Social determinants of health and the needed role of insurers and the safety net

In 3 recently published articles in the Medical Sciences section of the Journal of Gerontology Series A, the effects of the neighborhood environment on the health of older adults are examined. Nguyen et al. found that while inflammation—measured by C-reactive protein—was not generally related to a neighborhood’s physical disadvantage or level of social cohesion, individuals with higher levels of hopelessness and pessimism did seem to be negatively affected by their environment. This suggests the importance of emotional well-being in moderating the effects of the environment surrounding us. Roberts Lavigne et al. evaluated whether several different biomarkers of aging were associated with the disorder at the level of the city block. Their study design, which controlled for confounding using propensity score matching, helps strengthen their finding that the presence of disorder in older adults’ immediate surroundings can hasten the aging process at a biological level. Finally, and in this issue, Zhang et al. characterized an individual’s built environment across several domains and found that 2 of these, higher community economic deprivation and lower individual socioeconomic status, were associated with higher 5-year mortality.

Taken together, these articles add to the growing literature on the effects of the local environment on health, with a special focus on older adults. While these studies bring us closer to a mechanistic understanding of how health is affected by the lived environment, further inquiry and introspection are required to identify effective interventions to mitigate the risks imposed on residents of disadvantaged neighborhoods.