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Living in a high-deprivation neighbourhood has long term health effects, according to unique refugee relocation study

Living in a high-deprivation neighbourhood may lead to an increased risk of type 2 diabetes, according to a unique study looking at the health of refugee immigrants in Sweden, published in The Lancet Diabetes & Endocrinology.

The study followed the long-term health of over 60000 refugee immigrants who arrived in Sweden in 1987-1991 and were dispersed in housing throughout the country – allowing for a natural experiment studying the effect of neighbourhood deprivation on health. Although previous studies have shown an association between deprivation and health, these findings suggest a more direct link, especially in vulnerable populations such as refugees.

“We found that living in a high-deprivation neighbourhood led to an increased risk of type 2 diabetes, compared to living in the least deprived areas. Although the increased risk was small, we found that the effect accumulated over time,” said study author Dr Justin White from the University of California, San Francisco, CA, USA. “The increased risk didn’t develop immediately, which is consistent with the way neighbourhoods are thought to affect health, and chronic diseases in particular. There are likely to be a number of factors explaining the link, such as increased exposure to chronic stress from living in a high-crime or segregated area, the limited income and employment opportunities that affect a person’s ability to afford healthy food, the lack of availability of healthy food in the neighbourhood or its low levels of walkability.”1

Studies have consistently shown that living in a high-deprivation neighbourhood is associated with increased risk of chronic diseases like type 2 diabetes and heart disease. However, because of the lack of randomised trials, most studies have been unable to show more than a statistical association and were unable to account for limitations such as selection bias (e.g. that less healthy individuals might move to more disadvantaged neighbourhoods). The only randomised trial that has looked at neighbourhood effects was in the USA in the 1990s, where 4600 low-income families were randomly assigned to receive a housing voucher to move out of high-deprivation neighbourhoods.

In this new study, researchers analysed data from 61386 refugee immigrants aged 25 to 50 who arrived in Sweden between 1987 and 1991. This period saw a large influx of refugees to Sweden, largely from the Middle East and North Africa, and policy at the time aimed to actively distribute refugees across Sweden to improve integration and to avoid a large influx of recently arrived, unemployed people arriving in major cities, putting strain on local job markets.