Chapter 14-Neighborhoods, Housing, and Health.doc

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Family Relations and Human Development
FRHD 3090
Michelle Preyde

Chapter 14 - Neighborhoods, Housing, and Health NEIGHBORHOOD ENVIRONMENT AND RESIDENTS HEALTH • Mortality and disease rates vary across neighborhoods in the UK and other developed countries • It is clear that health in certain areas is worse than in other areas • Its also less clear whether differences can be explained by the association between individual risk factors and health combined with the clustering of people with similar risk profiles into the same areas (a compositional effect) or if they are due to additional effects of area of residence over individual risk factors (contextual effect) • Some studies have been designed to study the association b/w neighborhood environment and health o Ecological studies that relate population characteristics to population health o Individual quantitative or in-depth studies that relate perceptions of the local environment to health o Multilevel studies that combine neighborhood level data with individual health; allows the investigation of health of people living not just in the same type of area, sharing the same physical space, the same transport, retail and health services, and the same neighbors o This chapter focuses ore on evidence from multilevel studies • A challenge when studying neighborhoods is deciding how the neighborhood should be operationalized administrative boundaries like census wards • Economic, social relational, service, and physical aspects of the neighborhood may be important for health Neighborhood Economic Characteristics and Health • Economic factors such concentrated deprivation, de-industrialization and unemployment rate have received the most attention in empirical literature • Studies have shown associations be/w residence in a multiply deprived area and infant and child health, health related behaviors, perceived general and mental health, coronary heart disease, violence and murder, and all cause mortality • Most studies found the associated graded, and that with steadily increasing deprivation being associated with incremental increases in the risk of morbidity and mortality Neighborhood Social Environment and Health • Social-relational factors like social capital, social cohesion, and social control • There has been much debate over the definition and measurement of these constructs • Putnam’s approach: social capital can be defined as “features of social organization, like networks, norms and trust, that facilitate action and cooperation for mutual benefit” • Social interactions between people resident in a given neighborhood may produce externalities that have the potential to influence the health and well being of people who don’t take part in those social interactions but who live in the same locality • At a neighborhood level this has been operationalized in many ways, for example the proportion of residents who report that they trust others • Typical design: ask one set of respondents about their perceptions of there social environment, aggregate these responses up to neighborhood level, and link aggregate scores to a different database that includes data on individual health • The neighborhood social environment may be observed directly • This approach first taken in the Public Health and development in Chicago’s Neighborhood Study where public incivilities were recorded by trained observers • Found an inverse relationship between civic participation and mortality • Mohan and Colleges created estimates of various neighborhood level indicators of altruistic activities and informal sociability and how they are related to mortality. They found that volunteering and social activity showed significant associations with mortality over and above individual age, sex, and socioeconomic characteristics • British Household Panel Survey showed that perceived individual attachment to neighborhood does not predict subsequent onset of common mental illness.... longitudinal studies show that the effect is fairly immediate and does not have a long lag time • US general social survey has not been used for neighborhood level research Neighborhood Amenities and health • The service environment covers publicly and privately provided facilities and amenities, like health services, transport, retail outlets etc • There aren’t many multilevel studies on this • Cummins and colleagues (2005) collected info on transport, health, retail and financial services form a wide range of routine and non routine sources like central government departments, local authorities, voluntary and public sector agencies, and commercial and industrial organizations • They found a positive association b/w perceived health and health service provision and access to financial services was found for women and a positive association b/w perceived health and access to large food stores was found for men o A scale measuring ease of access to four different services was created using Health Survey for England 2000 participants’ self reports o Responses were aggregated up to neighborhood level: they found that ease of access was not associated with perceived general or mental health, smoking, or obesity over and above individual socio economic factors o But a social class gradient in ease of access was found, so its possible that access to services mediates some of the social inequality in other health outcomes • Almaeda County Study - authors speculate that neighborhood problems might curtail the level of activity outside the home, thereby increasing the risk of functional decline • General Household Survey 2000 - men who perceived their area to have poor local facilities were more likely to rate their health as less good compared to men who perceived their area to have better facilities. So association found for women • It is apparent that simple summation of the number of services and amenities, which are located in the area, does not capture the everyday experiences of residents and their contact with these facilities. Quality of these facilities is likely to be just as important and if access to them is easy it may not matter that they are not located within one’s immediate neighborhood Neighborhood Physical Environment and Health • In developed countries, physical aspects of the neighborhood that may be salient for health include pollution levels, presence of industrial and waste disposal sites, degree of urbanization, green spaces, and other aspects of urban design • Many physical aspects like climate and water hardness vary over relatively large areas and are not relevant for neighborhood studies • Multilevel studies suggest that a run down built environment is associated with poorer perceived general health • Housing stock characteristics by predominately deck access and predominantly recent construction are associated with poor mental health over and above individual factors • Presence of attractive walkable spaces has been shown to predict survival amongst older people and physical activity in general adult population • Physical environmental factors, personal attitudes, and peer support appear to be equally important in encouraging walking Co-Varying Pathogenic Features of the Neighborhood • Economic, social relational, service and physical features of the neighborhood are likely to co-vary • More economically deprived areas are likely to have different physical and social relational characteristics from more affluent areas • Neighborhood deprivation shows a large inverse correlation with social cohesion • Physical aspects of the built environment are associated with neighboring and other aspects of social interaction • Some of these environmental characteristics may only be associated with health in the presence of other risk factors • The study of neighborhood environment and health is further complicated by the possibility that certain sections of the population will be more exposed to or be more vulnerable to local features than others • They are likely to be statistical interactions between individual characteristics, features of the neighborhood environment and health • Associations b/w neighborhood environment, and health may vary by sex, social position, employment status and race INTERVENTION STUDIES • Intervention studies of the link between neighborhood and health address the problem of selection bias in neighborhood research • Moving to Opportunity (MTO) program started in five US cities in 1994. Eligible participants were randomly assigned to one of three groups o An experimental group receiving housing subsidies to move into low poverty areas plus assistance in finding suitable accommodation o A group receiving housing subsidies which were not limited geographically o A control group • Baseline: health status was not included in the survey of participant, so the MTO program has not yet been able to look at change
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