While people are often encouraged to get healthier, the social determinants of health — conditions in which individuals are born, grow, live, work and age that are shaped by factors of oppression and privilege — can make that challenging. These conditions have been shown to contribute to health disparities, according to the Centers for Disease Control and Prevention (CDC).
Now a new study, published on July 14 in the Journal of the American Heart Association, illustrates how exposure to violent crime can affect heart health.
For the study, researchers looked at death rates for cardiovascular disease, stroke, and coronary artery disease in the 77 community areas of Chicago from 2000 to 2014, and compared them with violent crime rates in each area over the same period. During that 14-year period, researchers noticed a 16 percent decrease in violent crime in the city overall, which coincided with a 13 percent decrease in deaths from cardiovascular disease. Looking at neighborhood-level numbers, researchers saw that where violent crime rates dropped the most, so did heart-disease related deaths: Neighborhoods with an average drop in violent crime of 59 percent saw a nearly 15 percent drop in heart disease deaths.
“It’s important to acknowledge the impact of the built environment on health,” said the study’s lead author, Lauren Eberly, MD, MPH, a clinical fellow in cardiovascular medicine and an associate fellow of the Leonard Davis Institute at the University of Pennsylvania in Philadelphia, in a news release. “Exposure to violent crime appears to be an important social determinant of cardiovascular health within the broader context of the ways in which structural racism harms health.”
Research shows that violent crime tends to occur more often in communities of color. The current study didn’t look at the racial makeup of neighborhoods analyzed, and the researchers caution against using this single, one-city study in the United States to make generalizations about all cities. On the other hand, she said, they do suspect the situations may be similar in other large urban areas in the United States.
“We must acknowledge the legacy of racist policies and practices that have led to concentrated disadvantage and crime in Black and other racially and ethnically minoritized neighborhoods," Dr. Eberly said.
Rigved Tadwalkar, MD, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, California, who was not involved in the study, says that the findings highlight the need for more vigorous community-level interventions to improve the health and well-being of those who are hit hardest by crime.
“People should understand that crime does not only harm someone because of the physical injury that it causes. The emotional stress and suboptimal lifestyle behaviors that result from recurrent exposure to crime are impactful,” Dr. Tadwalkar says.
Community Investment Can Improve Health
Heart disease is the leading cause of death for men, women, and people of color in the United States, according to the CDC. In 2020, approximately 139,000 Black Americans died of heart disease. In an April 2022 Pew Research Study that surveyed more than 1,400 Black Americans on their views of science, Black Americans stated that less access to quality care contributes to worse health. A large number of participants also listed environmental quality problems as a contributor to poorer health outcomes for Black people.
The findings of this new study offer further evidence that the built environment — neighborhoods, communities, homes — can have a direct effect on a person’s health. The researchers note that communities with high crime rates receive less economic investment, which perpetuates the cycle of violence and poverty.
“Targeted and sustained investment to break the link between long-standing community disinvestment and subsequent poor health outcomes is needed, particularly in Black neighborhoods,” the authors write.
A coauthor of the study, Eugenia South, MD, is the director of the Penn Urban Lab and coauthored another study, published in JAMA Network Open in July 2021, on whether place-based, environmental, non-police interventions decrease neighborhood violent crime. She found that financial investment in structural repairs to the houses of low-income individuals were linked with a decrease in crime in these communities.
“As a physician working in Philadelphia, a city with high gun violence rates, almost every day I care for a patient that has lost a friend or a loved one to gun violence,” Dr. Eberly says, “We hope that our paper will raise awareness of the many harms of gun violence and the results will advocate for community investment and non-police interventions to decrease crime rates, particularly [in] Black urban communities, that historically have suffered from intentional and sustained community divestment, which has fueled high crime rates.”