Poor Neighbourhoods Can Kill

How poverty and social disadvantage and associated stress affects health and well-being...

Excerpt from the New Scientist, 13 January 2010

'...Across the US, death rates among black women diagnosed with breast cancer are 37 per cent higher than for whites, but in Chicago the difference is an astonishing 68 per cent (Cancer Causes & Control, vol 18, p 323). Something about this heaving metropolis is sending black women to an early grave.

Poor access to screening and therapy is clearly an important factor. But according to a novel collaboration between sociologists and biologists, the strain of living in some of the toughest neighbourhoods in the US may cause biological changes that lead directly to earlier deaths.

Results from the collaboration indicate that social isolation and a fear of crime cause an overload of stress hormones that can change cell biology, sending tumours into overdrive. "We're showing that your social environment can affect your health directly," says Suzanne Conzen of the University of Chicago. "It goes into gene expression. That concept is really new."

Crucially, this insidious influence is felt most by Chicago's African American women, who are far more likely to live in the city's deprived areas than their white counterparts.

The provocative hypothesis highlights the need for new ways of fighting breast cancer in black women in Chicago specifically, including via social interventions. More broadly, other health researchers are hailing the union of biology and sociology as a model for future studies into a whole range of health disparities. "It's a great example of the kind of direction in which I can see us heading," says Tim Rebbeck, an epidemiologist at the University of Pennsylvania in Philadelphia. There are already hints that stress and social deprivation could have similar effects on diabetes and cardiovascular disease.

To get a handle on how tough life in Chicago can get, a good place to start is the neighbourhood of Englewood in the city's South Side. Poverty in Englewood is grinding, crime is endemic and amenities that the mostly white residents of comfortable suburbs like Clearing take for granted are long gone. "Even churches have moved out," says Sarah Gehlert of Washington University in St Louis, Missouri, lead sociologist on the project.

New Scientist got a taste of conditions on a tour of the South Side with members of Gehlert's research team. At vacant lots strewn with beer bottles and other debris, I'm told to watch my step. A previous visitor stumbled on a bag of urine and other medical waste. Along one Englewood street, we pass three burnt-out houses. On this winter morning, the gang activity that blights the area has yet to ramp up for the day. But the grilles on the windows of the Simon Guggenheim Elementary School are a testament to the crime that stalks these streets. You wouldn't want to be here after dark, says Charles Mininger, a graduate student on the project...'