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Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader, dynamic context in which individuals live and in which health care systems function. The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-profit care, and the closure of less profitable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term \"health care gentrification.\" In this commentary, we frame access to health care in the United States in the context of neighborhood gentrification and a concurrent process of changes to the health care system itself. We describe the concept of health care gentrification, and the complex ways in which both neighborhood gentrification and health care gentrification may lead to inequitable access to health care. We then present a framework for understanding health care gentrification as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more effectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the effects of health care gentrification in the United States.

Purpose of Review Many neighborhoods which have been unjustly impacted by histories of uneven urban development, resulting in socioeconomic and racial segregation, are now at risk for gentrification. As urban renewal projects lead to improvements in the long-neglected built environments of such neighborhoods, accompanying gentrification processes may lead to the displacement of or exclusion of underprivileged residents from benefiting from new amenities and improvements. In addition, gentrification processes may be instigated by various drivers. We aimed to discuss the implications of specific types of gentrification, by driver, for health equity. Recent Findings Several recent articles find differential effects of gentrification on the health of underprivileged residents of gentrifying neighborhoods compared to those with greater privilege (where sociodemographic dimensions such as race or socioeconomic status are used as a proxy for privilege). Generally, studies show that gentrification may be beneficial for the health of more privileged residents while harming or not benefiting the health of underprivileged residents. Very recent articles have begun to test hypothesized pathways by which urban renewal indicators, gentrification, and health equity are linked. Few public health articles to date are designed to detect distinct impacts of specific drivers of gentrification. Summary Using a case example, we hypothesize how distinct drivers of gentrification—specifically, retail gentrification, environmental gentrification, climate gentrification, studentification, tourism gentrification, and health care gentrification—may imply specific pathways toward reduced health equity. Finally, we discuss the challenges faced by researchers in assessing the health impacts of gentrification.

BackgroundIntraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography.MethodsThis cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables.ResultsNeighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index.ConclusionLike other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.

Although cities globally are increasingly mobilizing re-naturing projects to address diverse urban socio-environmental and health challenges, there is mounting evidence that these interventions may also be linked to the phenomenon known as green gentrification. However, to date the empirical evidence on the relationship between greenspaces and gentrification regarding associations with different greenspace types remains scarce. This study focused on 28 mid-sized cities in North America and Western Europe. We assessed improved access to different types of greenspace (i.e. total area of parks, gardens, nature preserves, recreational areas or greenways [i] added before the 2000s or [ii] added before the 2010s) and gentrification processes (including [i] gentrification for the 2000s; [ii] gentrification for the 2010s; [iii] gentrification throughout the decades of the 2000s and 2010s) in each small geographical unit of each city. To estimate the associations, we developed a Bayesian hierarchical spatial model for each city and gentrification time period (i.e. a maximum of three models per city). More than half of our models showed that parks—together with other factors such as proximity to the city center—are positively associated with gentrification processes, particularly in the US context, except in historically Black disinvested postindustrial cities with lots of vacant land. We also find than in half of our models newly designated nature preserves are negatively associated with gentrification processes, particularly when considering gentrification throughout the 2000s and the 2010s and in the US. Meanwhile, for new gardens, recreational spaces and greenways, our research shows mixed results (some positive, some negative and some no effect associations). Considering the environmental and health benefits of urban re-naturing projects, cities should keep investing in improving park access while simultaneously implementing anti-displacement and inclusive green policies.

The COVID‐19 outbreak triggered a combined health, social and economic crisis, imposing multiple restrictions that altered the use and perception of public green and blue spaces (PGBS). In this article, we explored how the different stages of the COVID‐19 pandemic restrictions affected the use and perceptions of public greenspaces and seafront in gentrifying neighbourhoods, focusing specifically on women and non‐binary residents. We conducted a comparative analysis of two densely populated neighbourhoods in Barcelona, Spain, employing a participatory mixed‐methods approach including surveys, focus groups, participatory walks and semi‐structured interviews. We collected the perceptions from women and non‐binary residents for the pre‐pandemic period, the lockdown period and the period during the post‐lockdown gradual ease of restrictions. Our findings reveal that during the COVID‐19 lockdown, the use of neighbourhood PGBS was maintained or intensified, highlighting the existing deficit in the denser areas of the city. However, post‐lockdown, use patterns changed, with differences based on neighbourhood characteristics and gentrification pressures. This suggests that while COVID‐19 seemed to temporarily impact how people used PGBS, these changes were rapidly reversed once mobility restrictions were lifted. During and after the pandemic, PGBS facilitated informal care networks and community cohesion that helped residents endure the impacts of the pandemic, but the return of gentrification and touristification pressures disrupted these networks, heightening feelings of displacement and exclusion among women and non‐binary residents. The research underscores the dual role of PGBS as both essential community spaces and sites of exclusion, emphasizing the need for inclusive and just green planning strategies. Policy implications. Urban planning must prioritize the quality and accessibility of PGBS with a gender‐sensitive approach and address broader issues of gentrification and touristification to protect vulnerable populations. An environmentally just greening approach should consider proximity, safety, accessibility and design to facilitate the use of PGBS by socially vulnerable groups. Read the free Plain Language Summary for this article on the Journal blog. Resumen El inicio de la pandemia de COVID‐19 desencadenó una crisis combinada sanitaria, social y económica, imponiendo múltiples restricciones que alteraron el uso y la percepción de los espacios públicos verdes y azules. En este artículo, exploramos cómo las diferentes etapas de las restricciones de la pandemia de COVID‐19 afectaron el uso y las percepciones de los espacios públicos verdes y azules en barrios en proceso de gentrificación, enfocándonos específicamente en mujeres y minorías de género. Realizamos un análisis comparativo de dos barrios densamente poblados en Barcelona, España, utilizando un enfoque participativo de métodos mixtos que incluyó encuestas, grupos focales, marchas exploratorias/participativas y entrevistas semiestructuradas. Recopilamos las percepciones de mujeres y residentes no binarios para el período anterior a la pandemia, el período de confinamiento y el período durante la gradual disminución de restricciones post‐confinamiento. Nuestros resultados revelan que durante las restricciones de movilidad por COVID‐19, el uso de los espacios públicos verdes y azules en los barrios se mantuvo o intensificó, destacando el déficit existente en las áreas compactas de la ciudad. Sin embargo, después del confinamiento, los patrones de uso cambiaron, con diferencias basadas en las características del barrio y las presiones de gentrificación. Esto sugiere que, aunque el COVID‐19 parece haber impactado temporalmente cómo las mujeres y personas no binarias usaban los espacios públicos verdes y azules, estos cambios se revirtieron rápidamente una vez levantadas las restricciones de movilidad. Durante y después de la pandemia, estos espacios públicos facilitaron redes informales de cuidado y cohesión comunitaria que ayudaron a las residentes a sobrellevar los impactos de la pandemia, pero el regreso de las presiones de gentrificación y turistificación interrumpieron estas redes, aumentando los sentimientos de desplazamiento y exclusión entre mujeres y residentes no binarias. La investigación subraya el doble papel de los espacios públicos verdes y azules como importantes espacios comunitarios y sitios de exclusión, enfatizando la necesidad de estrategias de planificación verde inclusivas y equitativas. Implicaciones para las políticas. La planificación urbana debe priorizar la calidad y accesibilidad de los espacios públicos verdes y azules con un enfoque sensible al género y abordar problemas más amplios de gentrificación y turistificación para proteger a las poblaciones vulnerables. Una planificación del verde ambientalmente justa debe considerar la proximidad, seguridad, accesibilidad y diseño para facilitar el uso de los espacios públicos verdes y azules por parte de grupos socialmente vulnerables. Read the free Plain Language Summary for this article on the Journal blog.

While access and exposure to green spaces has been shown to be beneficial for the health of urban residents, interventions focused on augmenting such access may also catalyse gentrification processes, also known as green gentrification. Drawing from the fields of public health, urban planning and environmental justice, we argue that public health and epidemiology researchers should rely on a more dynamic model of community that accounts for the potential unintended social consequences of upstream health interventions. In our example of green gentrification, the health benefits of greening can only be fully understood relative to the social and political environments in which inequities persist. We point to two key questions regarding the health benefits of newly added green space: Who benefits in the short and long term from greening interventions in lower income or minority neighbourhoods undergoing processes of revitalisation? And, can green cities be both healthy and just? We propose the Green Gentrification and Health Equity model which provides a framework for understanding and testing whether gentrification associated with green space may modify the effect of exposure to green space on health.

The COVID-19 pandemic crisis has compromised the ‘healthy cities’ vision, as it has unveiled the need to give more prominence to caring tasks while addressing intersectional social inequities and environmental injustices. However, much-needed transdisciplinary approaches to study and address post-COVID-19 healthy cities challenges and agendas have been scarce so far. To address this gap, we propose a ‘just ecofeminist healthy cities’ research approach, which would be informed by the caring city, environmental justice, just ecofeminist sustainability and the healthy cities paradigms and research fields. Our proposed approach aims to achieve the highest standards of human health possible for the whole population—yet putting the health of socially underprivileged residents in the centre—through preserving and/or improving the existing physical, social and political environment. Importantly, the proposed approach recognises all spheres of daily life (productive, reproductive, personal and political) and their connections with inequities, justice and power dynamics. Last, the just ecofeminist healthy cities approach understands human health as interconnected with the health of non-human animals and the ecosystem. We illustrate the proposed new approach focusing on the implications for women’s health and public green spaces research and propose principles and practices for its operationalisation.

We aimed to create a theoretical framework to understand how neighborhood gentrification may impact urban health and health equity, taking into account perspectives and evidence from multiple disciplines. In addition to reviewing the literature and harnessing our own experience and expertise, we elicited input from researchers, activists and professionals from multiple fields using an eDelphi process, determined the agreements and disagreements between respondents on the causes, consequences, and health impacts of gentrification. Respondents agreed that neighborhood gentrification has important implications for mental health and on many of the causes and consequences of gentrification but reached less agreement on the pathways by which gentrification may affect health and the specific health outcomes that may be affected. Finally, we generated an evidence-informed conceptual framework taking into account the input from the eDelphi process. Here we present this conceptual framework for understanding the relationship between gentrification and health and discuss a future research agenda for this emerging theme in public health research.

Greenspace is widely related to mental health benefits, but this relationship may vary by social group. Gentrification, as linked to processes of unequal urban development and conflict, potentially impacts health outcomes. This study explores the relationships between greenspace and mental health and between gentrification and mental health associations. It also further examines gentrification as an effect modifier in the greenspace–mental health association and SES as an effect modifier in the gentrification-mental health association. We used cross-sectional Barcelona (Spain) data from 2006, which included perceived mental health status and self-reported depression/anxiety from the Barcelona Health Survey. Greenspace exposure was measured as residential access to (1) all greenspace, (2) greenways and (3) parks in 2006. Census-tract level gentrification was measured using an index including changes in sociodemographic indicators between 1991 and 2006. Logistic regression models revealed that only greenways were associated with better mental health outcomes, with no significant relationship between mental health and parks or all greenspace. Living in gentrifying neighborhoods was protective for depression/anxiety compared to living in non-gentrifying neighborhoods. However, only residents of gentrifiable census tracts benefited from the exposure to greenways. SES was not found to be an effect modifier in the association between gentrification and mental health. Future research should tackle this study’s limitations by incorporating a direct measure of displacement in the gentrification status indicator, accounting for qualitative aspects of greenspace and user’s perceptions. Gentrification may undermine the health benefits provided by greenspace interventions.