Written by: Anna Jonczyk
Edited by: Isabella Mary Polsfuss, Shivani Patel, Xavier Westergaard
Illustrated by: Gabe de la Cruz
New York City is one of the greatest cities in America in terms of resource availability, diversity, and opportunities. Throughout 2021 and 2022, the New York State Department of Labor reported more than 40,000 additional private sector jobs per month on average, compared to previous years [1]. However, along with enormous economic growth, New York is experiencing a rapid gentrification crisis that leaves several lower-income residents struggling to afford living in the city [2]. Gentrification is a course of neighborhood change, in which lower-income households experience displacement by higher-income households [3]. A household is said to undergo displacement when the residents are forced to move regardless of their previous condition of occupancy since the household’s conditions became unaffordable or hazardous [4]. However, gentrification is not limited to only demographic changes in income. Throughout the gentrification process, the social character and essence of a neighborhood fundamentally changes since gentrification breaches physical, social, economic, and cultural spheres [5]. As displacement occurs, the change in culture is visible through replacement of local businesses, such as traditional “mom and pop” stores and restaurants, with big-name chains [5, 6] Research surrounding gentrification has mainly emphasized the transition of these neighborhoods from racial or ethnic enclaves to middle-class white neighborhoods along with how gentrified neighborhoods experienced a change in their crime rate, economic prosperity, and racial or ethnic demographic [6, 7].
In contrast, exploration of how gentrification affects public health is limited and severely understudied. One of the fundamental issues when studying public health in neighborhoods in varying stages of gentrification is the broad and all-encompassing definition of public health [8]. The Institute of Medicine (IOM) defines public health as “fulfilling society’s interest in assuring conditions, in which people can be healthy” [9]. According to the IOM, the intentional use of broad terms, such as “assuring conditions,” demonstrates how various factors of social, economic, political, and medical care may influence health. Moreover, the key phrase “society’s interest” deliberately seeks to protect the health and well-being of everyone by promoting the idea of public health as a societal interest [9]. However, throughout the process of gentrification, the efflux of lower-income residents and influx of middle-class residents creates an unstable environment by disrupting the complex and interconnected systems that play a part in public health [10]. Therefore, gentrification may differentially affect the health of low-income populations, with conflicting opinions regarding the potential benefits or harm due to the complexity of the phenomenon [10]. Gentrification not only affects several spheres of life, but also sub-populations differently [10]. To approach research on the effect of gentrification on public health, it may be beneficial to focus through the lens of a specific disease as an example. Research which focuses specifically on the impact of unstable housing on one disease, such as human immunodeficiency virus (HIV), demonstrates the detrimental effects gentrification may have on the directly impacted subpopulation [10-13]. When viewing public health through the IOM’s definition and using HIV as a representative case, understanding how people directly impacted by HIV are affected by public health can lead to an understanding of wider public health needs within society as a whole.
When generally speaking about the effects of gentrification on a population’s public health, no decisive claims or direct links can be made between public health and gentrification [10]. For example, one common characteristic of gentrifying neighborhoods is increased investment into green spaces to promote healthy habits as well as add aesthetic elements to a neighborhood [14-18]. In a way, the lower income residents who stay in gentrifying areas may benefit from new green spaces, which provide lower exposure to air pollution, stress relief, and space to improve cardiovascular health [19]. However, these investments into neighborhoods often lead to rent prices increasing, thereby catalyzing displacement of lower-income residents [20]. We can therefore conclude that skyrocketing rent prices cause lower income populations to have less money to allocate to medications, food, and transportation negatively impacting their health. Additionally, populations may experience psychosocial burdens when people within their social circles and families may undergo displacement [21]. In a study which interviewed 44,167 New York City residents, the overall assessment found that the addition of green space to a neighborhood significantly reduced self-reporting of fair or poor health [22]. However, upon further analysis, only the non-Hispanic and White population with higher education benefited from the greenspace, while all other ethnic or racial groups with lower education reported being negatively impacted in their health [22]. Although the majority of studies report similar findings, as more researchers investigate the effects of gentrification on health, the results are often mixed regarding which populations use the green space more frequently and are more physically active [23]. Additionally, comparative studies between health outcomes of the low-income residents who stayed and those who were displaced by the gentrification currently do not exist [23]. Through the analysis above on one aspect of gentrification--the addition of green spaces--on public health, the varied impact amongst different populations is demonstrated, yet the results are not always consistent between studies itself. Therefore, with the current available studies, no substantial claims can be made that directly link public health and gentrification.
However, rather than focusing on the wide-ranging theme of public health, when focusing research on one disease, such as HIV, studies demonstrate the massive impact housing has on treatment [24]. HIV, is a virus that targets and attacks the body’s immune system and if left untreated, progresses into its most advanced stage: acquired immunodeficiency syndrome (AIDS) [25]. After two to four weeks of infection with HIV, people experience flu-like symptoms, such as fever, chills, or rash, as well as night sweats, sore throat, and muscle aches. Some people do not experience any symptoms during early HIV infection. If left untreated, HIV will advance to AIDS in about 10 years. AIDS is characterized by a badly damaged immune system and opportunistic infections, which are life-threatening infections that pose a threat to immunocompromised individuals, but would not to healthy individuals [25]. HIV is transmitted through forward transmissibility, the ability for an infection to be transmitted from one person to another [26]. Regardless of symptoms or stage of infection, HIV is always transmissible through bodily fluids, such as blood, semen, breast milk, and vaginal fluids [27]. HIV infection affects 38.4 million people living worldwide at the end of 2021 and has been diagnosed in 103,900 New Yorkers as of December 2021 [28]. These jarring statistics illuminate how HIV/AIDS is a worldwide epidemic and must be treated with the utmost concern.
In order to understand the severity of HIV/AIDS and why housing plays an essential role in treatment, it is crucial to understand the irreversibility of the virus. The HIV virion particle contains a viral spike, which is a protein structure that helps the virus enter the human cell [29]. The viral spike is made of smaller proteins called glycoproteins, one of which is called gp120 that attaches to the surface of a human CD4+ cell, a crucial human immune cell [29]. The interaction between the gp120 and the CD4+ membrane allows for fusion between the two particles, and the HIV virus can enter the cell [29, 30]. Once released into the human cell, HIV uses its reverse transcriptase, a type of enzymatic protein, to convert its RNA genetic material into DNA genetic material [31]. Since humans also have DNA as their genetic material, the HIV DNA can then enter the human nucleus, the location where human genetic material is stored, and integrate into the human DNA [32-34]. At this point, the cell has undergone lethal and irreversible damage, since the cell’s machinery that is used for normal cell replication is now exploited to replicate the viral HIV DNA [35, 36]. Once the virus replicates inside several times, the host CD4+ cell eventually swells and bursts, killing the human cell and allowing new HIV particles to circulate in the body and infect other cells [37, 38]. Without treatment, the CD4+ cell population decreases to a dangerously low level, leading to a weaker immune system and changing HIV to AIDS [39].
Since HIV directly alters the human genetic material, the treatment for HIV/AIDS cannot fully eradicate infection [40]. The most common treatment is a combination of antiretroviral medicines that target the reverse transcriptase protein to prevent virus replication [40]. However, at most, the medicine can transform HIV/AIDS infection from a deadly virus to a chronic, yet manageable virus that allows individuals to live high-quality, healthier lives [41-43]. This treatment must be taken on a strict daily regimen for the rest of a person’s life, which requires a long-term commitment—a commitment that can be influenced by the housing situation of an HIV-positive individual [24, 25]. Housing is considered a social determinant of health since housing affordability, stability, quality, and safety are all important factors to consider regarding health and well-being [44]. As aforementioned, one of the defining characteristics of gentrification established by several studies is how it causes displacement, especially of lower-income households. In doing so, the lower-income households experience an unstable housing situation [4]. In a 1997 study of HIV-positive patients receiving care from 47 different specialized HIV-care clinics, unstable housing or stable but poor housing, but in poor conditions, was the strongest predictor of nonadherence to treatment [45]. As such, without adherence to the treatment, one can conclude that forward transmission also ensues, causing HIV to spread within the population. When researching the effect of stable housing on HIV/AIDS treatment, Dr. Angela Aidala of Columbia University concluded that people diagnosed with HIV/AIDS without stable housing experienced a significant barrier to receiving a proper diagnosis, adequate HIV care, access to the medication, the subsequent adherence to the treatment regimen, and viral suppression [24]. Within each stage from diagnosis to viral suppression, the number of people who followed through the treatment decreased, with one major factor of influence being housing [24]. Although Dr. Aidala’s review studied unstable housing through a broader definition of housing as a “protected space to maintain physical and psychological well-being,” Dr. Aidala’s findings translate to gentrified areas, since it is well-established that gentrification affects more than the physical shelter, but also the social, economic, and political spheres of the neighborhood [5, 24].
Since HIV/AIDS requires lifelong care and treatment with antiretroviral medication, adherence is the largest barrier to overcoming the spread of the virus and to prevent HIV/AIDS from progressing to terminal stages [24]. Moreover, since housing is the largest predictor of adherence, it is hard to overlook how gentrification and its major effect on displacement and housing instability could affect individuals living with HIV/AIDS [46]. Policy makers and public health officials should conduct further studies on how unstable housing situations created by gentrification may prevent attainable HIV/AIDS treatment plans or affect other diseases, in addition to HIV/AIDS. In adherence with the IOM’s definition of public health, it is crucial to delve into understanding the intricacies of gentrification’s widespread effects, since the displaced may lose assurance of conditions in which they can be healthy. When compared with the baseline New York adult population, displaced individuals exhibited higher numbers of hospitalization visits (0.9 visits vs. 0.7 yearly average), emergency department visits (2.6 visits vs. 2.1 yearly average), and were more likely to be diagnosed with a mental health condition (37% of displaced individuals compared to 18% baseline) [21]. Arising statistics regarding the displaced population demonstrate that if public policy makers are meant to serve society as is stated in the IOM’s definition of public health, then there must be a broader study of how policies can protect all communities, specifically of lower-income residents, and a greater effort is required to provide housing stability to the neighborhoods that need it most.
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