Does Neighborhood Status Affect Access to a Healthy Built Environment?

Abstract Background: When looking to better understand the links between income and health, urban settings add an additional dimension of structural inequity. Without proactive urban planning, some neighborhoods are deprived of essential services, while other neighborhoods enjoy easier access to services and providers. The case of Indore, India was used to explore differentials in available services, infrastructure, and access to goods and services relating to non-communicable disease risk when the data was disaggregated by neighborhood type (slum vs non-slum). Methods: The environmental data for this paper came from a city-wide multi-level survey conducted in 2018, which included a neighborhood environmental assessment tool adapted from pre-validated questionnaires. Wards were randomly selected using a probability proportional to size (PPS) method after stratification by presence of slums. Within each ward, three colonies were then selected by PPS. The environmental data were collected from the same 30 wards and 93% (84/90) of the same colonies as the individual data. Results: The analysis highlighted some expected inequalities by neighborhood status, such as neighborhoods with no parks (62% slum vs 31% in non-slum). In neighborhoods where parks were present, there appeared to be issues with safety within the parks. Regarding walkability, slum neighborhoods generally had a higher prevalence of broken glass, liquor bottles, and stray dogs on footpaths. Non-slum neighborhoods had, on average, more vegetable stores, while slum neighborhoods had more snack and tobacco stores. The ratio of pro-tobacco versus anti-tobacco ads was twice as bad in slums than in non-slums. Conclusion: Better understanding of the access and availability of green spaces, transportation, and food markets between neighborhoods will help local officials, developers, and citizens as they formulate more equitable ways to distribute resources to build healthier environments for all citizens.