Consider the experience of two groups of children in different neighborhoods during the pandemic. One group’s parents had a stable income to access healthy food, and they had space to play inside or outside without worrying about crime or COVID-19 transmission from neighbors. This group was able to stay active and maintain their health. During the same time period, another group of children in a neighborhood with a higher rate of single-parent households, unemployment, poorer housing conditions, and crime– was found to have a higher increase in obesity rates. 

This describes the findings of a new study by LDI Senior Fellow Stephanie Mayne and Children’s Hospital of Pennsylvania (CHOP) Principal Biostatistician Jungwon Min. Children aged 2-17 living in Philadelphia County experienced an almost five percentage point increase in obesity prevalence during the onset of the pandemic compared to pre-pandemic timeframes, and the increases were greater among those in poor and dangerous neighborhoods. 

These results aren’t surprising since the pandemic triggered a host of changes that limited movement for many children, such as lockdowns, the switch to remote schooling, limited outdoor time, and more barriers to healthy food. 

Communities that have suffered from historic disinvestment and displacement now often have lower income rates, higher rates of violence, and lower access to healthy food than wealthier communities. It’s important to note that federal policies that shaped our neighborhoods did so by race, both directly and indirectly, leading to the segregation and racial disparities we see in our communities today.

Mayne and Min examined these aspects by measuring the association of social vulnerability with changes in the prevalence of childhood obesity. The authors looked at children aged 6-11-years-old in Philadelphia, which has a high rate of obesity and significant racial disparities. They found that Black children and those on Medicaid had much higher obesity rate increases than their counterparts.

How Researchers Measured Neighborhood Social Vulnerability

The team used a suite of indices to measure neighborhood social vulnerability. These include:

• The Center for Disease Control and Prevention’s (CDC) Social Vulnerability Index measures a community’s resilience following public health disasters in four domains: socioeconomic status, household composition-disability, minority status-language, and housing type-transportation.
• The Child Opportunity Index analyzes the level of resources and conditions that matter for children to develop in a healthy way.
• The Index of Concentration at the Extremes compares the richest and poorest households to capture economic and racial/ethnic segregation.
• The Philadelphia Police Department Data reports violent and property crime data.
• The Environmental Protection Agency’s (EPA) EnviroAtlas measures land covered by trees and walkability.
• OpenDataPhilly is an open-source database that identifies parks and playgrounds in a neighborhood.
• The CDC’s modified Retail Food Environment Index measures the percentage of healthy food retailers out of the total amount of food retailers considered healthy or less healthy within census tracts.

Which Neighborhoods Were Most Affected by Rising Rates of Obesity?

Neighborhood conditions appeared to influence childhood obesity rates during the pandemic. Those from racially/ethnically minoritized groups tended to reside in more disadvantaged neighborhoods with less tree cover and higher crime rates. Areas with better socioeconomic and built environmental characteristics did not experience the same rising obesity rates. Racially/ethnically minoritized children from disadvantaged neighborhoods experienced a greater increase in childhood obesity; however, the strong sense of community support, measured as collective efficacy, was associated with smaller increases.

Social Buffering

Collective efficacy refers to the neighborhood’s trust, cohesion, and willingness to intervene for the common good among residents. Other research has shown the positive impact of high collective efficacy on mortality, psychological stress, intake of fruits and vegetables, and psychological distress.

What Can Be Done to Address Children’s Health?

The study findings highlight the importance of stable income and parenting, access to educational and social resources, and safe housing in maintaining child health during crises. Philadelphia has various initiatives aimed at addressing structural inequities in urban planning related to health outcomes. These initiatives include:

• Philly Tree Plan: In 2023, the city established its first-ever tree canopy plan. The plan emphasizes tree canopy to provide protection from heat, improve physical and mental health, and combat climate change.
• Vision Zero: The Philadelphia Office of Transportation, Infrastructure, and Sustainability’s Vision Zero plan “aims to eliminate all traffic deaths and severe injuries on Philadelphia streets by 2030, while increasing safety, health, and mobility for all.”
• Mayor’s Initiative: A City of Philadelphia small grants program that promotes healthy activities outdoors in safe, clean, green public spaces gives cash grants to projects looking to promote walkability and access to green space.

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The study, “Pediatric Obesity During COVID-19: The Role of Neighborhood Social Vulnerability and Collective Efficacy,” was published in December, 2023 in the International Journal of Obesity. Authors include Jungwon Min, Vicky Tam, and Stephanie Mayne. 

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