Role of health in predicting moves to poor neighborhoods among Hurricane Katrina survivors

In contrast to a large literature investigating neighborhood effects on health, few studies have examined health as a determinant of neighborhood attainment. However, the sorting of individuals into neighborhoods by health status is a substantively important process for multiple policy sectors. We use prospectively collected data on 569 poor, predominantly African American Hurricane Katrina survivors to examine the extent to which health problems predicted subsequent neighborhood poverty. Our outcome of interest was participants’ 2009–2010 census tract poverty rate. Participants were coded as having a health problem at baseline (2003–2004) if they self-reported a diagnosis of asthma, high blood pressure, diabetes, high cholesterol, heart problems, or any other physical health problems not listed, or complained of back pain, migraines, or digestive problems at baseline. Although health problems were not associated with neighborhood poverty at baseline, those with baseline health problems ended up living in higher poverty areas by 2009–2010. Differences persisted after adjustment for personal characteristics, baseline neighborhood poverty, hurricane exposure, and residence in the New Orleans metropolitan area, with baseline health problems predicting a 3.4 percentage point higher neighborhood poverty rate (95% confidence interval: 1.41, 5.47). Results suggest that better health was protective against later neighborhood deprivation in a highly mobile, socially vulnerable population. Researchers should consider reciprocal associations between health and neighborhoods when estimating and interpreting neighborhood effects on health. Understanding whether and how poor health impedes poverty deconcentration efforts may help inform programs and policies designed to help low-income families move to—and stay in—higher opportunity neighborhoods. Significance Although neighborhood outcomes and health may influence each other reciprocally, existing studies overwhelmingly focus on neighborhood effects on health. Health’s influence on neighborhood is largely viewed as a nuisance that may bias neighborhood effects estimates. However, if health shapes whether individuals attain better neighborhoods, understanding selection processes may advance both health and urban policy objectives. We follow a socially vulnerable cohort of Hurricane Katrina survivors from 2003–2010 and find that although health was not associated with neighborhood poverty before the disaster, those with