Neighbourhood deprivation and health: does it affect us all equally?

Abstract

Evidence is accumulating that the place where a person lives may influence their health, even after accounting for individual risk factors, 1-10 although some studies have found no independent effects of area on health once individual factors have been controlled for. [11][12][13] On the whole, the literature points to relatively small effects of area characteristics in comparison with the larger effects of individual socioeconomic position, 10 although most findings are based on secondary analysis of existing datasets so may not have identified and measured important area level determinants of health. Some studies have used ecological analyses relating average health in an area to some characteristic of that area, such as neighbourhood socioeconomic status (SES). [14][15][16] It is argued that a relationship between neighbourhood status and health in these studies cannot be taken to mean that living in a deprived neighbourhood is bad for one's health -the influence of an individual's SES on health may be driving this association. Individual-level data on health and SES and neighbourhood level data on deprivation must be analysed simultaneously to determine whether living in a deprived neighbourhood increases the risk of poor health over and above the effect of individual risk factors. Another possibility is that the health effects of living in a deprived neighbourhood are different for rich and poor individuals. Poorer people tend to live in poorer places and an individual's decisions and options are played out in various settings, including the residential setting. The SES of a neighbourhood may affect rich and poor individuals' decisions and options, and ultimately their health, differentially. We are now dealing with the interaction between person and place in determining health.Socioeconomic factors at the individual and area level may act together to influence health in two ways. In a 'collective resources model', people in non-deprived areas have better health than people in deprived areas because there are more collective resources (including material and social resources, such as services, job opportunities, and social supports). The ability of wealthier, more powerful individuals to attract high © International Epidemiological Association 2003 Printed in Great Britain International Journal of Epidemiology 200332:357-366 DOI: 10.1093/ije/dyg084 Neighbourhood deprivation and health: does it affect us all equally?Mai Stafford and Michael Marmot Accepted November 2002Background Neighbourhood socioeconomic status (SES) may affect rich and poor residents differentially. Two models are proposed. Model 1: living in a non-deprived neighbourhood is better for health because better collective material and social resources are available. Model 2: being poor (rich) relative to the neighbourhood average is associated with worse (better) health because of the discrepancy between an individual's situation and those around them.

Individual, Housing, and Neighborhood Correlates of Asthma among Young Urban Children

“…27 However, data linking neighborhood education level with asthma is sparse. The protective influence of increased education level in a child's neighborhood may represent an important construct for increased access to collective resources and capital, 28 medical care, or healthy behaviors, reduced stress, or decreased allergens. For example, a greater proportion of individuals with higher education may indicate greater social capital and therefore the potential to improve neighborhood conditions and reduce neighborhood disorder 29 -which may in turn reduce an individual's negative psychophysiological response to the larger neighborhood environment.…”

Neighborhood disadvantage, individual‐level socioeconomic position, and self‐reported chronic arthritis: A cross‐sectional multilevel study

“…Preventive health care and increased participation in medical checkups may also be a characteristic of a neighborhood with greater social capital, thereby enabling residents to identify potential health problems prior to onset. Social capital has the potential to reduce individuals' focus on disease and illness, potentially explaining why individuals from disadvantaged neighborhoods are more likely to self-rate their general health as poor, compared to their counterparts residing in less disadvantaged areas (25). Neighborhoods of greater social capital share "norms" that influence preventive health behaviors such as physical activity and lower caloric intake, both of which are key predictors of body habitus and obesity.…”

Neighbourhood socioeconomic indicators and depressive symptoms in the Czech Republic: a population based study

“…The interaction between individual and neighbourhood-level socioeconomic factors were assessed by Yen and Kaplan 21 but no interaction effects were found. Stafford, in the analysis of mental health in Whitehall II participants, 18 reported non-significant interaction between neighbourhood deprivation and individual occupational class. As shown above, virtually all of the existing research on social and economic factors and depression came from Western Europe and Northern America.…”

“…Nevertheless, over the recent decades there have been several multilevel studies on this topic. 8,[14][15][16] Most of these studies have shown an association between neighbourhood SES and depression or depressive symptoms [14][15][16][17][18] , although some studies found no association after adjusting for individual-level socioeconomic factors 19,20 . Two longitudinal studies 21,22 reported that the SES of neighbourhood was associated with incidence of depression independent from individual socioeconomic status and other individual risk factors.…”