Neighborhood effects on health: Exploring the links and assessing the evidence

This article explores the possible causal pathways through which neighborhoods might affect health and then reviews the existing evidence. Although methodological issues make the literature inconclusive, the authors offer a provisioned hypothesis for how neighborhoods shape health outcomes. They hypothesize that neighborhoods may primarily influence health in two ways: first, through relatively short-term influences on behaviors, attitudes, and health-care utilization, thereby affecting health conditions that are most immediately responsive to such influences; and second, through a longer-term process of "weathering," whereby the accumulated stress, lower environmental quality, and limited resources of poorer communities, experienced over many years, erodes the health of residents in ways that make them more vulnerable to mortality from any given disease. Finally, drawing on the more extensive research that has been done exploring the effects of neighborhoods on education and employment, the authors suggest several directions for future research.