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Transcript of Healthy places and healthy people - gcph.co.uk · • Health is worse in deprived areas compared to...
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Healthy places and
healthy people
Anne Ellaway
MRC Social & Public Health Sciences Unit (at the University of Glasgow)
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• Health is worse in deprived areas compared to more affluent areas
• Is that just because deprived areas contain lots of poorer people?
• Poverty is bad for your health - well established
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Is where you live related to health?
• Many studies have shown that where you live affects health, after taking your own personal attributes into account (age, gender, social class, income etc.)
• Health effects include mortality, cancers, mental health, cardiovascular disease, obesity
• Health behaviours such as diet, smoking and physical activity (less so for alcohol consumption!)
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Why does where you live relate to health?
• Who lives in a place
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Why does where you live relate to health?
• Who lives in a place
• What’s in a place
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Why does where you live relate to health?
• Who lives in a place
• What’s in a place
• What a place is like to live in
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Who lives in a place
• Population characteristics and mix
• Residential stability
• Degree of social interaction
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What’s in a place
• Amenities - recreation facilities, schools, shops, transport, greenspace etc.
• Buildings
• Physical configuration (street layout etc.)
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What a place is like to live in
• Quality of the local social & physical environment
• Crime and fear of crime
• How conducive it is to social interaction
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21%
Value of house prices by proximity to parks
Netherlands study
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Physical features of the environment shared by all residents in a locality
Availability of healthy environments at home, work and play
Services provided to support people in their daily lives
The socio- cultural features of a locality
The reputation of an area
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Two socially contrasting localities in Glasgow City
one more affluent one more deprived
age groups: now aged around 28, 48 & 68
Study began in 1987 – last data collection 2007
West of Scotland Twenty-07 study
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More affluent Locality
built for Victorian middle classes, Sandstone villas and tenement flats,
also contains inter-war mainly good quality public housing
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More deprived Locality
peripheral public housing schemes. Contains some good quality public
sector housing
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Examples of study data
• Range of mental and physical health and well- being measures
• use of health care services• medications• aspects of day to day life, relationships, work,
housing & neighbourhood• income and expenditure
• direct measurement of features of the local environment
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Health worse in more deprived Locality
• higher blood pressure
• people more likely to be overweight/obese
• higher anxiety and depression
• mortality rates higher
• more likely to smoke and eat a ‘poorer’ diet
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• “Obesity 'could bankrupt the NHS' “
• Obesity linked to a range of diseases and disorders, including heart disease, cancer, depression, back pain, diabetes and skin problems.
• Causes include imbalance between energy intake and expenditure
• Govnt recommend people be more physically active and eat a better diet
• People living in deprived areas more likely to be overweight/obese than those in more affluent areas, and eat a poorer diet.
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Proportion reporting that they never did any exercise
affluent deprived% %
24 35
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Public Facilities
0
3
6
9
swimmingpools
sportscentres
recreationcentres
tennis bowlinggreens
footballpitches
affluent deprived
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Public transport poorer in more
deprived Locality and
fewer people have cars
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% reporting that they had gone for 2 mile walk in the last year
0
20
40
60
80
100
27s 47s 67s
affluent deprived
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Proportion of respondents reporting problems in the local environment
05
101520
litter & rubbish assaults &muggings
disturbances vandalism
%
affluent deprived
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0
10
20
30
females males
%
more affluent more deprived
Proportion of respondents reporting never walk alone in
neighbourhood after dark
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Crime rates higher in more
deprived area - especially crimes
against the person
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In Scotland
Perceptions of the local environment as threatening or unpleasant are related to
poorer mental and physical health
- associated with anxiety, depression and poorer self assessed health, after taking into
account age, sex and socioeconomic circumstances.
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Glasgow Localities: PLAY AREAS
NW Locality:off Nasby Avenue, Broomhill
SW Locality:Raeswood Drive, Nitshill
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Distribution of play areas within Glasgow city
• Appear to be slightly more in deprived areas but their quality and management needs further exploration.
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Access to green space
• More space in deprived areas but is it more ‘unwanted’ space?
Vacant/derelict land
more affluent area: 16 spaces
more deprived area: 56 spaces
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Number of food outlets in Localities in 2005
02468
101214
Supermark
ets
grocers
butchersfru
it/veg
shops
freez
er shop deli
North West South West
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Smoking• People in deprived areas more likely to
smoke*• Possible reason (among many): smoking
helps people cope with living in a stressful local environment
• *even after taking their sex, age and socio- economic circumstances into account
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Likelihood of smoking
living in an area with lots of ‘incivilities’ compared to those living in more pleasant areas
Men - twice as likely
Women – 30% more likely
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‘Social settings establish the categories
of persons likely to be encountered there’
GoffmanStigma: notes on the management ofspoiled identity (1963, p11)
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Address discrimination
More people in the deprived area
have been refused services
(e.g. credit, police, ambulance, taxi)
because of their address
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Proportion of respondents who perceived a ‘serious
problem’ with the reputation of their area
more affluent area 1%
more deprived area 12%
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Low self esteem
• Linked to mental health problems
• Linked to likelihood of undertaking physical activity
• Linked to eating a poorer diet
• Linked to life chances (e.g. education, employment)
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Self esteem scaleExamples:
• On the whole I am satisfied with myself
• I take a positive attitude towards myself
• I feel I am a person of worth, at least equal to others
4 point ‘agreement’ scale
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41
41.5
42
42.5
43
43.5
44
44.5
age 27 age 47 age 67
affluent deprived
Self esteem scores
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Health may be enhancedby taking part
in groups & associations
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Membership of clubs, associations etc.
%
affluent area 80
deprived area 60
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Monitoring area variations in provision and quality of:
• food retail provision• employment opportunities• unfit or substandard housing• recreation facilities• public transport• community resources• child care facilities• education, health and welfare services
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Targets for ensuring that every community over a certain size has access to:
• grocery store• bus or train service• safe play space for children• community hall or meeting place• child care facilities• post office, etc.
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Implications for action
• Create well lit & attractive public spaces
• maintain stable populations
• counter stigma
• positive media representations of place
• foster self esteem - pre-school, schools
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Need to focus on places and people
• Increasing evidence that local social and physical
environment affects health & well-being
• Individual deprivation may be amplified by
environmental deprivation