Gentrification pathways and their health impacts on historically marginalized residents in Europe and North America: Global qualitative evidence from 14 cities

Highlights

• Multiple pathways account for the impacts of gentrification on health.

• Pathways to poor health include economic security and socio-cultural displacement.

• Marginalized residents also suffer from a loss of public services and amenities.

• Last, they face increased risks of criminal behavior and compromised public safety.

• Gentrification is thus experienced as a chain of community and individual traumas.

Abstract

As global cities grapple with the increasing challenge of gentrification and displacement, research in public health and urban geography has presented growing evidence about the negative impacts of those unequal urban changes on the health of historically marginalized groups. Yet, to date comprehensive research about the variety of health impacts and their pathways beyond single case sites and through an international comparative approach of different gentrification drivers and manifestations remains scarce. In this paper, we analyze qualitative data on the pathways by which gentrification impacts the health of historically marginalized residents in 14 cities in Europe and North America. We build on 77 interviews with key neighborhood stakeholders. Data analysis indicates four main concurrent processes: Threats to housing and financial security; Socio-cultural displacement; Loss of services and amenities through institutional gentrification; and Increased risks of criminal behavior and compromised public safety. Gentrification is experienced as a chain of physical and emotional community and individual traumas – an overall shock for historically marginalized groups – because of permanent pressures of insecurity, loss, state of displaceability, and the associated exacerbation of socio-environmental disadvantages.

Introduction

Over the last four decades, gentrification has prompted intense academic debate in planning and geography, predominately over its manifestations, drivers, and impacts on neighborhoods and residents. However, only recently has the public health community actively engaged with this extensive literature and considered the ramifications of gentrification on the health of different types of urban residents, from new residents to historically marginalized ones. This paper zooms in on the health of marginalized groups, that is working class, low income, racialized minorities, youth and older residents whose neighborhoods are being gentrified. It offers a novel, in-depth and comparative analysis of the potential pathways between gentrification and health impacts. We do so using an international comparative approach, which allows us to further nuance our understanding of pathways and examine commonalities independently from each city's particularities of urban change and redevelopment while also pointing at nuances that might reflect those differences.

Gentrification is characterized by widespread neighborhood transformation through new capital targeting previously under-invested areas. This process tends to be illustrated by new housing projects, cultural amenities, and commercial venues that target and reflect the consumption, recreation and housing tastes of new residents (i.e., “gentrifiers,” privileged residents usually from high-income and white backgrounds) – either local, national, or transnational (Brown-Saracino 2010; Lees and Ley 2008; Lees et al. 2015; Cocola-Gant and Lopez-Gay 2020). Gentrification is globalizing through a process with multiple waves, manifestations, and drivers, including – above all – real estate (re)development, speculation, and increasing housing prices (Lees et al. 2015; Pattaroni et al. 2012) which can reach the point of hypergentrification, that is large-scale government-driven and private investment-financed redevelopment of neighborhoods (Lees 2008). Distinct drivers and singularities of gentrification may lead to different social impacts for residents (Mehdipanah et al., 2018) which may happen in conjunction with housing-driven displacement (Elliott-Cooper, Hubbard, and Lees 2020).

For instance, commercial gentrification takes place when long-time “mom and pop” stores and daily businesses are replaced by high-end and exclusive boutiques, restaurants and bars (Shaw and Hagemans 2015; Anguelovski 2015), which prices vulnerable groups of residents out. In tourism gentrification, the development of mass tourism compromises housing availability, neighborhood services, existing commercial venues and prices, and public space use for existing residents (Cocola-Gant 2018; Versey et al., 2019; Sánchez-Ledesma et al., 2020; Gotham 2005; Oscilowicz et al., 2020; Degen and García 2012), and is associated with increased crime (Maldonado-Guzmán 2020). Most recently, environmental (or green) gentrification is defined as the targeted cleaning of derelict or contaminated land or as the creation of environmental amenities as a contribution to increased real estate prices, entrepreneurial investments, and demographic changes – leading to the exclusion of historically marginalized groups from the benefits of urban greening (Anguelovski et al., 2019; Argüelles et al., 2021; Gould and Lewis 2017; Levenda and Tretter 2020; Connolly 2018; García Lamarca et al., 2021).

Extending the study of gentrification to understand the effect of gentrification specifically on the health of historically marginalized residents, recent research reveals that, while mixed associations exist between gentrification and health outcomes for privileged residents as neighborhoods gentrify, negative associations tend to predominate for historically marginalized residents’ mental and physical health (Schnake-Mahl et al., 2020, Bhavsar et al. 2020, Tulier et al., 2019, Jelks et al. 2021, Mehdipanah et al., 2018, Gibbons and Barton 2016, Huynh and Maroko 2014, Izenberg, Mujahid, and Yen 2018b, a, Smith et al. 2018), except in rarer exceptions (Narita et al., 2020). Most health studies on gentrification do not differentiate between different gentrification drivers however. They tend instead to mostly analyze and use quantitative, demographic change-centered (and at times housing price)-centered markers of gentrification – the most traditional, visible, and acute marker of gentrification and the easiest to measure when relying on quantitative measures of gentrification (for the only exception we are aware of see Sánchez-Ledesma et al., 2020). All in all, the growing number of systematic reviews on gentrification and health outcomes (Schnake-Mahl et al., 2020; Bhavsar et al. 2020; Tulier et al., 2019; Jelks et al. 2021; Mehdipanah et al., 2018) report that historically marginalized residents are more likely to experience worse mental health (i.e., higher stress, anxiety, depression, sleep deprivation) as well as physical health (i.e., increase of respiratory diseases, deterioration of nutrition and diet, or preterm birth).

As for physical health in particular, Black residents in gentrifying tracts have been found more likely to report worse self-rated health; and almost 75% more likely to report poor/fair self-rated health when living in a Black gentrifying neighborhood (Gibbons and Barton 2016). Similarly, Izenberg et al. found that in California, among residents self-identified as Black, gentrification accounted for a 144% increase in the odds of fair/poor self-rated health (Izenberg, Mujahid, and Yen 2018b). Gentrification has also been reported to be associated with increased likelihood of preterm birth and fair/poor self-rated health for Black residents when these are compared with Black residents in non-gentrifying neighborhoods or compared with white residents (Gibbons and Barton 2016; Izenberg, Mujahid, and Yen 2018b; Huynh and Maroko 2014).

As for mental health, residents in gentrifying tracts are more likely to report above-average stress, which highlights how racial loss and displacement affects the mental health of remaining racialized residents (Gibbons 2019). Similarly, living in a gentrified neighborhood is associated with an increased likelihood of serious psychological distress for historically marginalized groups (Tran et al., 2020). Displaced residents from gentrifying areas are also likely to make more emergency department visits and experience hospitalizations due to mental health concerns – in comparison with those residents who remained in place (Lim et al., 2017).

The health effects of gentrification may also vary by residents’ life stages. Research in New York finds that gentrification is associated with moderate increases in diagnoses of anxiety or depression in children living in market-rate housing, a population most at risk of housing displacement (Dragan et al. 2019). Meanwhile, a national study at the US metropolitan level found that both lower-income and higher-income older adults in gentrifying neighborhoods had more depression and anxiety symptoms than when those same groups live in more affluent areas (Smith et al. 2018), possibly due perceived cultural shifts and increased housing concerns (Versey et al., 2019).

Gentrification and health: Pathways.

Gentrification health effects certainly have specific pathways. To elucidate the pathways by which gentrification affects health may be particularly meaningful for understanding how health inequities are created and sustained (Cole et al., 2021a; Anguelovski et al., 2019a, Anguelovski et al., 2019b). Recent studies have begun to explore these specific pathways. Accordingly, existing evidence suggests that the potential pathways linking gentrification and health include loss of social networks, social capital, and overall community cohesion (Sánchez-Ledesma et al., 2020; Weil 2019; Versey et al., 2019; Huynh and Maroko 2014; Gibbons and Barton 2016; Pérez del Pulgar, Anguelovski, and Connolly 2020; Wolch et al. 2014); an eroded sense of place (Shaw and Hagemans 2015; Anguelovski 2015; Versey et al., 2019; Oscilowicz et al., 2020); an erasure of identity (Sánchez-Ledesma et al., 2020; Cocola-Gant 2018; Anguelovski 2015); and socio-cultural exclusion and physical displacement. Further factors involve the loss of a secure home and constant threats of eviction and property speculation due to poor landlord practices (Sánchez-Ledesma et al., 2020; Versey 2018; Versey et al., 2019; Desmond and Gershenson 2017). Such experiences may result in increased and prolonged stress, or a reduction in sense of belonging, which in turn have multiple implications for health. In the case of actual displacement or loss of safe housing, environmental exposures are modified, with significant implications for all types of health outcomes.

In a majority of studies, gentrification is also associated with increased criminal activity (Schnake-Mahl et al., 2020; Oscilowicz et al., 2020), especially violent crime (Kreager et al. 2011; Williams 2014), which in turns affects the health of residents via stress, fear, or even physical harm, although some do find that this relationship fades away in later stages of gentrification (Kreager et al. 2011) and others find that, when neighborhoods start gentrifying, they experience a decline in crime (Papachristos et al., 2011), especially assault, homicide, and robbery in the case of greater gentrification rates – in this case New York City (Barton 2016). Last, links between gentrification and substance abuse have been more recently explored, with gentrification associated with binge drinking among new residents (Izenberg, Mujahid, and Yen 2018a) and with increased drinking and loss of social connection (Pennay et al. 2014). Other pathways include increased policing and barriers to access overdose prevention sites for drug users living in gentrifying neighborhoods, which in turns exacerbates their structural vulnerability (Collins et al., 2019).

Emerging research also points to possible pathways associated with specific types and drivers of gentrification (Cole et al., 2021a), including commercial changes and urban greening in the case of commercial gentrification and green gentrification. For instance, although gentrifying neighborhoods tend to have new food venues and options, affordable, healthy food options are mostly absent in gentrifying census tracts (Breyer and Voss-Andreae 2013), with working-class residents faced with so-called “food mirages” (Sullivan 2014; Anguelovski 2016) and trade-offs between paying for housing and buying food (Whittle et al., 2015). Thus, these changes have implications for diet, thus affecting health. In regard to green gentrification, recent studies identify how new green space in gentrifying neighborhoods -- and gentrification more broadly -- can create “disruptive green landscapes” for historically marginalized residents (Triguero-Mas et al., 2021) while failing to resolve existing environmental risks (Cole et al., 2021) or to create “relational wellbeing” (Pérez del Pulgar, Anguelovski, and Connolly 2020).

However, to our knowledge, there is only one study that has previously formally and purposefully explored these potential pathways, which did so in the context of tourism gentrification (Sánchez-Ledesma et al., 2020). Building on this emerging literature about gentrification and health pathways, our paper addresses an empirical gap by qualitatively investigating how historically marginalized residents’ health is impacted by different processes of gentrification (i.e., commercial, tourism, or green) and their embeddedness in associated real estate (re)development (and clean-up at times) in a diversity of cities and contexts of Europe and North America. Our study is also uniquely positioned for being able to relate findings to different gentrification drivers (commercial, tourism, and green gentrification). We focus on marginalized residents since they are traditionally at higher risk of worse social and health outcomes in cities (Wallace et al. 2016; Krieger 2011; Bakhtiari et al. 2018). Although some of those residents have lived in their gentrifying neighborhood for decades whereas others, such as racialized immigrants, have settled more recently, their social and racial status make both groups at risk for negative health effects from gentrification. In short, to the best of our knowledge, this study is the first at answering: (1) How does gentrification shape the health of historically marginalized groups across different gentrification processes? (2) What are the main pathways in that relationship in a variety of gentrifying neighborhoods and gentrifying trends and drivers across countries?