Feeling rooted in community and socializing with neighbors may strongly contribute to better cardiovascular health by improving diet, exercise habits, and weight control, new research among Black adults in Georgia suggests. And better cardiovascular health may add up to fewer heart attacks and strokes, two leading causes of disability and death.
"There's a range of interactions within the community that can improve one's cardiovascular health, not to mention the effect on mental health — the sense of belonging, of being seen — which is tightly related to cardiovascular outcomes in the long run," says Dr. Dhruv Kazi, director of the cardiac critical care unit at Beth Israel Deaconess Medical Center (BIDMC) and associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
"Another way to put it is that these unique sources of resilience in communities may directly affect diet, exercise, weight, and mental well-being, all of which lead to improved cardiovascular health," he adds.
A positive perspective on health within Black communities
The new analysis is part of the ongoing Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study in Atlanta. MECA builds on prior research indicating that living in disadvantaged areas is associated with higher rates of having heart disease or dying from it. But unlike much of that research — which focused on negative aspects of Black neighborhoods that may contribute to poor cardiovascular health — the new study fills a gap. It zeroes in on positive neighborhood features, especially social interactions, that can promote ideal cardiovascular health despite higher risks related to race or socioeconomic status.
"Typically, researchers are identifying factors that result in health disparities on the negative side, such as deaths or co-existing diseases, or that cause increased rates of a particular disease," explains Dr. Fidencio Saldana, dean for students at Harvard Medical School and an attending physician in medicine and cardiology at Brigham and Women's Hospital (BWH), whose research interests include racial disparities and outcomes in cardiovascular disease. "It's quite unique to be able to look for solutions, or to look at these positive attributes of communities and think about how to replicate them."
Measuring social environment and heart health
The study included 392 Black men and women between the ages of 30 and 70 living in the Atlanta area. None had existing cardiovascular disease. About four in 10 participants were men.
Social environment includes perceptions of neighbors and any support system, as well as how often neighbors interact. Participants answered questions about seven neighborhood features: aesthetics, walking environment, availability of healthy foods, safety, social cohesion, activity with neighbors, and violence.
Heart health was measured using Life's Simple 7 (LS7) scores, developed by the American Heart Association to determine ideal cardiovascular health. LS7 calculates seven elements that influence cardiovascular health: self-reported exercise, diet, and smoking history, as well as measured blood pressure, sugar level, cholesterol level, and body mass index (BMI). Researchers also gathered information about annual income, education, and marital and employment status, and physical exams that included blood tests.
What did the researchers learn?
After controlling for factors that could skew results, researchers found participants who reported more social connection and activity with neighbors were about twice as likely to record ideal LS7 scores. The association was even stronger among Black women than men.
"Our health is more closely related to these social networks than we appreciate," Dr. Kazi says, noting that individual efforts to combat obesity and smoking, for instance, are more likely to gain steam "when shared by neighbors."
"The more we're able to engage with our neighbors and the communities we live in, the better it probably is for our cardiovascular health," he says.
The study was observational, so it cannot prove cause and effect. It's also possible that those who are already healthier are more likely to engage with their neighbors, Dr. Kazi notes. Other limitations are the location of all participants in a single metropolitan area, and the self-reported nature of neighborhood characteristics. Another key area that went unexamined, Dr. Kazi says, involves a "missing piece" in LS7 scores: mental health.
"Living in a community where you feel safe and know your neighbors — where you feel part of the social fabric — is critically important to mental health, and therefore cardiovascular health," he explains. "If anything, this study underestimates the health benefits of feeling part of a cohesive neighborhood."
What are a few takeaways from this study?
Social environment and feeling rooted within a community matter to health, and may even help counter negative risk factors. However, long-term lack of investment and the effects of gentrification threaten many Black neighborhoods in cities throughout the US.
"When a neighborhood gets gentrified and longstanding residents are forced to leave, the community is gone forever," Dr. Kazi adds. "Simply offering the departing residents housing elsewhere doesn't make up for what is lost. Going forward, we need to be cognizant of the value of community, and invest in our neighborhoods that allow people to safely engage in physical and community activities."
Dr. Saldana agrees. "Our system is not set up for some communities to have those advantages. It's important to look to the positive aspects of our communities, and as a system encourage those positive traits in other communities."