Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities

Abstract

BackgroundUrban regeneration policies are area-based interventions addressing multidimensional problems. In this study, we analyse the impact of urban regeneration processes on the evolution of inequalities in mortality from certain causes. On the basis of Fundamental Cause Theory (FCT), our main hypothesis is that the impact of urban regeneration programmes will be more clearly observed on the causes of preventable deaths, as these programmes imply a direct or indirect improvement to a whole range of ‘flexible resources’ that residents in relevant areas have access to, and which ultimately may influence the inverse relationship between socioeconomic status and health.MethodsUsing a quasi-experimental design and data from Longitudinal Statistics on Survival and Longevity of Andalusia (Spain), we analyse differences in the evolution of standard mortality ratios for preventable and less-preventable causes of premature death. This encompasses 59 neighbourhoods in 37 municipalities where urban regeneration projects were implemented in the last decade within the framework of three different programmes and in 59 counterparts where these policies were not implemented.ResultsAs expected in line with FCT, there are no significant patterns in the evolution of internal differences in terms of less-preventable mortality. However, excessive preventable mortality strongly decreases in the neighbourhoods with intervention programmes, specifically in those where two or more projects were in force. This is even more apparent for women.ConclusionsThe urban regeneration policies studied seem to contribute to reducing health inequity when the interventions are more integral in nature.

Do multiple community-based interventions on health promotion tackle health inequalities?

“…Of these, 14 were set in Europe [ 16 – 29 ], five in North America [ 30 – 34 ], three in Australia/Oceania [ 35 – 37 ], and one study took place in a country in Central America [ 38 ] (see Table 2 ). The studies used various designs, including RCTs ( n = 1) [ 38 ], cluster randomized trials ( n = 3) [ 25 , 30 , 34 ], quasi-experimental designs ( n = 11) [ 16 , 18 , 22 , 23 , 27 – 29 , 33 , 35 – 37 ], pre-post-tests without control group ( n = 3) [ 17 , 19 , 31 ], and secondary analyses ( n = 5) [ 20 , 21 , 23 , 26 , 32 ]. The sample sizes at baseline varied from 200 to nearly 250,000 in 60 intervention areas, with study populations having a variety of socio-demographic and socio-economic backgrounds.…”

“…partnership agreements, steering committees, school co-ordinator models) 4) Environmental change (e.g. healthy eating in schools, physical activity opportunities) Anthropometry; health-related behaviors; quality of life Few reduced inequalities (area level) Buscail et al, 2016 [ 17 ] Pre-post-test (no control group), France (n of adults in a low-income neighborhood: 199 and 217) 2 1) Social marketing (flyers and informative brochures on physical activity) 3) Networking/partnership (questioning residents on barriers) 4) Environmental change (offering and access to physical activity at community centers; pedestrian orientation paths) Physical activity behavior (WHO guidelines) Reduced inequalities (area level) Cummins et al, 2005 [ 18 ] Quasi-experimental, UK (n of men and women in a deprived community: 493 aged 16+; comparison group: 310) 3 1) Social marketing (advertisement) 4) Environmental change (provision of a new food supermarket) Fruit and vegetable consumption; self-reported health; psychological health No difference (area level) Egan et al, 2016 [ 19 ] Pre-post-test (no control group), UK (n of 14 differentially disadvantaged neighborhoods: 1006) 2 2) Individual or group education (anti-social behavior services/initiatives) 3) Networking/partnership (stakeholders’ consultation including residents) 4) Environmental change (complex housing improvements, demolition and new build) Self-reported mental and physical health Reduced inequalities by subgroups (lower income and higher investment groups respectively) Gans et al, 2018 [ 29 ] Cluster randomized controlled trial, USA (n in 8 intervention sites with low income: 837; 7 control sites: 760) 1 1) Social marketing (motivational campaigns, cooking demonstrations/taste-testing events) 2) Individual or group education (multi-component nutrition education) 4) Environmental change (discount prices, mobile fresh F&V markets) F&V intake Reduced inequalities (area level) Gautam et al, 2014 [ 34 ] Quasi-experimental, New Zealand (n in low-income area: 345; control area: 631) 3 1) Social marketing (biannual information campaign to retailers, wallet card, DVD) 5) Regulatory interventions (controlled purchase operations) 6) Sense of community (social artwork) Parental and retail supply of tobacco to minors No difference (area level) Goodman et al, 2013 [ 20 ...…”

“…Only one of the programs contained elements of all six strategies [ 16 ]. Six programs comprised five strategies [ 22 , 23 , 25 – 27 , 32 ], five consisted of four [ 21 , 23 , 25 , 28 , 37 ], six of three [ 17 , 19 , 29 , 33 , 34 , 36 ] and five of two strategies [ 18 , 20 , 28 , 30 , 36 ].…”

Urban regeneration policies and mental health in a context of economic crisis in Andalusia (Spain)

“…), and others focusing on place, which aim to improve 'collective resources' (infrastructure, services, equipment, transport, citizen participation, etc.). A previous study has also documented a larger reduction of inequality in preventable mortality in those target areas where interventions on individuals and places were combined, given as result more comprehensive intervention processes (Zapata Moya and Navarro Yáñez 2017). In this line, Interventions focused on collective resources linked to places could be interpreted like 'interventions which minimize the importance of individual resources' for health (Phelan et al, 2014), and accordingly would facilitate the distribution of health benefits for residents in target areas.…”

Making the Case for “Whole System” Approaches: Integrating Public Health and Housing

“…While the evidence is mixed, this raises again the essential need for community participation to create more socially cohesive environments [ 168 ]. Importantly, delivering home improvements alongside neighbourhood regeneration with community engagement (with increased access to nature spaces and age friendly environments) has been found to improve community resilience and health outcomes [ 4 , 136 , 169 ].…”