Gebel, Bauman, and Petticrew, “The Physical Environment and Physical Activity: A Critical Appraisal of Review Articles,” American Journal of Preventive Medicine 32, no. 5 (2007): 361-69.
  2. Schulz and Northridge, “Social Determinants of Health: Implications for Environmental Health Promotion,” Health Education and Behavior 31, no. 4, (2004): 455-71.
  3. Mather and Scommegna, “How Neighborhoods Affect the Health and Well-Being of Older Americans”; and Robert Wood Johnson Foundation (RWJF), “Neighborhoods and Health,” Exploring the Social Determinants of Health Series No. 8 (May 2011).
  4. Jana A. Hirsh et al., “How Much Are Built Environments Changing, and Where?: Patterns of Change by Neighborhood Sociodemographic Characteristics Across Seven U.S. Metropolitan Areas,” Social Science & Medicine 169 no. 1 (2016): 97-105.
  5. Jana A. Hirsch et al., “Neighborhood Sociodemographics and Change in Built Environment,” Journal of Urbanism: International Research on Placemaking and Urban Sustainability 10, no. 2 (2017): 181-97.
  6. RWJF, “Neighborhoods and Health.”