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GREEN AND HEALTHY HOUSINGObesity in Low-Income Communities

Written by Rachel Goldman

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The Cost of Obesity, and the Individuals it Targets

It is no surprise that poor nutrition has become increasingly common in the United States; it is a fact that can be observed in the general population through obesity. What may come as a surprise is the true cost of obesity, the underlying causes and the alarming rate at which it affects low-income individuals when compared to their higher income counterparts. Weight-related medical costs are estimated to have reached $147 billion in 2008 (that’s 9.1 percent of all medical spending), and show no signs of subsiding. 1 Besides the obvious mobility disadvantage to being obese, it is known to cause a series of physical and psychological ailments including: diabetes, heart disease, high blood pressure, asthma, depression and anxiety. These are in addition to the social discrimination and stigmatization one faces as an overweight or obese member of society.2 The effects of obesity are lethal, and together cause an estimated 300,000 deaths per year in the United States.3 According to the National Institute of Health, obesity and being overweight are the second leading cause of preventable death in the United States4 Low-income individuals face a hardship when dealing with health issues because of their general lack of access to quality health care, combined with a shortage of expendable income for medical expenditures and higher deductibles. To make matters worse, low-income individuals are at higher risk of becoming overweight or obese due to community infrastructure deficits such as the limited availability of fairly priced produce and safe outdoor parks. In a 2010 study of more than 6,000 adults, BMI and income were found to have an inverse relationship. Those with lower incomes were statistically more likely to have higher BMIs and vice versa.5 According to a 2007 national study of 40,000 children, children from lower income households had more than two times higher odds of being obese than children from higher income households.6 Rates of severe obesity were also 1.7 times higher among low-income children and adolescents nationwide.7 The mission for Center for the Greater Good is to eradicate poverty and create healthy communities through: innovative financial investments, and distinctive strategies for community enhancement. We have identified the following as contributing factors to the alarming poor health in low-income communities:

• Limited resources and lack of access to healthy, affordable foods, • Fewer opportunities for physical activity.

Instead of simply treating the health conditions caused by poor nutrition, Center for the Greater Good is committed to solving the problem. Improved nutrition leading to reduced obesity is just one of the many ways in which we are realizing our vision for healthy, stable communities in the United States.

1 “Consequences of Adult Overweight and Obesity « Food Research & Action Center.” Food Research & Action Center. Web. 15 Nov. 2011. <http://frac.org/initiatives/hunger-and-obesity/what-are-the-consequences-of-adult-overweight-and-obesity/>.

2 Consequences of Adult Overweight and Obesity3 U.S. Department of Health and Human Services. Overweight and obesity: a major public health issue. Prevention Report 2001;16.4 Clinicalguidelinesontheidentification,evaluation,andtreatmentofoverweightandobesityinadults.Executivesummary. National

Institutes of Health, National Heart, Lung, and Blood Institute, June 1998.5 “Relationship Between Poverty and Overweight or Obesity « Food Research & Action Center.” Food Research & Action Center. Web. 15

Nov. 2011. <http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/>.6 Relationship Between Poverty and Overweight or Obesity7 Relationship Between Poverty and Overweight or Obesity

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Poor Nutrition in Low-Income Communities

Arguably, the main cause of disproportionate obesity in low-income communities in the United States is limited access to resources such as healthy, affordable foods. Often, low-income communities lack high quality community infrastructure, including full-service grocery stores and farmer’s markets.8 Residents are sometimes forced to shop for groceries in convenience stores and other small stores, which do not offer the wide variety of fruits, vegetables, whole grains and low-fat dairy products necessary to maintain a healthy diet.9 When healthy foods are offered, they are often higher cost and lower quality than similar items in larger stores, because of their perishable nature.10 Due to the high cost and low quality of produce and dairy products at small grocery stores, households with limited resources are sometimes forced to rely on cheaper, more densely caloric, non-perishable low-nutrition foods (such as products containing processed sugar, refined grains and added fats) in order to minimize and maximize caloric density.11 A 2009 study examining neighborhood disparities in food access found that, “neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity”12

Low-income neighborhoods not only lack affordable sources of quality nutritious foods, they commonly contain disproportionate amount of fast food restaurants (sometimes twice as many)13 which offer a low cost, convenient yet nutritionally void alternative to fresh, perishable foods. According to a study conducted by UCLA, when asked, “46 to 49 percent of low-income teens reported eating fast food on the previous day, compared with 37 percent of more affluent teens.”14 The scarcity of fresh, affordable, nutritious food makes it difficult for an individual with restricted income and limited transportation to maintain a healthy diet. Unfortunately, nutrition is only half the battle in the war on obesity. Not only do low-income neighborhoods commonly lack community supporting retail such as full-scale grocery stores, studies also show residents have less opportunity for physical activity. In middle and upper class communities, it is easy to take for granted the presence of parks, trees, bike paths and quality recreational facilities because they are abundantly available. In both urban and rural low-income communities, green space is hard to come by and trees are few and far between. When a park does exist, it is often ill equipped for safe inhabitance by children and even adults. Crime, traffic, unsafe playground equipment, visual signs of trash and disrepair, and noise15 are just some of the factors driving individuals away from public parks. Such conditions make it difficult for them to lead active lives16, and in turn contribute to obesity.17 With parks in a state of disrepair and the absence of bike paths, people end up spending more time engaging in sedentary activities such as reading, watching TV, playing video games and using the computer.18 An excess of sedentary activities 8 Beaulac, J., E. Kristjansson, and S. Cummins. 2009. A systematic review of food deserts, 1966–2007. Preventing Chronic Disease9 Beaulac , 200910 Andreyeva, Tatiana, Michael W. Long, and Kelly D. Brownell. “The Impact of Food Prices on Consumption: A Systematic Review of

Research on the Price Elasticity of Demand for Food.” Government,Politics,andLaw. American Journal of Public Health, Feb. 2010. Web. 15 Nov. 2011. <yaleruddcenter.org>.

11 Drewnowski A. Barratt-Fornell A. Do healthier diets cost more? Nutrition Today 2004:39:161-168.12 Larson, N.I., M.T. Story, and M.C. Nelson (2009). “Neighborhood Environments: Disparities in Access to Healthy Foods in the U.S.,”

American Journal of Preventive Medicine, 36(1): 74-81.e10.13 Driscoll,Gwendolyn.“ObesityamongState’slow-incomeTeensNearlyTripleThatofMoreAffluentPeers/UCLANewsroom.”Home/

UCLANewsroom. Web. 15 Nov. 2011. <http://newsroom.ucla.edu/portal/ucla/obesity-among-california-s-low-72532.aspx>.14 Driscoll, Gwendolyn15 Neckerman, K.M., M. Bader, M. Purciel, and P. Yousefzadeh (2009). “Measuring Food Access in Urban Areas,” National Poverty Center

Working Paper, www.npc.umich.edu/news/events/food-access/index.php16 Powell, Lisa M., Sandy Slater, and Frank J. Chaloupka. “The Relationship between Community Physical Activity Settings and Race,

Ehtnicity and Socioeconomic Status.” Evidence-BasedPreventativeMedicine I.2 (2004): 135-44. Open Mind Journals. Web.17 Singh, G. K., Siahpush, M., & Kogan, M. D. (2010). Rising social inequalities in US childhood obesity, 2003-2007. Annals of Epidemiology,

20(1), 40-52.18 Singh, 2010

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can be detrimental to the development of children and teens whom should be growing, learning and exploring, socializing, developing new skills and establishing healthy habits before transitioning into adulthood. The same UCLA study also found that, “56 percent of low-income teens watch more than two hours of television per day, compared with 46 percent of more affluent teens.”19 Some might argue a sedentary after school lifestyle is not alarming for a teen, especially if he or she attends public school with mandated Physical Education classes; but schools in low-income communities have been reported to have less recess and lower-impact PE classes than other schools.20 In fact, of low-income teens surveyed, nearly one fifth of them admitted to not getting at least 60 minutes of physical activity per week, as recommended by the Federal Dietary Guidelines for Americans.21 Schools in low-income communities are often underfunded and do not offer the variety of after school sports opportunities as one would find at an affluent school. Barely one third of low-income teens were reported to be active participants in school sports teams, when almost half of affluent teens do participate.22 The combination of poor quality food and sedentary lifestyles is leading to an epidemic of obesity in low-income communities, causing children to become overweight and obese at an alarming rate. As the children become teenagers and later adults, they lack the tools and education to help their own children achieve a higher level of physical health. Center for the Greater Good is committed to providing low-income individuals with the tools they need to improve their own unhealthy habits, as well as ensure the well being of generations to come.

Center for the Greater Good Promotes Nutrition and Exercise for Residents Center for the Greater Good has multiple strategies for battling obesity and promoting health in low-income communities. We offer low interest loans for community revitalization projects, and we offer developer incentives for the creation of community support services and other improvements. One of our strategies is to invest in community infrastructure. The current tax credit system encourages the development of low-income housing in prime locations, walking distance to destinations such as grocery stores, transit, parks and gyms. Housing ends up being built in prime locations, often in middle to upper class communities, which is great for those areas and the residents of the building. The trouble is, the system does nothing to improve communities that do not already have the infrastructure in place. Center for the Greater Good invests in all kinds of community beneficial projects, such as providing low cost space in the community and incentives to bring grocery stores and other retailers to neighborhoods. Afterall, sometimes all it takes is one project to revitalize an entire area. Instead of moving people away, we let the market study and resident input dictate the community’s needs, and deliver it to them to guarantee success! By bringing a neighborhood a grocery store, we are not only offering access to improved nutrition; we are also giving citizens the opportunity to be employed at the grocery store. This creates a cycle of benefits where the money invested in your street, stays in your street instead of going to investments which only focus on financial returns. For projects built in infrastructure rich areas, Center for the Greater Good could potentially offer bus passes to residents. Access to transit, in some cases, eliminates the need for a resident to own a car; saving time and money for the resident, and reducing the strain on roads due to wear, tear and traffic. Transit passes also allow residents to travel to grocery stores and recreation facilities if there aren’t any within walking distance, improving their chance to engage in healthy activities. Depending on the needs of individual communities, some housing projects contain a gym within their

19 Driscoll, Gwendolyn20 Barros et al., 2009; UCLA Center to Eliminate Health Disparities, 2009.21 Driscoll, Gwendolyn22 Driscoll, Gwendolyn

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facility, offering residents the most convenient, safe and cost effective access to the physical activity everybody needs in order to live a healthy life.

The most important solution to the issue of deteriorating health in low-income communities due to poor nutrition and lack of exercise is the Center for the Greater Good’s commitment to resident education. Residents cannot be expected to change their habits if they are unaware of: the resources provided to them; the importance of exercise and nutrition; and how to use the gym and cook healthy, low cost meals. One of our main strategies for improved nutrition in our residents is the existence of a community garden. A community garden is an education tool disguised as a hobby. It can be tended to and enjoyed by residents of all ages, and the food grown can be used in community meals. Residents can take pride in their own ability to grow and cook healthy foods.

Education and Access to Infrastructure are key to Breaking the Cycle of Poor Nutrition The obesity epidemic in the United States is a growing concern in all communities, but low-income communities produce a disproportionate percentage of overweight and obese individuals. “Our neighborhoods are literally making us fat,” said Susan H. Babey, one of the authors of UCLA’s policy brief. “We need better strategies and more thoughtful urban planning if we are going to make our towns and cities livable, not just places where we live.”23 Fortunately, Center for the Greater Good offers an innovative financial model for community revitalization projects, bundled with community support services to ensure success.

23 Driscoll, Gwendolyn