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>> Jens Ludwig: Starting in the early 1990s, the U.S. Department of Housing
and Urban Development sponsored our Residential Mobility Demonstration,
a randomized experiment, called "Moving to Opportunity."
So MTO operated in five U.S. cities, Baltimore, Boston, Chicago, Los Angeles, and New York.
Women with children living in very disadvantaged public housing neighborhoods were invited
to participate in the program.
Families voluntarily joined and signed up for MTO
and then were randomly assigned in different mobility groups.
One group was given no residential mobility assistance under MTO
and other families were randomly assigned to receive the opportunity to move
to less economically disadvantaged neighborhoods using a housing voucher.
Ten to fifteen years after baseline what we find is that something like seventeen percent
of the women in the control group are extremely obese and about twenty percent of the women
in the control group have diabetes.
The chance to move from a high poverty to a low poverty neighborhood through moving
to opportunity reduces the rate of extreme obesity and diabetes for women
in the study sample by about one-fifth.
Previous researchers have looked at this question of neighborhood effects
on health outcomes and have raised four candidate explanations
for why neighborhoods might affect obesity and diabetes.
One is diet; that is, access to healthy foods might vary across neighborhoods.
The second type of explanation is opportunities
for physical activity might vary across neighborhoods.
This could be opportunities for actual exercise, like differential access to parks and gyms.
It could also be more mundane things, like just having sidewalks
in the neighborhood or neighborhood safety.
Some of these neighborhoods that families are living in are just not safe to walk around in.
The third kind of explanation that people have focused on is the possibility that access
to medical care might vary across communities, and a final sort of explanation is
that psychological stress, levels of psychological stress,
might systematically differ across neighborhoods,
for reasons like neighborhood safety.
There's growing concern within the medical community that stress might change diet,
might change exercise patterns, and might affect metabolism.
We spend a huge amount on healthcare in the United States every year.
I think one of the things that our study raises is the possibility that over the long-term,
well-targeted interventions at improving neighborhood environments might be
cost-effective compliments to medical care in reducing obesity and diabetes.
[Silence]