one of those college streets (Image Source: Remax)

My professor walked into class on Wednesday morning wearing a full suit and Jordans. This, he said, was his walking outfit.

At the end of class, he took us on a tour of downtown New Brunswick. More specifically, a section of town called Unity Square.

To give you some context, New Brunswick is both a college town and a city. Near my university, there are three or four well-known streets where restaurants and shops cater to a young demographic. You’ll see things like vegan places, Instagram-worthy date spots, and a Rite-Aid for everything your dorm room would ever need. A business has to be very successful in order to survive on these streets because the rent is so high. As a result, there’s a high turnover in restaurants — we get one or two new restaurants almost every year.

Most students never leave this college bubble. The academic buildings are all clumped together, with only a handful of medical school and hospital buildings going deeper into the city. On our Wednesday morning walk, my class saw a completely different world: Unity Square.

Unity Square is home to about 5,000 low-income residents who are mostly Spanish-speaking immigrants from Oaxaca, Mexico. As you pass the three to four college town streets, you start to see more bodegas, houses with toy cars in the front, and stores with Spanish signage.

The small family restaurants and cantinas in Unity Square, my professor said, couldn’t compete with the youthful restaurants in the college town despite having better food.

As we walked through the residential areas of Unity Square, we saw duplex houses that had up to eight satellite dishes set up. I didn’t realize it until my professor pointed it out, but that means that there are at least eight families in a house built for two.

There’s an academic theory called the “broken window theory” which basically says that visible signs of disorder in a community (things like broken windows or shuttered buildings) increases disorder and crime in that community. I like this theory because it verbalizes ideas and generalizations that usually sit in the back of our head when we avoid walking through a so-called “bad part of town.”

So what do those satellites really mean?

In healthcare, we have social determinants or qualities of a location or population that indirectly affect the quality of life and health in that area. For example, areas with more green space are typically healthier. More jobs, access to good school systems, and little pollution are some other examples. Those are pretty obvious connections.

When you look at the data, the satellites bring up a couple of interesting ideas. Typically, Latino immigrants like the ones in Unity Square have lower mortality rates than your usual non-Hispanic white person. It’s a concept well-known as the Latino Paradox: despite having less access to higher-education and higher income, these populations are healthier in a number of ways.

Many of the immigrants that live in Unity Square and other similar places come to the United States because they already have an existing network of family and friends that will support them. That’s how we get these pockets of ethnicities and communities of similar cultures. That’s how we get eight satellite dishes on one house.

A social support network like that provides stress-reducing advantages that could contribute to the Latino Paradox.

When I see the eight satellite dishes my first thought is that multiple families are living in that house to save money. There’s a high population density because of the poverty in the area. My second thought is that the number of moms in that house must keep all the kids in line and the fathers must let off steam together all the time. Studies show that smoking and substance abuse are all lower in this immigrant population and again, with that kind of family presence, I’m not even surprised.

It’s one thing to read these statistics in a journal study and another to see it with your own eyes. Actually, you can see things and still not know what they represent. For example, we were walking around Unity Square during the middle of a school day and the streets were so quiet.

None of us noticed, except our professor.

“That means the kids are at school and the adults are working,” he said. This was different from a few years ago, when the streets would be more active during the middle of a weekday.

Last Saturday, I volunteered nearby Unity Square at a health clinic that was doing breast cancer screenings and prostate exams for free. With a little over 20 patients showing up in a three-hour window, the nurses said it went better than their previous clinic events. Why? It was on a Saturday.

On weekdays, the kids are at school and the adults are working.

Understanding these social factors and symbols are important for knowing how to engage a population in healthy practices and how to treat individuals in that community. Take a walk doc, maybe your patients’ streets will teach you more than what their symptoms will tell you.

Originally published at on September 21, 2019.