Haan M, Kaplan GA, Camacho T. Poverty and health: prospective evidence from the Alameda County Study. American Journal of Epidemiology. 1987; 125: 989-98.

This study attempts to elucidate the effect of the socio-physical environment on health, and finds that these effects are independent of individual behaviors such as smoking, alcohol consumption, or obesity, or factors such as race, income, employment status or access to medical care. The data were collected from a sample of residents in Oakland, California, and suggests that there is an independent effect on health of residence in a poverty area. Lack of access to medical care in a poverty area did not further adversely affect health in this study although it may play a small, hard to detect role.  

Abstract

To examine the reasons for the association between socioeconomic status and poor health, the authors examined the nine-year mortality experience of a random sample of residents aged 35 and over in Oakland, California. Residents of a federally designated poverty area experienced higher age-, race-, and sex-adjusted mortality over the follow-up period compared with residents of non-poverty areas (relative risk = 1.71, 95 per cent confidence interval 1.20-2.44). This increased risk of death persisted when there was multivariate adjustment for baseline health status, race, income, employment status, access to medical care, health insurance coverage, smoking, alcohol consumption, physical activity, body mass index, sleep patterns, social isolation, marital status, depression, and personal uncertainty. These results support the hypothesis that properties of the socio-physical environment may be important contributors to the association between low socioeconomic status and excess mortality, and that this contribution is independent of individual behaviors.

Keywords

• behavioral factors
• community
• city
• education
• health inequalities
• medical care
• mental illness
• mortality
• neighborhoods
• poverty
• race
• relative deprivation
• smoking
• social cohesion
• socioeconomic status
• unemployment