Most Philadelphians have trauma. Fixing our neighborhoods can help.

Philadelphia is a city marked by trauma and grief.

A 2012 study found that more than 80% of Philadelphians had been affected by a traumatic experience before they reached adulthood. That rate is likely higher now, considering the pandemic, persistently high numbers of opioid-related deaths, and ever-increasing levels of gun violence.

Trauma doesn’t just affect mental health — it impacts physical health as well. A history of trauma is associated with a higher risk of obesity, cancer, depression, and suicide, among other health problems. As health professionals practicing in the region, we have seen this firsthand and witnessed the effects of trauma on physical and mental health for over 25 years.

Philadelphia is in desperate need of new approaches to dealing with the level of trauma its residents now bear. We propose making our neighborhood environments into the type of places that can support healing from and growth after trauma.

This type of approach is dubbed “trauma-informed care.” It hasn’t been applied widely to physical neighborhood environments yet, but it has been applied in settings such as child welfare, schools, and mental health service providers. Most typically, trauma-informed care is implemented by workplaces or other organizations, which may change policies or train staff to respond to clients in a way that takes their trauma into consideration, and avoids retraumatizing them.

It can be hard to imagine how to apply trauma-informed care to physical neighborhood environments — the buildings, sidewalks, greenery, structures, and lighting that make up the settings in which residents live, work, attend school, and play. Yet, research tells us that characteristics of neighborhoods ― such as green space, traffic, noise, vacant land, and artificial light — are associated with physical and mental health.

Applying trauma-informed approaches to the physical neighborhood environment — an approach we have coined “trauma-informed neighborhoods” — may help promote better health outcomes for those impacted by trauma, as well as for all neighborhood residents.

As this idea is novel, we don’t yet know what the ideal trauma-informed neighborhood would look like. But we do have some ideas.

Adding green landscapes to neighborhoods might help support well-being after trauma.

We know that many neighborhoods have disruptive traffic, poorly lit spaces, and loud noises from construction or police sirens. Those characteristics can be stressful or anxiety-provoking for many, particularly for those with a history of trauma. In addition, the quality of green space across Philadelphia neighborhoods varies widely — from peaceful, lush parks to poorly maintained vacant lots with limited greenery. Adding green landscapes to neighborhoods might help support well-being after trauma. Similarly, certain building characteristics like razor wire or police cameras might make a neighborhood feel threatening. In contrast, the beautiful murals that we see throughout the city can promote a sense of collectivism and pride.

Of course, many neighborhood residents have been advocating for these types of changes for years. As with many issues in Philadelphia, it’s not possible to wave a magic wand and install green space and remove razor wire from all our neighborhoods just because it can help residents heal and grow from trauma. But knowing that these changes could have wide-reaching impacts on Philadelphians who experience trauma may provide more incentives to get them done.

Trauma-informed neighborhoods have the potential to interrupt the associations between trauma and poor health outcomes. Consider obesity, which already impacts roughly one in three Philadelphians. Our research has shown that people with a history of trauma tend to live in neighborhoods with poor access to supermarkets, more crime, and less green space. Taking a trauma-informed approach to those neighborhoods, such as by adding more green space, could help avert trauma’s harmful effects on body weight.

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Efforts toward the creation of trauma-informed neighborhoods in Philadelphia could complement many other activities in our city, including violence reduction, advancing neighborhood equity, and improving health. Community voices would be key to envisioning what a trauma-informed neighborhood would look like. Partnerships among community members, policymakers, and academics may be a particularly powerful approach to create healthier neighborhoods. Other trauma resources — like support for communities, families, and individuals — will remain vitally important and can complement neighborhood efforts.

It’s critical that the city develops creative and action-oriented solutions to support the well-being of Philadelphians affected by trauma. Translating established tenets of trauma-informed care to neighborhood physical environments could support health, healing, thriving, and resilience.

We believe that Philadelphia is well poised to take the national lead in the creation of “trauma-informed neighborhoods” to improve the health and well-being of all.

Krista Schroeder is an assistant professor of nursing at the Temple University College of Public Health. David Sarwer is the director of the Center for Obesity Research and Education at the Temple University College of Public Health.