Foreclosures may raise neighbors’ blood pressure, study finds

May 2014 WashingtonPost; The stress of living near a foreclosed home may increase a person’s chances of developing high blood pressure, according to research published Monday in an American Heart Association journal called Circulation.

While foreclosures are known to drag down the values of neighboring properties, the new research suggests that they can also undermine the health of the neighbors themselves.

The study tracked 1,750 Massachusetts residents from 1987 through 2008 and found that each foreclosure within 100 meters of a person’s home affected their systolic blood pressure, the top number in the reading. The neighbors may be worried that foreclosures are hurting their home values or the safety of their communities, and that anxiety can boost blood pressure, the study said.

The increase was not significant enough to present a huge health risk to the people affected, but it suggests that the housing crisis has extended beyond the economy into the public health arena, said Mariana Arcaya, lead author of the study and a postdoctoral research fellow at Harvard University’s Center for Population and Development Studies.

“It demonstrates that a phenomenon that we think of as being solely in the financial realm is getting reflected in measured aspects of our physiology,” Arcaya said. “It’s less about how big the increase in blood pressure is and more about the fact that you can put a blood-pressure cuff on a person and see that this is having an effect on their health.”

The research tracked a subgroup of people who are part of a much broader umbrella study that dates back to the 1940s, when researchers signed up Massachusetts residents with the goal of tracking their habits to determine factors that affect cardiovascular health. Every few years, clinicians would assess the enrollees’ health.

In 1971, researchers began tracking the children of the original enrollees as well as their spouses, and Arcaya and fellow researchers from the University of California at San Francisco School of Medicine, the Federal Reserve Bank of Boston and Yale University based their own research on that cohort, again drawing from the results of clinical exams. They found that each foreclosure within 100 meters of a person’s home corresponded with an increase in systolic blood pressure by 1.71 millimeters of mercury. As a point of reference, each year of age is associated with a rise of 0.65 millimeters of mercury, so the effect of a foreclosure is on par with three additional years of aging, Arcaya said.

The authors said they used the 100-meter measure because it is the standard length of a block and encompasses about two properties on either side of a house. Various real estate studies also show that that’s the range in which a foreclosure can affect neighboring home prices, Arcaya said.

The study controlled for age, income, education, race, sex and other factors, including whether the participants were taking blood-pressure medications. It also considered alcohol consumption and weight and found that both increase when there are foreclosures nearby. But those two factors alone do not explain the blood pressure phenomenon.

And not all foreclosures are equal.

Homes that lapse into foreclosures but are quickly purchased do not appear to lead to a rise in blood pressure, whereas homes that are seized by banks and stand vacant do, the study said.

Arcaya warned against extrapolating the results to other areas.

“We don’t know how the results would translate to a different setting,” she said. “We’re not sure what the effects would be in very different housing environments.”

 

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“I think the bank was ideological”, in an interview with The Guardian last month the President of the World Bank surprised everyone by acknowledging that his institution had for years promoted user fees on the basis of an ideology.
Remember, this is the same organisation that published a report in 1987 asserting that “charg[ing] users of government health facilities [will] increase access for the poor.” In 2014, one of the authors of that report backtracked on his statements, declaring that user fees are “a practice that effectively burdens sick and needy people, a small and vulnerable segment of the population.”  These days there appears to be a general consensus emerging against user fees and supporting their abolition. The United Nations agencies, the European Union (2009) and the African Union (2010) have been calling for it. The World Bank now finally appears to be following in their footsteps.

The progression of these ideas, even if they are not yet fully shared by everyone on the ground, is due in large part (though not exclusively) to the accumulation of scientific evidence. The unjust and unnecessary nature of user fees has been clearly proven. For at least 10 years now, we have also been compiling a body of evidence on the effects of user fees abolition on the use of services. Several syntheses have been published in Health Policy and Planning and elsewhere.  The recent article by McKinnon and colleagues fits within this evidence gathering process. This study is particularly interesting because it is one of very few studies to use population data. These data confirm the positive impacts of user fees abolition on use of services and reductions in neonatal mortality, which is consistent with conclusions coming out of studies in Niger, Burkina Faso and Thailand regarding other health outcomes.

Despite these lessons, McKinnon’s study does not really capture the issues involved in the complexity of such an intervention, and yet these are immense. Of course, that was not the authors’ objective. It should, however, become a priority for the scientific community. While there is a growing body of quantitative knowledge on health services use, there are still far too few mixed methods interdisciplinary studies, which are essential to understand these complex interventions in their context, that is, in real-life conditions. Our most recent survey on this topic revealed the desperate lack of any systemic approach. Yet the task is not impossible, as shown by research teams in Burkina Faso, Mali, Niger, and Zambia, and by others who are expected to report soon on their work along these lines in Benin and Morocco.

Now that the effectiveness of user fees abolition has been demonstrated, we need to support decision-makers by supplying them with knowledge on the appropriate measures to take to fund abolition, implement it, improve its equity, adapt it to local contexts and healthcare systems, understand the roles of social actors, etc. While some studies on these subjects are beginning to emerge, they are still in very short supply. Are researchers and research funding agencies not interested in these issues? How do we explain, for example, the recent call put out by the Alliance for Health Policy and Systems Research for a better understanding of the implementation of results-based financing, which is very relevant, whereas this has never been done for user fees abolition interventions? Scientific choice, or ideological?

Producing evidence on the complexity of user fees abolition interventions is crucial to support the implementation of universal coverage, as called for in March 2014 by WHO and the African Union and which all international actors hope to see in place by 2030. For this to happen, it would be good, and necessary, to deploy a new generation of studies that focus on people and explore the complexity of these interventions.

– See more at: http://blogs.lshtm.ac.uk/hppdebated/2014/05/12/abolition-of-user-fees-do-we-really-know-enough/?utm_content=buffer6b1e2&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer#sthash.GHzjzZh6.dpuf

“I think the bank was ideological”, in an interview with The Guardian last month the President of the World Bank surprised everyone by acknowledging that his institution had for years promoted user fees on the basis of an ideology.
Remember, this is the same organisation that published a report in 1987 asserting that “charg[ing] users of government health facilities [will] increase access for the poor.” In 2014, one of the authors of that report backtracked on his statements, declaring that user fees are “a practice that effectively burdens sick and needy people, a small and vulnerable segment of the population.”  These days there appears to be a general consensus emerging against user fees and supporting their abolition. The United Nations agencies, the European Union (2009) and the African Union (2010) have been calling for it. The World Bank now finally appears to be following in their footsteps.

The progression of these ideas, even if they are not yet fully shared by everyone on the ground, is due in large part (though not exclusively) to the accumulation of scientific evidence. The unjust and unnecessary nature of user fees has been clearly proven. For at least 10 years now, we have also been compiling a body of evidence on the effects of user fees abolition on the use of services. Several syntheses have been published in Health Policy and Planning and elsewhere.  The recent article by McKinnon and colleagues fits within this evidence gathering process. This study is particularly interesting because it is one of very few studies to use population data. These data confirm the positive impacts of user fees abolition on use of services and reductions in neonatal mortality, which is consistent with conclusions coming out of studies in Niger, Burkina Faso and Thailand regarding other health outcomes.

Despite these lessons, McKinnon’s study does not really capture the issues involved in the complexity of such an intervention, and yet these are immense. Of course, that was not the authors’ objective. It should, however, become a priority for the scientific community. While there is a growing body of quantitative knowledge on health services use, there are still far too few mixed methods interdisciplinary studies, which are essential to understand these complex interventions in their context, that is, in real-life conditions. Our most recent survey on this topic revealed the desperate lack of any systemic approach. Yet the task is not impossible, as shown by research teams in Burkina Faso, Mali, Niger, and Zambia, and by others who are expected to report soon on their work along these lines in Benin and Morocco.

Now that the effectiveness of user fees abolition has been demonstrated, we need to support decision-makers by supplying them with knowledge on the appropriate measures to take to fund abolition, implement it, improve its equity, adapt it to local contexts and healthcare systems, understand the roles of social actors, etc. While some studies on these subjects are beginning to emerge, they are still in very short supply. Are researchers and research funding agencies not interested in these issues? How do we explain, for example, the recent call put out by the Alliance for Health Policy and Systems Research for a better understanding of the implementation of results-based financing, which is very relevant, whereas this has never been done for user fees abolition interventions? Scientific choice, or ideological?

Producing evidence on the complexity of user fees abolition interventions is crucial to support the implementation of universal coverage, as called for in March 2014 by WHO and the African Union and which all international actors hope to see in place by 2030. For this to happen, it would be good, and necessary, to deploy a new generation of studies that focus on people and explore the complexity of these interventions.

– See more at: http://blogs.lshtm.ac.uk/hppdebated/2014/05/12/abolition-of-user-fees-do-we-really-know-enough/?utm_content=buffer6b1e2&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer#sthash.GHzjzZh6.dpuf

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