A selection offactors and issues

Prepared by Patricia LarkinMarch 11, 2011

Brief Historical Perspective

Defining Place

◦ Neighbourhood

Perception of Place

◦ Delineation

Methodologies

Place effects

◦ Future directions

Explanations for spatial variations in health◦ Compositional – individualistic elements

◦ Contextual – neighbourhood elements

◦ Combination of the two?

Contextual◦ Features of local social and physical environment

Emphasis on SES – [human geography] – harder to discern?

Define by Function◦ Cutchin (geographer) – security , freedom, and

identity◦ Brower (urban studies) – shelter, housekeeping,

accommodation, connection, meaning, and recreation

◦ Macintyre (place associated needs) – clean air, water, food, education, work, social involvement and play

◦ Ramirez (ecologic public health approach) – macro-level policy and community combined with interpersonal and individual factors

Define by mechanism of effect – so that it can be measured◦ Exposures can be calculated for environmental

hazards◦ Environments that elicit stress

predispose to other disease erode social capital

◦ Environments that elicit health Contact with nature Walkability, access to good food

Define by qualities◦ Indices

Happiness index, Index of socio-economic deprivation

Psychosocial hazards scale ◦ Visible blight – graffiti and boarded up buildings◦ Planning – walkability◦ Contact with nature - opportunities

Define by boundaries◦ Which spatial scale is most relevant to health?

Move on up from chair to bioregion◦ Census tracts or neighbourhood boundaries or

shared sense of place?

 

As the neighbourhood integrates place as well as people, its conceptualization must consider characteristics of both place and people, and the interaction between them.” (Dennis et al 2009)

Unit that helps define impacts of place on health Depends on point of view; refers to an aspect of the

territory’s reality. Consider:◦ humanistic approach emphasizes social bonds in a physical setting –

use word ‘community’◦ instrumental approach sees the neighbourhood as a functional

system used for planning purposes – use word ‘district’◦ phenomenological approach considers bonds between places and

people created by time and events; produces a specific dynamic that influences organization and architectural typologies

People from lower SES have particular view of their place – more likely to see it as it is

Environmental problems – ◦ more directly discerned – (metaphor of pulmonary and

digestive functions) SES - mediating variables

◦ operate through process of stress and involve both psychosocial and physiological pathways (i.e. self-esteem, self-efficacy, neuroendocrine and immune system functions)

From this perspective, mixture of perceived problems in the neighbourhood (noise, dense traffic, drug use and crime) considered chronic stressors heightening the level of anxiety, insecurity (From Pompalon et al 2007)

1995 publicationThose with high school education level generally have higher rate of responses as “high” risk compared with college education level

Public Perception of Population Health Risksin Canada: Health Hazards and Sources of InformationDaniel Krewski et al 2006

Human and Ecological Risk Assessment, 12: 626–644, 2006

From 2002 studyThe % difference in perception of ‘high’ health risks between high school and college educated respondents

Life course and sense of identity – an aside Seniors

◦ Mechanism of effect, qualities◦ Instrumental approach to neighbourhood

First Nations and Inuit◦ Physical environment and culture intertwined

Special case: Extreme events will change people’s views of place, with subsequent negative effects on health

Neighbourhoods can be seen as overlapping areas in relation to one's needs, the whole being centered on the residence◦ Home area - belonging and family

psycho-social purposes strongest within a 5–10 minute walk around someone's residence

◦ Locality - wider area residential activities are still highly predictable, familiar visited frequently

◦ Urban district - even larger landscape social and economic opportunities might vary considerably from one

individual to another

Rural/Urban – scale very different◦ Cross municipal boundaries

Regardless of format, community mapping efforts help ◦ track economic, social and health trends, ◦ document change over space and time and ◦ visualize spatial phenomena such as variable

distributions and densities (from Dennis et al 2009)

Example from Lebel et al 2007 – 3 determinations of neighbourhood; 2 urban, 1 rural

Historical - Map boundaries weighted according to◦ length of utilization◦ decade of use◦ relevance of a limit according to the research theme (social and health

inequalities) and ◦ collected information's accuracy

SES - StatsCan - Deprivation analysis according to dissemination area ◦ Material = education, employment and income◦ Social = single parenting, marital status, and living alone◦ Availability by DA

Perception - Key community players only

Perception perspective

Historical perspective

Problems with data◦ Some data available at a small area level and capable

of being aggregated to many spatial scales – e.g., shops, schools

◦ Other data at much larger scale – e.g., investment in secondary education, or in municipal functions such as street lighting, street cleaning, garbage disposal, and water or sewage treatment

◦ Many other examples of data to be analysed … Rural measures – different considerations?

◦ adequate provision of public transport giving access within a reasonable time to a grocery store or primary school?

◦ peripatetic services visiting communities to supply food, post, or library or dentistry services?

Multilevel regression analysis◦ Statistical modelling

GIS

Qualitative◦ Transcribed interviews◦ Focus groups

Participatory Photo Mapping – see Dennis et al, 2009

People from more deprived areas◦ more readily discuss the adverse effects on health and

wellbeing of structural and contextual features◦ more readily accept statistics on area inequalities in

health than those based in more affluent areas Those with least experience of deprivation or

hardship◦ more likely to draw on behavioural (individualistic)

explanations of area inequalities (from Davidson, 2008)

Study at more than one level of aggregation simultaneously ◦ more informative about the source of variations related

to different geographies◦ neighbourhoods and localities are relevant for perception

of problems ◦ mainly localities matter for social cohesion

Rural areas deserve more attention since their characteristics differ from those of urban areas, particularly in terms of social cohesion◦ Although rural areas are experiencing an important

economic decline and a massive population exodus, they are characterized by strong social ties among residents.

Davidson R, Mitchell R, Hunt K. Location, location, location: The role of experience of disadvantage in lay perceptions of area inequalities in health” Health and Place 2008; 14 (2): 167-181

Day R. Local environments and older people's health: Dimensions from a comparative qualitative study in Scotland. Health and Place 2008 (June); 14 (2): 299-312

Dennis SF, Gaulocher S, Carpiano RM, Brown D. Participatory photomapping (PPM): Exploring an integrated method for health and place research with young people. Health & Place 2009;15: 466–473

Frumkin, H. The measure of place. Am J Prev Med 2006;31(6)

Krewski D, et al. Public perception of population health risks in Canada: health hazards and sources of information. Human and Ecological Risk Assessment 2006; 12: 626–644

Lebel A. A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region. International Journal of Health Geographics 2007; 6(27)

Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalize and measure them? Social Science & Medicine 2002; 55: 125-139

Pampalon R et al. Perception of place and health: Differences between neighbourhoods in the Quebec City region. Social Science & Medicine 2007; 65:95–111

Richmond CAM, Ross NA. The determinants of First Nation and Inuit health: A critical population health approach. Health & Place 2009; 15: 403–411

Siegrist J. Place, social exchange and health: proposed sociological framework. Social Science & Medicine 2000; 51: 1283-1293

Tapsell, SM. "I wish I'd never heard of Banbury": The relationship between 'place' and the health impacts from flooding. Health and Place 2008;14(2): 133

Taylor S, Repetti RL. What is an unhealthy environment and how does it get under the skin? Annual Review of Psychology 1997; 48

Williams GH. The determinants of health: structure, context and agency. Sociology of Health & Illness. 2003; 25: 131-154.