During my daily visits to ill patients throughout Durham County, it is staunchly apparent that many low income neighborhoods often predominately high in racial and ethnic minorities, have no proper functional sidewalks. As a nurse practitioner who provides home visits to patients I see a blatant disparity in Durham neighborhoods. My patients who are in dire need of food, transportation and mobility assistance are often the ones living in housing that is not wheelchair or walker friendly, far from grocery stores, without sidewalks and have living environments that even getting in and out of the front door is an overwhelming challenge. In 2016 Thornton et al. published a study identifying low-income neighborhoods and neighborhoods with a high proportion of racial and ethnic minorities had poorer aesthetics, had fewer sidewalks and crosswalks. Sidewalks are needed to get safely to the bus stops, grocery stores, health care appointments and to be connected with social and spiritual support.
Utilizing public transportation may be the only means of transportation for many residents in the low income neighborhoods, however there are limited sidewalks to get to transit access locations, which is a serious crisis for those requiring the use of a cane, walker or wheelchair.
Having access to a suitable grocery store with fresh healthy foods is important for health. In many low income neighborhoods adequate grocery stores are a privilege that is not a reality, so residents need to walk to public transit, then to a grocery store, or succumb to what is available at a smaller store with fewer healthy choices, often which are more expensive. Installing sidewalks could improve health, access to grocery stores as well as improving self-worth.
Healthy lifestyle is nearly impossible when there is no access to sidewalks, parks and ability to safely exercise. As a health care provider, after going into the homes of patients I now realize, if people have limited transportation or a home that is not easily manageable with their physical ability as well as no sidewalks, it is highly unlikely for a person to be able to achieve the exercise health care providers request. It was found by 2016 Thronton et al. that sidewalk quality, crosswalks, and neighborhood aesthetics may affect residents' physical activity.
Those of you who have not been exposed to the lack of sidewalks in low income neighborhoods, withhold your judgments. Those of you who have the thought that the resident can just move, it is not that simple. It is difficult to find housing that is safe and affordable for many people, especially those on a fixed income with little support and a chronic health condition. Lobbying and installing sidewalks in low income areas may frustrate other community members who feel they also deserve sidewalks.
However they have access to personal automobiles, gym memberships and ease of choosing where they live due to not having a limited monthly income. If we can push past our fear of “those having what we think they did not work for” and compassionately advocate for usable sidewalks in low income neighborhoods we may have a healthier and happier community.
Limited functioning, or no sidewalks in low income neighborhoods or neighborhoods of color is a public health issue that we cannot ignore.
The assumptions people may have that the residents choose to live in the low income neighborhoods or the bias that it is the fault of the residents that they can afford only such a neighborhood are contributors to this public health issue.
Let us work together for our low income Durham neighborhoods installing sidewalks to improve the health of the community and those who live there.
Amie Gray Koch is a Family Nurse Practitioner practicing community based palliative care and hospice in and around Durham.