Health Effects of Socially Toxic Neighborhoods: The Violence and Urban Asthma Paradigm

Exigencies of inner-city living, such as the high prevalence of violence exposure, may increase psychosocial risk factors, which in turn may confer increased asthma morbidity on high-risk urban populations. High crime rates and the real or perceived threat of violence are specific aspects of the inner city that may impact the psychologic functioning and the health-promoting behaviors of the inhabitants. More research is needed to examine the public health impact of living with violence on children and their families. Systematic exploration of an association between violence (an urban stressor) and asthma throughout childhood may help one to understand the rise in asthma prevalence, severity, and medical care use and further the understanding of its disproportionate occurrence in poor urban children in this country. One question repeatedly raised is what can be done even if empirical research links violence exposure to asthma morbidity. Interventions need to be designed outside of the traditional biomedical model. Notably, dissemination of research findings related to violence and asthma has already translated into public health interventions. For example, in Oxnard, California, a recent gang injunction focused in part on the health implications of the threat of violence in their neighborhoods on the high prevalence and increased morbidity related to asthma as another factor to leverage when seeking resources aimed to reduce violence in their communities [83]. It is unlikely that the health problems of these disadvantaged populations can be solved unless one tries to understand the potential role of such social determinants of health. Sociologists have long suggested that improvements in living conditions (ie, a safe environment) and life opportunities may be more effective interventions aimed at getting deprived populations to attend to health education and make behavioral changes [84].