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Keeping kids out of the doctor’s office much easier in well-off neighborhoods

Keeping kids out of the doctor’s office much easier in well-off neighborhoods

Picture of Katharine Gammon
San Francisco residents wait in line for a food basket giveaway. (Photo by Justin Sullivan/Getty Images)
San Francisco residents wait in line for a food basket giveaway. (Photo by Justin Sullivan/Getty Images)

Researchers are increasingly discovering how much neighborhoods impact life trajectories. That’s even more true for kids.

Ellen Kersten, a population health researcher at the University of California, San Francisco, has been exploring how urban environments affect public health for years. In 2014, she found that children who lived in redeveloped public housing were less likely to have repeat visits to the emergency room compared to children who lived in lower-quality public housing.

“There is a rapidly developing literature about how health care providers can screen for and help mitigate social barriers to health,” said Kersten.

In a new study out in the journal Pediatrics, Kersten and colleagues used a measure called the Child Opportunity Index, created by researchers at Brandeis University, to figure out how neighborhoods were associated with pediatric acute care visits. The index uses 19 measures from publicly available census data across 100 large metropolitan areas across the U.S.

Researchers identified clusters of high- and low-risk neighborhoods in San Francisco. And she found some stark differences: children living in the lowest opportunity neighborhoods were four times more likely to visit acute care in a year compared with those in the highest opportunity neighborhoods.

So what, exactly, does a low-opportunity neighborhood look like? Kersten outlined some common qualities: proximity to toxic waste sites, few health food retail locations, a long distance to parks or greenspace, few licensed early childhood education centers, a high foreclosure rate, and few job opportunities within five miles. She warns that the study only looked at associations, not causation, between neighborhood features and health outcomes. In other words, she can’t say these factors are causing more acute care visits.

In the Dogpatch neighborhood of San Francisco, for example, incomes are considered moderate for the city. However, the Child Opportunity Index identifies it as a low-opportunity neighborhood — the health needs of the community could be overlooked by policymakers only focused on income levels.

Kersten says her latest findings should provide fresh impetus for health care systems and providers to collaborate with community organizations and agencies outside of the health care setting to address health disparities. Tools such as the Child Opportunity Index can serve as a screening tool to identify at-risk communities.

Although the study didn’t set out to examine race as a factor, Kersten noted that more than three out of every four African American or Latino patients in the study’s sample lived in a low- opportunity neighborhood, compared with just one out of every four white patients. And 82 percent of publicly insured patients lived in low-opportunity neighborhoods, compared with 27 percent of privately insured patients.

“We need interventions directly in low-opportunity neighborhoods to make a dent in these disparities,” Kersten said.

Those interventions would vary by neighborhood and should be guided by community input but could include investments in public schools and day cares, improving access to healthy food and parks, and expanding local hiring and housing assistance programs.

Kersten is continuing her work, looking at health outcomes before and after neighborhood revitalization projects occur. She wants to know how the downstream effects of revitalization projects. For example, what happens to health outcomes when housing, education and job training improves?

Said Kersten: “If we want to see a change in kind of racial health disparities, we also have to think broadly about the environments where people are living.”



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USC Class '82. Read your article on the year 2050. It was interesting and full of apparent objective evidence but most opinion. More confirmation bias but I thought I'd give the benefit of the doubt. Read another article of yours about "public health" issue, Again your disclaimer came on the four or fifth paragraph. The subject title dates me. I'm old but … Being objective is the prime directive of any journalist. Specially a ":science" one. Not just regurgitating what other people tell you without proof. IMHO, it is why they enjoy the protection of the Constitution and part of the first amendment. Without this, almost scared directive, its only propaganda. You've got a difficult job, I realize, but you can't have two masters. Either the truth or the ones that pay your salary.


The Center for Health Journalism’s two-day symposium on domestic violence will provide reporters with a roadmap for covering this public health epidemic with nuance and sensitivity. The first day will take place on the USC campus on Friday, March 17. The Center has a limited number of $300 travel stipends for California journalists coming from outside Southern California and a limited number of $500 travel stipends for those coming from out of state. Journalists attending the symposium will be eligible to apply for a reporting grant of $2,000 to $10,000 from our Domestic Violence Impact Reporting Fund. Find more info here!


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