Building a healthy baby: Neighborhood structural deterioration and birth health outcomes

The built environment is increasingly recognized as an important component of public health. We examined the relationship between the physical environment and birth health outcomes in Flint, Michigan. Flint is an industrial city where the population grew and declined during the 20th century with the manufacturing capacity of the city's largest employer, General Motors. Between 1970 and 2000, the number of persons employed by General Motors declined by 80% and the city population declined 36.5%. Vacant and/or deteriorating structures are common in Flint, especially near the former factory. Data on neighborhood physical conditions in Flint were obtained from the Flint Environmental Block Assessment (EBA). The EBA project assessed all of nearly 60,000 real estate parcels located within Flint on a 0-25 scale based on the condition of the building foundation, exterior surfaces, stairs, rails, porches, roofs, gutters, downspouts, chimneys, windows, doors, and landscaping. Structures with scores from 5-9 were defined as being in “major disrepair” and those between 0-4 were defined as “not salvageable.” Premature birth and low birth weight are predominant factors in contemporary infant mortality. We used Geographical Information Systems software to map premature births, low birth weight births, and structures that were in major disrepair and not salvageable. We calculated the geographical concentration of adverse birth outcomes and dilapidated structures as a proportion of all births and structures in .25 mile square areas. Controlling for maternal education, paternal education, and private insurance status, there were significant direct relationships between structural deterioration and adverse birth outcomes.