Individual social capital, neighbourhood deprivation, and self-rated health in England

Individual social capital is increasingly considered to be an important determinant of an individual's health. This study examines the extent to which individual social capital is associated with self-rated health and the extent to which individual social capital mediates t.he relationship between neighbourhood deprivation and self-rated health in an English sample. Individual social capital was conceptualized and operationalized in both the social cohesion- and network resource tradition, using measures of generalized trust, social participation and social network resources. Network resources were measured with the position generator. Multilevel analyses were applied to wave 2 and 3 of the Taking Part Surveys of England, which consist of face-to-face interviews among the adult population in England (N(i) = 25,366 respondents, N(j) = 12,388 neighbourhoods). The results indicate that generalized trust, participation with friends and relatives and having network members from the salariat class are positively associated with self-rated health. Having network members from the working class is, however, negatively related to self-rated health. Moreover, these social capital elements are partly mediating the negative relationship between neighbourhood deprivation and self-rated health.     

Neighbourhood inequality, neighbourhood affluence and population health

While there is now considerable evidence that the neighbourhood income levels (poverty/affluence) exert an independent effect on health, there is little evidence that neighbourhood income inequality is consequential, net of individual-level socio-economic resources. We show that the usual explanation for the absence of an independent effect of neighbourhood inequality--the assumption of economic homogeneity at the neighbourhood level--cannot account for this result. The authors use hierarchical models that combine individual micro-data from Statistics Canada's 1996/97 National Population Health Survey (NPHS) with neighbourhood and city-level socio-economic characteristics from the 1996 Census of Canada to estimate the effects of neighbourhood affluence and income inequality on self-reported health status. The findings indicate that the negative "ecological" correlation between average neighbourhood health and neighbourhood income inequality is the result not only of compositional differences among individuals but also of contextual neighbourhood effects associated with low and high inequality neighbourhoods.     

Lay perceptions of neighbourhood health

While research has focused on objective indicators of community health, less attention has been paid to subjective indicators. Lay perceptions of neighbourhood health are explored in the present research through the analysis of survey data from 918 middle‐aged individuals in Victoria, Canada. Socio‐demographic variables, including neighbourhood socio‐economic status (SES), were included in a binary logistic regression model, along with health status and perceptions of the neighbourhood context. Additional logistic regression analyses were also performed to assess predictors of neighbourhood perceptions. Overall, individuals had no difficulty rating neighbourhood health: 77% rated it as very/somewhat healthy; and 23% as very/somewhat unhealthy. Individual measures of SES were not associated with neighbourhood health ratings, but the odds of rating a neighbourhood as healthy were three times higher among those who lived in high‐income areas compared with those who did not. Additional salient factors in perceived neighbourhood health are perceptions of personal safety, and to a lesser extent, sense of belonging and not identifying groups of ‘undesirable’ people in the area.     

Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors

OBJECTIVE: To explore the association between physical neighbourhood stressors and smoking, and the contribution of these stressors to neighbourhood and individual socioeconomic inequalities in smoking. METHODS: Data were analysed of participants of the baseline measurement of the Dutch GLOBE study (1991), aged 20 years and older, who lived in 79 neighbourhoods of the city of Eindhoven (n = 9062). The neighbourhood socioeconomic environment was assessed from aggregated self reported information of participants' education and occupation level, and employment status. Neighbourhood stressors included were the physical quality (decay), required police attention, noise pollution from traffic, and population density in neighbourhoods. Current smokers were distinguished from previous and never smokers. RESULTS: Compared with those living in the most advantaged neighbourhoods, residents living in the socioeconomically most disadvantaged neighbourhoods were more likely to smoke (adjusted for age, sex, education, occupation, and employment status) (OR = 1.24, 95% CI 1.05 to 1.46). An increase in a summary neighbourhood stressor score was associated with smoking, independently of the neighbourhood socioeconomic environment (OR = 1.57, 95% CI 1.11 to 2.21, in the neighbourhoods with the highest stress score). Adjustment for the score substantially reduced the odds ratio for living in the socioeconomic most disadvantaged neighbourhoods (OR = 1.03, 95% CI 0.84 to 1.28, for those in the most disadvantaged neighbourhoods). Neighbourhood stressors contributed 10% to the increased probability of smoking in the lowest educated persons. CONCLUSIONS: Physical neighbourhood stressors are related to smoking and contribute substantially to neighbourhood inequalities in smoking over and above individual level characteristics.     

Do perceptions of neighbourhood problems contribute to maternal health?: Findings from the Pacific Islands Families study

Research suggests that physical and social aspects of the neighbourhood have a bearing on our well-being. As part of the Pacific Islands Families Study, this study examined maternal perceptions and socio-demographic determinants of neighbourhood problems and their association with mental health. The main problems reported centred on noise, pollution and safety matters. Ethnicity, deprivation and alcohol consumption were the best predictors of greater perceived neighbourhood problems. Adjusted analyses showed that those reporting greater neighbourhood problems were almost twice as likely as those reporting fewer problems to have psychological morbidity. Mothers with high deprivation scores were 7.3 times more likely to have psychological morbidity. Findings suggest that neighbourhood quality and socio-economic position are important contributors to mental health. Negative effects on health are likely to derive from exposure to pollutants and from problem features in the neighbourhood acting as sources of psychosocial stress and barriers to health promoting activities. Improvements to services and regulations may contribute to health gains.     

Relative deprivation in income and self-rated health in the United States

Absolute income is robustly associated with health status. Few studies have, however, examined if relative income is independently associated with health. We examined if, over and above the effects of absolute income, individual relative deprivation in income as well as position in the income hierarchy is associated with individual poor health in the U.S. Using three rounds of the Current Population Surveys (CPS), we analyzed the association between self-rated health (1 = fair/poor, 0 = otherwise) and the Yitzhaki index of relative deprivation in income and percentile position in the income hierarchy across 17 reference groups. Over and above the effects of absolute income, the odds ratio for reporting poor health among individuals in the highest quintile of relative deprivation compared to the lowest quintile ranged between 2.18 and 3.30, depending on the reference groups used. A 10 percentile increase in income position within reference groups was associated with an odds ratio of poor health of 0.89. Relative deprivation appeared to explain between 33 and 94% of the association between individual income and self-rated health. Relative deprivation in income is independently associated with poor health over and above the well established effects of absolute income on health. Relative deprivation may partly explain the association between income inequality and worse population health status.     

Meeting health need, accessing health care: the role of neighbourhood

Much of what we know about the determinants of access to health care comes from studies undertaken at a large scale, such as between cities, regions/counties/provinces/states and countries. This paper examines local level variations in access to and utilization of health care services across four distinct neighbourhoods in Hamilton, Ontario, Canada. Survey data (n = 1500) were analysed using logistic regression to explore the potential relationships between neighbourhood and health care utilization and unmet health care need. Results show some relationships between neighbourhood of residence and levels of reported utilization as well as unmet need, even when controlling for predisposing, enabling, and need factors (i.e. Age, gender, household composition, income, education, perceived gp visit time) as well as health status. Findings from this empirical study suggest a finer lens is required to examine the mechanisms through which place impacts access to and utilization of care, one that recognizes the roles of compositional, contextual and collective aspects of neighbourhood.     

Neighbourhood quality and self-rated health: a survey of eight suburban neighbourhoods in the Vancouver Census Metropolitan Area

We investigated the relationship between perceptions of neighbourhood quality and self-rated health for residents of eight suburban neighbourhoods with modestly contrasting income profiles in the Vancouver Census Metropolitan Area. Survey respondents from lower income neighbourhoods more often rated their health as fair/poor, and perceived their neighbourhood to be of poor quality. The strongest predictors for fair/poor health status were employment status, body mass index, neighbourhood satisfaction, and age, while modest predictors were annual household income, neighbourhood median income profile, and perceptions of neighbourhood safety. The unique contribution of this study is its demonstration that social gradients in self-rated health are observable between neighbourhoods of even modestly contrasting income profiles.     

The association of neighbourhood psychosocial stressors and self-rated health in Amsterdam, The Netherlands

OBJECTIVE: To investigate associations between neighbourhood-level psychosocial stressors (i.e. experience of crime, nuisance from neighbours, drug misuse, youngsters frequently hanging around, rubbish on the streets, feeling unsafe and dissatisfaction with the quality of green space) and self-rated health in Amsterdam, the Netherlands. PARTICIPANTS: A random sample of 2914 subjects aged > or = 18 years from 75 neighbourhoods in the city of Amsterdam, the Netherlands. DESIGN: Individual data from the Social State of Amsterdam Survey 2004 were linked to data on neighbourhood-level attributes from the Amsterdam Living and Security Survey 2003. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance. RESULTS: Fair to poor self-rated health was significantly associated with neighbourhood-level psychosocial stressors: nuisance from neighbours, drug misuse, youngsters frequently hanging around, rubbish on the streets, feeling unsafe and dissatisfaction with green space. In addition, when all the neighbourhood-level psychosocial stressors were combined, individuals from neighbourhoods with a high score of psychosocial stressors were more likely than those from neighbourhoods with a low score to report fair to poor health. These associations remained after adjustments for individual-level factors (i.e. age, sex, educational level, income and ethnicity). The neighbourhood-level variance showed significant differences in self-rated health between neighbourhoods independent of individual-level demographic and socioeconomic factors. CONCLUSION: Our findings show that neighbourhood-level psychosocial stressors are associated with self-rated health. Strategies that target these factors might prove a promising way to improve public health.     

Neighbourhood characteristics,social capital and self-rated health - A population-based survey in Sweden

Background

In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health.

Methods

We used data from the survey 'Life &; Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model.

Results

The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer.

Conclusions

The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital - all important determinants of health.

     

Linking perceptions of neighbourhood to health in Hamilton, Canada

STUDY OBJECTIVE: To investigate the association between perceptions of neighbourhood physical and social characteristics and three health outcomes (self assessed health status, chronic conditions, and emotional distress). DESIGN: Cross sectional survey data analysed in small neighbourhoods. SETTING: Hamilton, Ontario, Canada, a medium sized industrial city, located at the western end of Lake Ontario (population at the time of the study about 380 000). PARTICIPANTS: Random sample of 1504 adults aged 18 years and older residing in four contrasting neighbourhoods. MAIN RESULTS: Significant differences across the four neighbourhoods are apparent in self assessed health status and emotional distress, but not in chronic conditions. Neighbourhoods with lower SES reported poorer health and more emotional distress. Perceptions of the physical environment dominated social concerns in all neighbourhoods. For all three health outcomes, individual risk factors followed expectations, with measures of poverty, age, and lifestyle all significantly associated with poor health outcomes. Physical environmental problems were positively and significantly associated with poor physical and emotional health. Specifically, people reporting they dislike aspects of their neighbourhood's physical environment are 1.5 times more likely to report chronic health conditions (OR 1.56, 95% CI 1.19 to 2.05), while those reporting physical likes with their neighbourhood are less likely to report fair/poor health (OR 0.50, 95% CI 0.28 to 0.90) or emotional distress (OR 0.45, 95% CI 0.26 to 0.80). CONCLUSIONS: These results demonstrate the importance of neighbourhood perceptions as a determinant of health, as well as conventional factors such as low income, lifestyle, and age. The dominance of physical environmental concerns may have arisen from the industrial nature of Hamilton, but this result merits further investigation.     

An investigation of the longitudinal relationship between neighbourhood income inequality and individual self-rated health in England

There are mixed findings on whether neighbourhood income inequality leads to better self-rated health (SRH) or not. This study considers two hypotheses: individuals living in more unequal neighbourhoods have better SRH and the level of neighbourhood income inequality and its impact on SRH is moderated by household and neighbourhood level income related variables. Data from Waves 8–10 of the UK Household Longitudinal Study for respondents living in England at wave 8 were used. Neighbourhood income inequality was measured using Gini coefficients of household income from the Pay As You Earn and benefits systems for Lower Super Output Areas. Longitudinal ordinal multilevel models predicted self-rated health in 2016–18, 2017–19 and 2019-20 by income inequality and its interaction with household income, neighbourhood median income and neighbourhood deprivation, conditional on individual educational attainment, age, sex, ethnic group, years lived in current residence, region of residence and study wave. There were 24,889 respondents analysed over three waves. SRH was worse for those living in more income equal neighbourhoods. There was no indication that neighbourhood inequality was moderated by household income, neighbourhood median income or neighbourhood deprivation. These findings are in line with the balance of existing evidence and support policy interventions that aim to create mixed communities for the purpose of improving population health.     

Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands

We investigated the association between the neighbourhood socioeconomic environment and physical inactivity, and explored the contribution of neighbourhood characteristics to this association. Data were analysed of 20-69 years old participants of the Dutch GLOBE study who lived in 78 neighbourhoods of Eindhoven (n = 8.767). The neighbourhood socioeconomic environment was assessed from aggregated self-reported information of participants' education and occupation level, and employment status. Aspects of physical inactivity investigated were based on the time spent on (a) walking and cycling to shops or work, (b) walking, cycling and gardening in leisure time, and (c) participation in sports activities. Characteristics of neighbourhoods included the proximity to food shops, general physical design of neighbourhoods, quality of green facilities, noise pollution from traffic and required police attention as evaluated by municipal services (professionals) responsible for these characteristics. Compared to those living in the most advantaged neighbourhoods, residents living in the quartile of socio-economically most disadvantaged neighbourhoods were more likely to walk or cycle to shops or work, but less likely to walk, cycle or garden in leisure time and less likely to participate in sports activities (adjusted for age, sex and individual educational level). Neighbourhood inequalities in walking or cycling to shops or work were not mediated by specific neighbourhood characteristics included in our analyses. The increased probability of almost never walking, cycling and gardening in leisure time in the most disadvantaged neighbourhoods was partly mediated by a poorer general physical design in these neighbourhoods. Similarly, the increased probability of almost never participating in sports activities in the most disadvantaged neighbourhoods was partly mediated by larger amounts of required police attention. The direction of neighbourhood inequalities differs for aspects of physical inactivity. Neighbourhood characteristics are related to physical inactivity and contribute to neighbourhood socioeconomic inequalities in physical inactivity.     

A multilevel analysis of the effects of neighbourhood income inequality on individual self-rated health in Hong Kong

We examined the effect on self-rated health of neighbourhood-level income inequality in Hong Kong, which has a high and growing Gini coefficient. Data were derived from two population household surveys in 2002 and 2005 of 25,623 and 24,610 non-institutional residents aged 15 or over. We estimated neighbourhood-level Gini coefficients in each of 287 Government Planning Department Tertiary Planning Units. We used multilevel regression analysis to assess the association of neighbourhood income inequality with individual self-perceived health status. After adjustment for both individual- and household-level predictors, there was no association between neighbourhood income inequality, median household income or household-level income and self-rated health. We tested for but did not find any statistical interaction between these three income-related exposures. These findings suggest that neighbourhood income inequality is not an important predictor of individual health status in Hong Kong.     

The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study

Background  

There is increasing evidence that individual health is at least partly determined by neighbourhood and regional factors. Mechanisms, however, remain poorly understood, and evidence from Germany is scant. This study explores whether regional as well as neighbourhood deprivation are associated with physical health and to what extent this association can be explained by specific neighbourhood exposures.