If two people with the same education, income, and asset levels reside in two communities - one affluent, one poor - the person in the poor community is more likely to be in worse health than the one in the affluent community.

That's the conclusion of Stephanie Robert, PhD, Robert Wood Johnson Foundation Scholar in Health Policy Research at the University of California at Berkeley.

"We have known for a long time that people living in poorer communities tend to have worse health than people living in more affluent communities," Robert says, "but it has not been clear whether this is simply because people living in poorer communities are more likely to be poor themselves, or whether living in poorer communities is associated with worse health even among the more affluent residents."

To determine that, Robert combined socioeconomic data about communities from the 1980 census with health and socioeconomic data about individuals from a 1986 University of Michigan survey of a national sample of 3,617 Americans aged 25 and older.

She reports in the March issue of the Journal of Health and Social Behavior that living in poorer communities is associated with worse health, even for people with relatively high levels of education, income, and assets. This is true not only when comparing the poorest communities to the most affluent, but also when comparing average communities to more affluent ones.

Robert cautions that, although her study suggests community characteristics are related to health, a person's own income, education, and assets are even more closely linked to health. She concludes that while health initiatives aimed at poorer communities may ultimately be necessary to improve health, they should not replace efforts to improve the health of poorer individuals, regardless of where they live.

Future studies are needed to determine why the socioeconomic characteristics of communities are associated with health, Robert reports. If it is found that living in poorer communities actually causes bad health, research will be needed to determine whether the physical, service, or social environments of poorer communities are responsible.

Funding for Robert's study was provided by the Robert Wood Johnson Foundation Scholars in Health Policy Research Program, the AARP Andrus Foundation Graduate Fellowship in Gerontology, and the University of Michigan Rackham Predoctoral Fellowship.