This study examines associations between low-density zoning and individual health outcomes across 44 large U.S. metro areas. Zoning laws that restrict housing density to low levels can restrict affordable housing, contribute to urban sprawl, and increase segregation. Density zoning is one of the oldest and most common forms of residential zoning in the United States, and conceptual models posit that low-density zoning should be associated with wider health disparities. However, empirical associations between density zoning and health have been largely undocumented. Using data from the National Longitudinal Land Use Survey and Behavioral Risk Factor Surveillance Selected Metropolitan/Micropolitan Area Risk Trends data (N = 87,752), we find that metro areas with a higher proportion of jurisdictions with restrictive low-density zoning have wider race, ethnic, and income disparities in poor self-assessed health. However, we also find suggestive evidence that race disparities in obesity may be narrower in metro areas with more low-density zoning.
Barrington-LeighChristopherMillard-BallAda.2015. “A Century of Sprawl in the United States.” Proceedings of the National Academy of Sciences112(27):8244–49. doi:10.1073/pnas.1504033112.
2.
BrouwerN. R.TrounstineJessic.2024. “NIMBYs, YIMBYs, and the Politics of Land Use in American Cities.” Annual Review of Political Science27:165–84. doi:10.1146/annurev-polisci-041322-041133.
ChandraboseManojRacheleJerome N.GunnLucyKavanaghAnneOwenNevilleTurrellGavinGiles-CortiBillieSugiyamaTakem.2019. “Built Environment and Cardio-metabolic Health: Systematic Review and Meta-analysis of Longitudinal Studies.” Obesity Reviews20(1):41–54. doi:10.1111/obr.12759.
5.
ChriquiJamie F.LeiderJulienThrunEmilyNicholsonLisa M.SlaterSand.2016. “Communities on the Move: Pedestrian-Oriented Zoning as a Facilitator of Adult Active Travel to Work in the United States.” Frontiers in Public Health4:71. doi:10.3389/fpubh.2016.00071.
6.
DavisJenn.2021. “How Do Upzonings Impact Neighborhood Demographic Change? Examining the Link between Land Use Policy and Gentrification in New York City.” Land Use Policy103(2021):105347. doi:10.1016/j.landusepol.2021.105347.
7.
DoironDeniseFiebigDenzil G.JoharMeliyanniSuziedelyteAgn.2015. “Does Self-Assessed Health Measure Health?” Applied Economics47(2):180–94. doi:10.1080/00036846.2014.967382.
8.
DuncanDustinKawachiIchir.2018. Neighborhoods and Health. 2nd ed. New York, NY: Oxford University Press.
9.
EllicksonRobert C.2022. America’s Frozen Neighborhoods: The Abuse of Zoning. New Haven, CT: Yale University Press.
10.
EwingReidHamidiShim.2015. “Compactness versus Sprawl: A Review of Recent Evidence from the United States.” Journal of Planning Literature30(4):413–32. doi:10.1177/0885412215595439.
11.
FenelonAndrewMaynePatrickSimonAlan E.RossenLauren M.HelmsVeronicaLloydPatriciaSperlingJonSteffenBarry L.2017. “Housing Assistance Programs and Adult Health in the United States.” American Journal of Public Health107(4):571–78. doi:10.2105/AJPH.2016.303649.
12.
FischlerRaphae.1998. “Health, Safety, and the General Welfare: Markets, Politics, and Social Science in Early Land-Use Regulation and Community Design.” Journal of Urban History24(6):675–719. doi:10.1177/009614429802400601.
13.
FreemarkYona.2023. “Zoning Change: Upzonings, Downzonings, and Their Impacts on Residential Construction, Housing Costs, and Neighborhood Demographics.” Journal of Planning Literature38(4):548–70. doi:10.1177/08854122231166961.
14.
GalsterGeorgeCutsingerJacki.2007. “Racial Settlement and Metropolitan Land-Use Patterns: Does Sprawl Abet Black-White Segregation?” Urban Geography28(6):516–53. doi:10.2747/0272-3638.28.6.516.
15.
GenoveseDarioCandiloroStefaniaD’AnnaAntonioDettoriMarcoRestivoVincenzoAmodioEmanueleCasuccioAlessandr.2023. “Urban Sprawl and Health: A Review of the Scientific Literature.” Environmental Research Letters18(8):083004. doi:10.1088/1748-9326/ace986.
16.
GraetzNickEspositoMichae.2023. “Historical Redlining and Contemporary Racial Disparities in Neighborhood Life Expectancy.” Social Forces102(1):1–22. doi:10.1093/sf/soac114.
HirtSonia A.2014. Zoned in the USA: The Origins and Implications of American Land-Use Regulation. Ithica, NY: Cornell University Press.
19.
HongBoyeongBonczakBartosz J.GuptaArpitThorpeLorna E.KontokostaConstantine E.2021. “Exposure Density and Neighborhood Disparities in COVID-19 Infection Risk.” Proceedings of the National Academy of Sciences118(13):e2021258118. doi:10.1073/pnas.2021258118.
20.
HuismanMartijnvan LentheFrankMackenbachJoha.2007. “The Predictive Ability of Self-Assessed Health for Mortality in Different Educational Groups.” International Journal of Epidemiology36(6):1207–13. doi:10.1093/ije/dym095.
21.
IhlanfeldtKeith R.2004. “Exclusionary Land-Use Regulations within Suburban Communities: A Review of the Evidence and Policy Prescriptions.” Urban Studies41(2):261–83. doi:10.1080/004209803200165244.
KarlsonKristian BerntHolmAndersBreenRichar.2012. “Comparing Regression Coefficients between Same-Sample Nested Models Using Logit and Probit: A New Method.” Sociological Methodology42(1):286–313. doi:10.1177/0081175012444861.
24.
KeeneDanya E.BlankenshipKim M.2023. “The Affordable Rental Housing Crisis and Population Health Equity: A Multidimensional and Multilevel Framework.” Journal of Urban Health100(6):1212–23. doi:10.1007/s11524-023-00799-8.
25.
KimMinjeeLeeHyojun.2024. “Upzoning and Gentrification: Heterogeneous Impacts of Neighbourhood-Level Upzoning in New York City.” Urban Studies62(10):2009–28. doi:10.1177/00420980241298199.
26.
KlingHannah K. M.2020. “Land-Use Regulations as Exclusion: A GIS Analysis.” Journal of Regional Analysis & Policy1(51):54–66.
27.
KohlerUlrichKarlsonKristian B.HolmAnder.2011. “Comparing Coefficients of Nested Nonlinear Probability Models.” Stata Journal11(3):420–38.
LensMichael C.2022. “Zoning, Land Use, and the Reproduction of Urban Inequality.” Annual Review of Sociology48:421–39. doi:10.1146/annurev-soc-030420-122027.
30.
LensMichael C.MonkkonenPaav.2016. “Do Strict Land Use Regulations Make Metropolitan Areas More Segregated by Income?” Journal of the American Planning Association82(1):6–21. doi:10.1080/01944363.2015.1111163.
31.
LevineJonatha.2006. Zoned out: Regulation, Markets, and Choices in Transportation and Metropolitan Land-Use. Washington, DC: Resources for the Future.
32.
ManvilleMichaelMonkkonenPaavoLensMichae.2020. “It’s Time to End Single-Family Zoning.” Journal of the American Planning Association86(1):106–12. doi:10.1080/01944363.2019.1651216.
33.
MasseyDouglas S.DentonNancy A.1993. American Apartheid: Segregation and the Making of the Underclass. Cambridge, MA: Harvard University Press.
34.
MasseyDouglas S.RughJacob S.2017. “The Intersections of Race and Class Zoning, Affordable Housing, and Segregation in U.S. Metropolitan Areas.” Pp. 245–65 in The Fight for Fair Housing: Causes, Consequences, and Future Implications of the 1968 Federal Fair Housing Act, edited by SquiresG. D.New York, NY: Taylor & Francis Group.
35.
MeltzerRachelSchwartzAle.2016. “Housing Affordability and Health: Evidence from New York City.” Housing Policy Debate26(1):80–104. doi:10.1080/10511482.2015.1020321.
36.
MleczkoMatthewDesmondMatthe.2023. “Using Natural Language Processing to Construct a National Zoning and Land Use Database.” Urban Studies63(13):2564–84. doi:10.1177/00420980231156352.
37.
MRLC (Multi-Resolution Land Characteristics Consortium). n.d. “NLDC 2019 Land Cover (CONUS).” November7, 2025. https://www.mrlc.gov/data.
38.
MuchombaFelix M.TeitlerJulienReichmanNancy E.2022. “Association between Housing Affordability and Severe Maternal Morbidity.” JAMA Network Open5(11):e2243225. doi:10.1001/jamanetworkopen.2022.43225.
PendallRol.1999. “Do Land-Use Controls Cause Sprawl?” Environment and Planning B: Planning and Design26(4):555–71. doi:10.1068/b260555.
43.
PendallRol.2000. “Local Land Use Regulation and the Chain of Exclusion.” Journal of the American Planning Association66(2):125–42. doi:10.1080/01944360008976094.
44.
PendallRolfLoLydiaWegmannJak.2022. “Shifts toward the Extremes: Zoning Change in Major U.S. Metropolitan Areas from 2003 to 2019.” Journal of the American Planning Association88(1):55–66. doi:10.1080/01944363.2021.1894970.
45.
PollackCraig EvanGriffinBeth AnnLynchJuli.2010. “Housing Affordability and Health among Homeowners and Renters.” American Journal of Preventive Medicine39(6):515–21. doi:10.1016/j.amepre.2010.08.002.
RagusettJared M.2014. “Is Urban Sprawl Good for Minorities?” Housing Policy Debate24(2):335–63. doi:10.1080/10511482.2013.835333.
48.
RagusettJared M.2016. “Black Residential Segregation in the Era of Urban Sprawl.” The Review of Black Political Economy43(3–4):253–72. doi:10.1007/s12114-015-9220-7.
49.
RossenLauren M.PollackKeshia M.2012. “Making the Connection between Zoning and Health Disparities.” Environmental Justice5(3):119–27. doi:10.1089/env.2011.0037.
50.
RothsteinRichar.2018. The Color of Law: A Forgotten History of How Our Government Segregated America. New York, NY: Norton.
51.
RothwellJonathanMasseyDouglas S.2009. “The Effect of Density Zoning on Racial Segregation in U.S. Urban Areas.” Urban Affairs Review44(6):779–806. doi:10.1177/1078087409334163.
52.
RothwellJonathan T.MasseyDouglas S.2010. “Density Zoning and Class Segregation in U.S. Metropolitan Areas.” Social Science Quarterly91(5):1123–43. doi:10.1111/j.1540-6237.2010.00724.x.
53.
SchuetzJenn.2009. “No Renters in My Suburban Backyard: Land Use Regulation and Rental Housing.” Journal of Policy Analysis and Management28(2):296–320. doi:10.1002/pam.20428.
54.
SerranoNatalicioLeiderJulienChriquiJamie F.2023. “Pedestrian-Oriented Zoning Moderates the Relationship between Racialized Economic Segregation and Active Travel to Work, United States.” Preventive Medicine177:107788. doi:10.1016/j.ypmed.2023.107788.
55.
ShertzerAllisonTwinamTateWalshRandall P.2021. “Zoning and Segregation in Urban Economic History.” Regional Science and Urban Economics94:103652. doi:10.1016/j.regsciurbeco.2021.103652.
56.
SorensenAndr.2015. “Taking Path Dependence Seriously: An Historical Institutionalist Research Agenda in Planning History.” Planning Perspectives30(1):17–38. doi:10.1080/02665433.2013.874299.
57.
SwopeCarolyn B.HernándezDian.2019. “Housing as a Determinant of Health Equity: A Conceptual Model.” Social Science & Medicine243:112571. doi:10.1016/j.socscimed.2019.112571.
58.
SwopeCarolyn B.HernándezDianaCushingLara J.2022. “The Relationship of Historical Redlining with Present-Day Neighborhood Environmental and Health Outcomes: A Scoping Review and Conceptual Model.” Journal of Urban Health99(6):959–83. doi:10.1007/s11524-022-00665-z.
WangRuoniuBalachandranSowmy.2021. “Inclusionary Housing in the United States: Dynamics of Local Policy and Outcomes in Diverse Markets.” Housing Studies38(6):1068–87. doi:10.1080/02673037.2021.1929863.
67.
WhittemoreAndrew H.2018. “The Role of Racial Bias in Exclusionary Zoning: The Case of Durham, North Carolina, 1945–2014.” Environment and Planning A: Economy and Space50(4):826–47. doi:10.1177/0308518X18755144.
68.
WhittemoreAndrew H.2021. “Exclusionary Zoning: Origins, Open Suburbs, and Contemporary Debates.” Journal of the American Planning Association87(2):167–80. doi:10.1080/01944363.2020.1828146.
69.
WilliamsDavid R.CollinsChiquit.2001. “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health.” Public Health Reports116(5):404–16. doi:10.1093/phr/116.5.404.
70.
Wolf-PowersLaur.2005. “Up-Zoning New York City’s Mixed-Use Neighborhoods: Property-Led Economic Development and the Anatomy of a Planning Dilemma.” Journal of Planning Education and Research24(4):379–93. doi:10.1177/0739456X04270125.
71.
WuTongYangShujuanLiuMeijingQiuGeLiHanqiLuoMiyangJiaPen.2021. “Urban Sprawl and Childhood Obesity.” Obesity Reviews22(S1):e13091. doi:10.1111/obr.13091.
72.
YangTse-ChuanParkKiwoongMatthewsStephen A.2020. “Racial/Ethnic Segregation and Health Disparities: Future Directions and Opportunities.” Sociology Compass14(6):e12794. doi:10.1111/soc4.12794.
73.
ZhaoZhenxiangKaestnerRober.2010. “Effects of Urban Sprawl on Obesity.” Journal of Health Economics29(6):779–87. doi:10.1016/j.jhealeco.2010.07.006.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
