Suburbanization of Poverty, Gentrification, and Health: Changing Geographic Inequalities and Implications for Health Care Access and Health Equity

Abstract

Over the past two decades, patterns of affluence and poverty have shifted in many U.S. metropolitan areas. The prosperous are urbanizing, while poor and lower-middle class populations have moved or been subsequently pushed out to the suburbs. Little is known about the the health consequences of this changing geography of affluence and poverty, and associated reorganization of racial/ethnic segregation, and these shifts remain largely overlooked in public health literature and policy. In this dissertation I investigated how socio-spatial change in metropolitan areas -- specifically gentrification, urban development, and increasing suburban poverty-- impacted health care access and health equity. In the first chapter we used descriptive statistics and multivariate regression of non-elderly adults (18-64 years) in the 2005-2015 Behavioral Risk Factor Surveillance Survey (BRFSS)- a nationally representative repeated cross-sectional study --to examine the differences in health care access and insurance coverage between suburban, urban, and rural areas, pre and post-the Affordable Care Act and between poor and non-poor respondents. We found that nearly 40% of the uninsured population lived in the suburbs, and more than one in three residents delayed care in the past year because of cost. These results suggest the need for increased research and policy attention to address these challenges for vulnerable populations living in the suburbs. In chapter two we conducted a systematic review to identify empirical studies that examined associations between gentrification, and similar but differently termed processes (urban regeneration, urban development, neighborhood upgrading), and health. We found that 22 articles met inclusion criteria, and though the studies found evidence of significant associations between the neighborhood change exposures and health, the direction of these relationships was not consistent. Chapter three analyzed the relationship between gentrification and BMI and self-rated health using a quasi-experimental study design. Our study design represents a methodological improvement over other studies on gentrification and health, but we found no evidence of a significant effect in our population of survivors of Hurricane Katrina. Findings from this dissertation advance social epidemiology and inequality research and inform policy interventions designed to reduce health disparities in U.S. metropolitan areas.