Improving health in deprived communities: What can residents teach us?

The purpose of this paper is to illustrate how residents of disadvantaged communities believe where they live influences their health. The authors describe focus group work they have undertaken with older and younger adults resident in three neighbourhoods in the West Midlands region of England, which are participating in the New Deal for Communities initiative. Drawing on the narratives of residents, examples are given of specific ‘pathways’ they described linking place to health experiences. Resident discussions highlight a number of key points. First, health was conceived in physical and non-physical terms: participants spoke of health not only in terms of physical disease or illness, but also as ‘being happy’, ‘having confidence’, ‘contentment’ and ‘peace of mind’. Second, place was seen by residents to impact on health through three core levers—physical structures (for example housing quality, visual amenity), social structures (for example, friendliness of neighbours, community norms) and service provision (for example, public transport, local police). Although the influence of each lever was described separately in certain instances, their interplay with health was often complex and intertwined. Third, although groups were not prompted to compare themselves with others, discussions frequently included comparison with other areas, and also consideration of what ‘others’ must think of them. Finally, it was noted that ‘fear’ was a common node in many of the pathways that residents described linking aspects of place with their health.