Do area-based interventions to reduce health inequalities work? A systematic review of evidence

Reducing health inequalities by focusing health promotion efforts on specific areas rather than individuals is based on the premise that changing something about a place may improve health outcomes for people living in that place. This paper examines the evidence base regarding the efficacy of area-based interventions by reviewing evaluations of interventions aimed at reducing inequities between groups and which are based on changing a specific place. Only 24 papers met our review criteria. The overall success of area-based interventions was difficult to gauge due to the use of multiple strategies, inadequate evaluation reports, variation in the size or type of area, insufficient funding for implementation, policy changes over the course of the program and lack of long-term evaluations. However, the value of changing a place, area or location in some way was demonstrated in several studies which were adequately funded and evaluated. Thus, there is some evidence that area-based interventions reduce inequities, but more well-designed and well-timed evaluations of outcomes are necessary to draw any firmer conclusions. Explicit attention must also be given to geographical concepts associated with an area-based approach, such as area, scale, location and locality, neighbourhood, community and place.