The project had two major purposes. The first was to contribute to expanding the range and usefulness of health indicators available at the neighborhood level in America's localities. It is well recognized that such indicators could be extremely valuable in planning, implementing, and evaluating health programs. Yet most cities do not regularly produce any indicators of health conditions at the neighborhood level, and in those that do, the range of available information is quite limited (mostly variables that can be derived from vital statistics files). Under this project, a selected group of NNIP partners were to assemble new health related indicators and incorporate them into their data systems. With assistance from the UI, they were then to analyze variations in these indicators in relation to other variables, report on the implications of the analyses, and take steps to encourage practical use of the data in local health initiatives.
The second purpose was to gain greater understanding of the relationships between characteristics of neighborhoods and health outcomes. Considerable theory supports the concept of neighborhood as an underlying cause or mediating mechanism in relation to a variety of health and social problems. This ecological research in some cities has shown that problems such as child maltreatment, low birth weight, and infant mortality are significantly clustered and correlated with such neighborhood variables as concentrated poverty, family instability, and residential turnover (Ellen, Mijanovich, and Dillman, 2001). However, these analyses have been limited as to the range of variables considered and the number of cities studied. In this research, the UI and the selected NNIP partners were to examine relationships between health indicators and a broader range of variables, including new tract-level data from the 2000 census. Special emphasis was to be given to the development of indicators pertaining to the health of children and youth, and to gaining understanding of disparities in health outcomes, considering race and other factors.
To accomplish these purposes, the first step was selecting five local NNIP partners (the maximum the budget would allow) to participate in the work. In October 2001, a request for proposals, based on the HHS accepted overall work plan for the project, was sent out to all 12 of the organizations that were partners in NNIP at that time. Proposals were received from 9 of the 12. The proposals were reviewed by a small panel of Urban Institute staff using a pre-established point system. Key factors for award included the extent and quality of the data already maintained in their systems (in terms of potential contribution to the cross-site analysis) as well as the creativity and professionalism exhibited in their proposals to conduct the site-specific analysis. All nine proposals were responsive and met our basic standards, but the five selected came out highest in overall points.
The selected partners were: the Center on Urban Poverty and Social Change, Case Western University (Cleveland); the Piton Foundation (Denver); the Polis Center of Purdue University at Indianapolis (Indianapolis); the Urban Strategies Council (Oakland); and the Providence Plan (Providence).(3) Project work was divided into two components:
- Site-specific analysis, which entailed assembling and analyzing new neighborhood level indicators pertaining to local health issues in each site and using the data to further local health improvement initiatives. In this component, the local partners took the lead in the work and the Urban Institute provided guidance to them and pulled together lessons learned from all of the sites for this report.
- Cross-site analysis, which entailed conducting research on the changing urban context in each of the five study sites, examining ecological relationships between metropolitan and neighborhood conditions and health outcomes in a comparable manner across sites, and developing a neighborhood disparity index. This work was done by Urban Institute staff, with data and guidance provided by the local partners along the way.
Urban Institute staff also took the lead in developing concluding sections covering the assessment of issues and the presentation of recommendations. In this work, however, they relied on interviews with local NNIP partners and other local leaders in public health in the five sites.
The Neighborhood Concept. Since the "neighborhood" is a central theme of this report, it is important to say what we mean by the term at the outset. A neighborhood is generally thought of as (1) a small residential area (size not exceeding the bounds of easy walking distance), where there is (2) considerable social interaction between neighbors, and probably (3) some degree of social homogeneity (as defined by class, ethnicity, or other social characteristics). Residents have common interests because they share the same physical space, and are likely to have other common interests as well. City planners most often adopt a neighborhood concept in planning new residential areas, thinking of it as an area with a radius of roughly one-quarter to one-half mile. Probably the most prominent explicit definition was by Clarence Perry in 1929 (Gallion, 1950). Perry saw a neighborhood as the area served by one elementary school (enrollment of 1,000 to 1,200 pupils), implying a total population in the range of 4,000 to 6,000.
Looking at an existing city, the task of defining a consistent set of neighborhood boundaries, satisfying to all people for all purposes, has proved to be impossible (Rossi, 1970). It is widely known that the extent of social cohesion and organization can vary widely across neighborhoods, and a number of studies (e.g., Lynch 1960) have shown that residents of the same area often see the boundaries of their neighborhood differently.
Nonetheless, there is wide agreement that the concept is important - that the neighborhood context can have important impacts on people's lives (Ellen and Turner, 1997). And, while recognizing that there can be no all-satisfying way to define boundaries, several acceptable approaches have been found to make the concept operational. First, community groups often come together to agree on boundary definitions of their own neighborhood for an improvement initiative. Second, many cities have adopted a set of "general purpose" neighborhood definitions that seem to work reasonably well for many purposes, even if individual communities sometimes develop alternatives (see further discussion in Kingsley, 1999).
Third, some cities and most national researchers rely on census tract boundaries as reasonable approximations of neighborhoods. Census tracts have an average population of around 4,000; thus they approximate the size of a neighborhood as traditionally defined. Also, in designing tracts initially, the Census Bureau has tried to be sensitive to what cities have regarded as important physical and socio-economic boundaries. Tracts cannot be expected to represent neighborhoods the way all local residents would define them, and tract analysis does not indicate patterns of intensity within tracts. The Oakland study described in section 5 provides an example of an alternative approach using isopleth maps. Even with these limitations, analysis of spatial patterns and trends using census tracts can be extremely valuable, and that is the approach we use in this report.
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