“Community input and voice needs to be treated as scientific input. Getting a sense of what residents prioritize—whether that’s social connection or changes to the built environment—makes all the difference.”
Dr. Kristen Berg’s research has examined neighborhood contexts of family functioning and child development, with a focus on how to enhance community health in historically disinvested neighborhoods.
Here, Dr. Berg, an assistant professor of medicine at the MetroHealth Population Health Research Institute and Case Western Reserve University School of Medicine in Cleveland, discusses how the built environment, social fabric and history of a neighborhood shape family health and well-being.
Q: What drew you to studying neighborhoods and health?
A: I work in our county safety net hospital, which means that we see patients regardless of their ability to pay for care. My colleagues and I see all the time how healthy people, family units and caregiver-child relationships are affected by stressful things in their neighborhood context—beyond their personal habits or clinical, biomedical factors. The neighborhood is a vast backdrop to people’s everyday lives, with characteristics that can promote health and family life or constrain them.
One thing that I’ve learned across a lot of studies I’ve read, worked on and conducted is that, if we had a magic pill for health, it would be social connectedness. Humans are social critters. We want to be in community with our people. The neighborhood environment has the capacity to either nourish social connection or really constrain it.
Q: You’ve written about how historical disinvestment shapes the resources available to neighborhoods, and in turn, family well-being. Can you explain that?
A: Neighborhoods don’t exist in a vacuum. It is a fact of American history that some neighborhoods have been differentially invested in, especially those that have historically had a high proportion of Black residents. Residential redlining policies, specifically in the form of banks not issuing home loans to Black families, mean that from the get-go, not all neighborhoods have been equally invested in. A lot of those patterns persist today.
The resources neighborhoods have are consequential for how healthy people and families can be. There are real stressors to living in a neighborhood that’s been in “hard mode” because the neighborhood hasn’t caught a break. One neighborhood could have third spaces for kids to be that are not home or school, like a wonderful rec center and aftercare programming. Others might not have those resources.
Q: Your research has looked at the effect of neighborhoods having a “social fabric” or neighbors acting with “collective efficacy.” What does that mean?
A: When we talk about collective efficacy, we are usually talking about the degree to which residents of a neighborhood feel like they can work together, and desire to work together, to achieve a common goal. A neighborhood that has a robust sense of collective efficacy is going to be one where residents are willing and eager to work together.
Some neighborhoods have active block groups or community groups that both produce and support collective efficacy. For example, residents may share strategies of keeping an eye on their yards, homes or cars, or communicate concerning things that they see. In some research I do in Cleveland, we’ll hear about informal neighborhood “presidents”: ‘You should talk to Mr. Joe. He knows people and keeps a close eye on what’s going on. He has a contact in City Council he can talk to about cleaning up a green space.’
Q: How does a neighborhood’s built environment and social environment work together to affect family life and well-being?
A: The neighborhood built environment has the power to nurture social connectedness. People will say, for example, ‘My kids get really stressed out in the house. If there was a park we could walk to, my kids would be able to get their energy out, and I’d benefit from the mental health break. Maybe I could meet another parent there that is grappling with some of the same stresses that I am, and we could talk and problem solve and I wouldn’t feel so alone.’ Across different domains of research, we know that social connectedness and relationships are beneficial in dampening the body’s stress responses. When people feel supported and connected, they tend to view stressors as less threatening.
A lack of neighborhood resources can be directly stressful and become internalized into family dynamics. In my research, residents will describe seeing abandoned houses, vacant lots, or a dumping problem that the city hasn’t dealt with. They’ll share, “It’s really stressful in my neighborhood when I see people over there doing things they shouldn’t be doing. It’s clear to me that this is not a good space for my kids to go out and play.” When you’re surrounded by signals day in and day out that your neighborhood isn’t worth investing in or tending to, eventually, you may not feel super good about yourself. It might lower your self-esteem, and affect how you show up with your full self—with all your patience, goodwill and flexibility.
In neighborhoods where people are able to stay long enough to put down roots, it can form a rich and stable social fabric. I’ll often hear residents wistfully think back on when they were raising kids, “They could open the door and run out across the lawns and there was always someone to play with. Now, renters cycle through and my neighbors change a lot.” When you’ve lost that social fabric, or it’s frayed, that affects how people perceive safety and a sense of community. A neighborhood environment that is constantly changing has huge consequences for how stable and safe it feels. All these things matter to whether or not there is a sense of collective efficacy.
Q: How do researchers study neighborhoods?
A: Neighborhood research often uses census data to measure socioeconomic conditions and how neighborhoods with more advantage compare to those with lower advantage. But that doesn’t always tell us about the social dynamics that are happening inside a neighborhood. For example, neighborhoods we might measure as ‘socioeconomically vulnerable,’ may have a core group of residents that feel connected and are collectively efficacious.
To get a sense of collective efficacy, studies will use assessments like scales or surveys that ask residents to rate on a scale of 1 to 5, for example, “How much do you agree that you can talk to your neighbor about this problem?” Or, “Could your neighbors be counted on to intervene if children were skipping school and hanging out on a street corner?”
You can also get a sense of collective efficacy through interviews in the neighborhood. You can learn about residents’ experiences of trying to work with others to problem solve. For example, do they feel like they’ve been supported by neighbors in figuring out how to deal with vacant lots? What was it like to reach out to the city to solve this problem?
Finally, studies can look at the neighborhood built environment, which is the physical, manmade aspects of the environment that we can see and feel. This includes whether there are family-friendly resources, like a playground or rec center; whether vacant lots have been taken over by bushes, or made into pocket parks that are lush and being tended to; or if sidewalks are level and usable by little kids or someone who might have mobility limitations.
Q: How can we translate neighborhood research into policy?
A: A rising tide lifts all boats. Any effort that invests in building up community and a neighborhood environment that is resourceful and good for child development and caregiver stress is going to benefit everyone—whether that’s cleaning up vacant lots, remediating homes, taking care of green space, creating spaces that are soothing to families, or offering kids places to play and spaces for caregivers to connect with one another and be in community. These policies can nurture a kinder neighborhood environment that is easier to live in.
Importantly, any intervention that doesn’t integrate what residents themselves prioritize is going to miss the mark. Community input and voice needs to be treated as scientific input right alongside the researchers and policy experts who don’t necessarily live there day-to-day. Getting a sense of what residents prioritize—whether that’s social connection or changes to the built environment—makes all the difference in whether any change or intervention will actually work.
Interview by Mahima Golani