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CONTEXT AND QUESTION OF RESEARCH Context The 2010 U.S. Census revealed many new urban trends that indicate a major shift in growth dynamics of U.S. metropolitan areas. From 2010 to 2012, large cities grew more quickly than in the past ten years. In fact, data indicates that growth rates in 16 of the 20 largest U.S. cities were accelerated in 2011-12 compared to 2010-11.1 This growth has created great interest and excitement around the possibilities for cities, but also complex demographic and socioeconomic challenges for low-income urban residents. For this reason, low-income populations that have lived in inner-city neighborhoods for decades are migrating out of central urban areas to suburbs or rural places for a number of reasons, including cost of living, quality of education, and safety concerns. Considering the different physical and geographic environments of urban, suburban and rural typologies, a gap in knowledge exists between understanding that suburban built environments pose certain challenges to public health and that low-income and minority populations suffer higher rates of health ailments due to environmental factors. Studying this gap is important in seeking to protect and maintain social and environmental justice for at-risk populations, manage public resources in a smart manner, particularly public healthcare, and enhancing the general well-being of people who possess fewer resources than Americans with average incomes. This papers uses the black American population to study the following question: What are the physical, mental, and cultural health effects of the migration of low-income, black populations out of urban neighborhoods? Scope of Research The criteria for understanding physical and mental health are physical activity, economic wellness, and safety with the assumptions that physical health is linked to physical activity and mental health is linked to economic well-being and perception of environmental safety. This study outlines and examines research studies, statistical reports, and articles that pertain to physical activity, chronic illness, job access and economic stability, and environmental safety. Next, it discusses the health implications of black migration out of inner-cities. Lastly, it briefly highlights this topic in Denver in light of the research conclusions and offers recommendations to the city of Aurora, CO.


A Big City Growth Revival. Frey, William H. Brookings Institute, May 28, 2013.


PART I: HEALTH IN SUBURBAN BUILT ENVIRONMENTS Physical Activity and Chronic Illness Before studying the health effects on the Black population in the suburban context, it is important to understand the health effects of suburbs on the general public. The most prominent way of studying health and suburbs has been through physical health, so I will start there. Chronic Illness Deborah Cohen and Roland Strum of the RAND Corporation studied urban sprawl and its association with chronic medical illnesses. They were interested in determining whether sprawl influences quality of life, chronic medical problems, and mental health problems. They merged geographic identifiers and predetermined urban sprawl measures including street network dimensions, land use mix, concentration of people and jobs and population density for environmental categorization. The results showed that sprawl in fact is associated with more health illnesses, having the most significant effect in the form of arthritis, breathing troubles, abdominal/digestive problems, migraine headaches, and urinary tract problems. Considering street network and land use mix factors specifically, heart disease and hypertension were significant ailments related to the environment as well. Though, no mental health effects were identified. The study found that an increase in sprawl typologies increases chronic illnesses by measures of standard deviation (96 more chronic problems would occur per 1000 residents per two deviations, which is the equivalent of aging four years). Physical Activity A study2 published in the American Journal of Preventative Medicine helps shed light on patterns of physical activity based on a neighborhood’s physical typology. It sought to go beyond the traditional “trichotomy” of urban, suburban, and rural typologies in describing neighborhood patterning as well as to see how the various physical environments effect physical activity and obesity in adolescents. Using neighborhood measures such as socioeconomic status, crime, street network and type, and recreation facilities, researchers exposed each groups relative risk of lack of activity based on neighborhood typology: 1. 2. 3. 4. 5. 6.

Rural working class Exurban Newer suburban Upper-middle class, older suburban Mixed-race urban Low-socioeconomic status (SES) inner-city areas

The results showed that adolescents living in newer suburbs, working class rural areas, exurbs, and mixed-race urban areas were more likely to be over weight, independent of individual SES, age, and 2

Built And Social Environments: Associations with Adolescent Overweight and Activity. Nelson, Melissa C., Gordon-Larsen, Song, Yan, Popkin, Barry M. 2006. American Journal of Preventive Medicine


race/ethnicity. Also, adolescents in older suburbs were more likely to be physically active than those in new suburbs. Similarly, those in low-SES inner-city areas were slightly more active than those in mixedrace urban areas.

It shows that physical typology of a neighborhood matters when considering the level of physical activity of an adolescent. Specifically that rural, exurban, new suburbs and mixed-race urban areas are correlated with lower physical activity. The study also demonstrates the complexity of factors of each typological cluster that influence the physical activity of the residents. Given that complexity, it also provides evidence that physical activity issues are common across the urban – rural spectrum while highlighting the distinctions between influencing factors associated with cluster groups. It did not include adult physical activity behavior within the study, but from existing research, the assumption can be made that many newer suburban, exurban, and rural areas restrict adult walkability and promote a more sedentary lifestyle that can adversely effect physical health. Access The Brookings Institute found that in metro areas of greater decentralization of employment opportunities, the poor are more suburbanized, which is mostly an issue in southern and western U.S. states. The study found that this decentralization of poor populations was caused by the job sprawl of metro regions. Despite the relocation of poor populations to these areas, poverty seemed to still be concentrated in areas of below-average number of jobs in the suburbs. In addition, the lack of adequate suburban public transportation and well-paying jobs that do not require work hours in the evening and on weekends requires poor suburban residents to take on the cost of automobile transportation. This cost can be a significant burden on the country’s most impoverished population because of the uncoordinated relationships between housing, jobs, and transportation. As the Surface Transportation Policy Project3 explains: “Although the average American puts 18 cents of every dollar they spend into transportation, the poorest fifth of American families spend more than 36 cents out of every dollar…


Surface Transportation Policy Project. Bureau Expenditure Survey, 2000.


The mismatch between employment and housing locations...necessitates travel while reducing transportation choices like walking, biking or transit. Sprawling locations usually lack frequent transit service or safe pedestrian and bike routes. Often, affordable housing is located so far from any public transportation that the families living in such housing, or receiving housing assistance, must purchase one or even two cars to access job markets.”

These factors present the context in which the mental health of poor suburban residents can be threatened. The suburban poor experience high auto-transport costs and lack of economic stability from low-wage jobs putting them at risk of economic stress, which can cause mental stress. This stress can be coupled with the threat of foreclosure, further exacerbating the threat to one’s ontological security4 while deteriorating their mental health. Health In Suburban Built Environments - Summary Sprawled environments pose many challenges related to chronic illness, physical activity, public mobility, and access to jobs. Below is a summary of the health effects of suburban built environments: •


Chronic illness is found to increase in areas of urban sprawl: arthritis, breathing troubles, abdominal/digestive problems, migraine headaches, and urinary tract problems. Poor street network and land use mix factors increase heart disease and hypertension issues physical activity amongst adolescents significantly decrease in newer suburbs, working class rural areas, exurbs, and mixed-race urban areas had the least amount of activity while those in old suburbs and low-SES inner-cities had more physical activity Finding and maintaining job security and adequate transportation can threaten economic security. The lost of economic security can lead to mental stress and health issues.

Kimberly Libman , Desiree Fields & Susan Saegert (2012) Housing and Health: A Social Ecological Perspective on the US Foreclosure Crisis, Housing, Theory and Society, 29:1, 1-24, DOI: 10.1080/14036096.2012.624881


PART II - BLACK HEALTH AND LONGEVITY With these findings in mind, what are the topics and issues surrounding the health of black Americans? Are there specific health issues related to physical, mental, and even cultural well-being related to the migration of Black populations out of the inner-city to suburbs or beyond? In the next section, this paper will examine specific topics related to physical, mental, cultural wellness and longevity and the relationship to the built environment. Black health and the built environment Some of the potential issues surrounding the migration of America’s black population from the city to the suburbs may exacerbate the existing health issues that characterize the U.S. black population5: • 2009 Highest death rates from heart disease and stroke amongst all other racial and ethnic populations • 2007-10 Highest prevalence of hypertension in black adults • 2007-10 Highest prevalence of obesity amongst black women when compared to white and Mexican-American women and men • 2010 The prevalence of diabetes among black adults was nearly twice as large as that for white adults • 2009 Highest death rates from homicide among all racial and ethnic populations Hypertension and heart disease can increase depending on street network patterns and level of land use mix in suburbs and physical activity has been found to decrease amongst adolescents in distant suburbs and rural areas. Given these issues, the common health ailments effecting black Americans such as diabetes, heart disease, and hypertension have potential to increase amongst certain black populations in suburbs that demonstrate poor built environments. Along with those issues, the unnecessary economic costs of sprawled suburban life could cause further mental stress and poor mental health. These issues imply that significant health difficulties can arise in low-income black populations. That said, there is a common thread in the research gathered for this topic on black people, the built environment, and suburbs, which implies that moving to the suburbs can increase physical activity and a positive perception of well-being. Mental Health: Fear and Public Space A study conducted by the University of Illinois at Chicago examined the relationships between aspects of the built and social environment and the walking behavior of black women in Chicago. The study tested walkability, aesthetics, accessibility of walking facilities, and safety as factors that could potentially influence black women’s propensity to walk. The results explained that robberies and parks in a neighborhood were negatively correlated to walking. In contrast, a public recreation facility in the neighborhood and a nearby shopping mall was positively associated with walking. This implied that the higher the amount of options to walk indoors, the more ‘walking' was viewed positively. The study implied that black women consider the built and social environments when deciding to walk. This is also a significant issue for black men as highlighted in Alec Brownlow’s paper, A Geography of 5

Center for Disease Control. Minority Health: Black or African American Populations. 2014. Http://Www.Cdc.Gov/Minorityhealth/Populations/Remp/Black.Html#Disparities


Men’s Fear. Data exposed “a chronic fear of violent crime victimization” amongst the young men in the study and a “persistent and chronic wariness of their environmental context that precedes any judgment of perceived safety.”6 The fear of public space is a significant factor amongst residents of inner-city neighborhoods because of potential social threats in the form of violence and victimization in the public sphere. Further focused studied is needed for conclusiveness, but the anxiety experienced in daily public life by some inner-city residents could be a main deterrent of outdoor physical activity in the public sphere. Perception of Safety and Physical Activity Shifting to the suburbs, we can get a glimpse of how a reduction of fear of the public environment can be beneficial to the amount of physical activity. The preliminary results of a longitudinal study7 of lowincome black women revealed that physical activity increased when they move away from the inner-city and into a conventional suburban neighborhood. This study is an ongoing study so the conclusions are not final, but a theory behind the increase in physical activity post-move says that the negative environmental factors of violence and crime associated with the public sphere have been diminished or eliminated, giving residents a higher sense of safety. This implies that there may be some mental and physical benefits of relocation to the suburbs for inner-city residents that have refrained from physical activity because of high crime and unsafe physical surroundings. Evolving Cultural Dynamics But what is being lost in this out-migration? From 2000 to 2010, Chicago’s population fell by 200,418 and blacks accounted for 89% of that number.8 But black out-migration is not strictly a Chicago phenomenon. Cities throughout the U.S. have experience large migrations of blacks away from there cities including, Oakland, Washington D.C., New Orleans, and Detroit. These cities have a rich history of Black culture, that included strong churches and faith organizations, jazz and blues scenes, and a substantial black middle class supported by manufacturing jobs. But those traditional, black institutions are either vanishing from or non-existent in cities today, constituting a reduction in what was once understood as a collective ‘black identity’ or “Black America.” Cultural and racial clichés or stereotypes now occupy the mainstream understanding of black culture, in which many black Americans do not resonate with. As Eugene Robinson, Editor and Columnist at the Washington Post, has described it, ‘Black America,’ or the collective institution of black culture and identity, has ‘splintered’ into four different groups (the mainstream, the forgotten, the emergent, and the transcendent) that are “increasingly distinct, separated by demography, geography, and psychology. They have different profiles, different mind-sets, different hopes, fears, and dreams.”9 This ‘splintering’ has been an ongoing process in which this recent migration is just a part of a larger process. This process is visible through the struggle that black churches in


A Geography of Men’s Fear. Brownlow, Alec. 2004. Temple University Dept. of Geography and Urban Studies Neighborhood Design & Physical Activity: Preliminary Results of a Longitudinal Study of Low-Income, Southern Women moving to Neotraditional or Suburban Neighborhoods. Wells, Nancy M. and Bainbridge, Kathleen E. 2005. Active Living Research Annual Conference 8 Blacks’ exodus reshapes cities. 2011. Keen, Judy, USA Today. May 5, 2011 9 Disintegration: The Splintering of Black America. Robinson, Eugene. New York 2010. 7


Oakland10 have experienced with dwindling attendance and the threat closing the city’s AfricanAmerican Museum and Library. The issues of high taxes, housing costs, the threat of displacement, poor schools, and crime in inner-cities are driving forces for black Americans to leave urban areas and relocate to suburban or rural locations. It is difficult to conclude what the cultural impacts of this transition will be, but it is important to understand that black culture is no longer a singular form of culture, but a set of cultures and identities that are experiencing a significant geographic transition from urban to suburban and exurban. Therefore, addressing black cultural health must respond appropriately to the multi-faceted character that ‘black culture’ embodies. Conclusions Literature on health and suburbs presents a general understanding that sprawled development causes poor human health for its residents. Increases in the likelihood of chronic illness, lack of physical activity, and poor access to employment opportunities are issues plaguing sprawled suburbs. With the existing problems of heart disease, hypertension, obesity, and diabetes, it would appear that the sprawled developments of U.S. suburbs might not be conducive to improving the health of African-Americans moving from urban areas in inner cities. But much of the available research on the U.S. black population’s migration supports the idea that moving to a suburb represents an improvement in quality of life, in the form of affordability, educational opportunity, and safety from violence and crime. Therefore, there is a need for ensuring safety in the built and social environments which would encourage and support physical and mental health in black American populations. Since active living requires one to use the public sphere as infrastructure for an active life (i.e. sidewalks, street, public transit, etc.), the assumption is that the public sphere is a safe place to be active in. But for many black Americans, their neighborhoods do not offer a safe public sphere and may deter people from physical activity. Consequently, this move could allow them to perceive their public environment as a positive place to recreate. That said, the physical limitations of existing sprawled suburbs persists and can only offer small benefits for active living. Compact neighborhoods of inner cities still offer the best environment for active living and cultural richness. Therefore, to provide low-income black Americans neighborhoods that promote quality living, the issues of physical displacement, affordable housing, and public education must be seriously addressed and rectified in cities. Improving those urban issues will create the social, economic, and physical environment in urban communities that will be conducive for low-income black Americans to continue to live in rich, diverse, and health promoting neighborhoods. Denver Metro Situation From to 2000 to 2010, the black population of the City of Aurora increased by nearly 20,000 while the historically African-American neighborhood of Five Points experienced a decrease of 1,500 black people. It is not clear if there is any correlation between the two statistics, but it is true that the suburb of Aurora grew its black population while inner-city Denver lost African-Americans. As the Denver Metro 10

Blacks’ Exodus Reshape Cities. Keen, Judy.May19, 2011. USA Today


continues to experience substantial growth, the city of Aurora should be prepared for continuing changes in population statistics. Part of this preparation should include a plan for protecting and enhancing the health of its population. Therefore, understanding the challenges and opportunities to creating healthy neighborhoods for its African-American community, among other ethnicities, is important for the city of Aurora. METRO COUNTIES POPULATION CHANGE BY RACE, 2000 TO 2010 - Metro Counties Population Change by Race, 2000 to 2010


This graph shows the population change, by race/ethnic group, for the metro counties from 2000 to 2010. Adams, Arapahoe and Jefferson counties reflect the metro-wide trend of a rapidly growing suburban Hispanic population. Jefferson County’s white population decreased by more than 18,000 people. If it weren’t for a large increase in the Hispanic population, the county’s total population would have declined. The black population in Denver decreased by more than 1,500 people in the past decade, whereas the black population in Arapahoe County increased by nearly 20,000. This reflects a pattern of black migration from Denver to Aurora and inner-ring suburbs. Hispanic White Black Asian














Data source: U.S. Census Bureau. *Broomfield was not a county in 2000. The 2000 data for Broomfield is composed from parts of Adams, Boulder, Jefferson and Weld Counties.

RELATIVE CHANGE IN DENVER METRO BLACK POPULATION, 2000 TO 2010 - Relative Change in Black Population, 2000 to 2010


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This map shows the relative change in the black population from 2000 to 2010 by census tract. The map is shaded by standard deviation and normalized by area: White regions represent average population change (people per square mile), blue regions represent greater-than-average decline and red regions represent greater-than-average growth.

Change, People Per Square Mile Decrease

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Bureau Expenditure Survey. Surface Transportation Policy Project. 2000.


Center for Disease Control. Minority Health: Black or African American Populations. 2014. Http://Www.Cdc.Gov/Minorityhealth/Populations/Remp/Black.Html#Disparities


Cohen, Deborah MD, MPH, Sturm, Roland, PhD. Urban Sprawl and Chronic Medial Problems. January 2004. RAND Corporation


Colorado Community Vulnerability Data. Map. Colorado Department of Public Health and Environment. U.S Census American Community Survey 2008-2012.


Criden, Madelaine. “The Stranded Poor: Recognizing the Importance of Public Transportation for Low-Income Households”. 2008. National Association for State Community Services Programs


Frey, William H. “A Big City Growth Revival”. Brookings Institute, May 28, 2013.


Keen, Judy. Blacks’ Exodus Reshape Cities. May19, 2011. USA Today


Kimberly Libman , Desiree Fields & Susan Saegert (2012) Housing and Health: A Social Ecological Perspective on the US Foreclosure Crisis, Housing, Theory and Society, 29:1, 1-24, DOI: 10.1080/14036096.2012.624881


Metro Counties Change By Race, 2000 To 2010. Chart. The Piton Foundation. June 2011.

10. Nelson, Melissa C. “Built And Social Environments: Associations with Adolescent Overweight and Activity”. Gordon-Larsen, Song, Yan, Popkin, Barry M. 2006. American Journal of Preventive Medicine 11. Raphael, Steven and Stoll, Michael. “Job Sprawl and the Suburbanization of Poverty”. The Brookings Institute, March 2010. Pgs 1-21 12. Relative Change in Black Population, 2000 to 2010. Map. The Piton Foundation. June 2011. 13. Robinson, Eugene. Disintegration: The Splintering Of Black America. New York: Doubleday, 2010. 14. Sturm, Roland, Cohen, Deborah. “Suburban Sprawl and Physical and Mental Health”. The Royal Institute of Public Health, Oct. 2004. Http://Www.Publichealthjrnl.Com/Article/S0033-3506(04)00052-6/Abstract 15. Tri-County Health Department. 2012 Arapahoe County Health Profile. 2012. Http://Www.Tchd.Org/Pdfs/Arapahoe_Chp.Pdf 16. Wells, Nancy M. and Bainbridge, Kathleen E. Neighborhood Design & Physical Activity: Preliminary Results of a Longitudinal Study of Low-Income, Southern Women moving to Neo-traditional or Suburban Neighborhoods. 2005. Active Living Research Annual Conference 17. Wen, Ming. Neighborhood Race, Poverty, and Access to Parks and Green Space. Feb. 2013. Active Living Research 18. Zenka, Shannon N., et al. Environmental Correlates of Walking Adherence in African-American Women. 2007. Univ. Illinois-Chicago



Photo Location: Ludlow Neighborhood, Philadelphia, Pennsylvania, USA

Urban Exodus: The Health Implications of Black American Out-Migration from Inner-Cities