What do we know about the health impacts of urban regeneration programmes? A systematic review of UK...
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Transcript of What do we know about the health impacts of urban regeneration programmes? A systematic review of UK...
What do we know about the health impacts of urban regeneration programmes?
A systematic review of UK regeneration programmes (1980-2004)
Hilary Thomson, 1 Rowland Atkinson, 2
Mark Petticrew, 1 Ade Kearns 2
1 MRC Social & Public Health Sciences Unit, Glasgow, 2 Department of Urban Studies,
University of Glasgow
Background
• Area Based Initiatives (ABI) are major means of urban regeneration to alleviate socio-economic deprivation
• Massive public investment tackling deprivation: » over £11bn (€16bn) 20 years
• Intuitive links between positive investment to tackle deprivation and improved health and reduction in health inequalities
A strategy to tackle health inequalities
‘Local neighbourhood renewal and other regeneration initiatives are in a
particularly good position to address health inequalities because they
have responsibility for dealing with the wider determinants that have
impact on people’s physical and mental health.’Tackling health inequalities: summary of the 2002 cross cutting spending review. London: HM Treasury & Department of Health, 2002.
Programme vision: New Deal for Communities, 2000
‘to have lower worklessness; less crime; better health; better skills and better
housing’A new commitment to neighbourhood renewal: national strategy action plan. London: HMSO: Social Exclusion Unit, The Cabinet Office, 2001.
Developing evidence base to support healthy public policy
‘every opportunity to generate evidence from current
policy and practice needs to be realised’
Wanless D. Securing good health for the whole population. London: HM Treasury & Department of Health. HMSO, 2004.
‘every opportunity to generate evidence from current policy and practice needs to be realised’…
• Little or no research evidence of the health impacts of regeneration
• Evaluations of previous national regeneration programmes of central policy relevance previously untapped resource in grey literature
• Systematic review of health impacts AND impacts on socio-economic determinants of health
Systematic review of national regeneration programmes (UK)
Review questions
What is the available evidence that national programmes of urban regeneration have an impact on:
– population health?
– socio-economic determinants of health? » employment, education, income, housing
– health inequalities?
Methods: search strategy
• Nine UK programmes included 1980 to 2004:
– Urban Programme
– Urban Development Corporations
– Estate Action
– City Challenge
– Small Urban Renewal Initiatives
– Single Regeneration Budget
– New Deal for Communities
– Social Inclusion Partnerships
– New Life for Urban Scotland
• Seven electronic bibliographic databases searched (1980 to 2004)
• Experts contacted
Methods: review inclusion/exclusion criteria
• Included: evaluations which reported on achievements or impacts of regeneration programme-
qualitative or quantitative
• Excluded: evaluations of strategy or process issues
evaluations of only one target area
evaluations of single projects within local ABI areas
• Two reviewers screened identified documents independently to ensure agreement about included evaluations
Search results
896 references identified
86 evaluations identified: examined independently by 2
researchers
10 evaluations reporting impacts on health or socio-economic outcomes
All data from 1988-2000
not relevant n=810
Process evaluation n=51 Inadequate assessment of health or socio-economic impacts n=25
Evaluation quality & methods
• Inadequate assessment of impacts n=25
– Gross outputs and activity reported as impact e.g. how many miles
of new road built n=17
– Impacts reported but with no supporting data n=2
– Retrospective assessment by stakeholders n=6
Evaluation quality & methods
• Inadequate assessment of impacts n=25
– Gross outputs and activity reported as impact e.g. how many miles
of new road built n=17
– Impacts reported but with no supporting data n=2
– Retrospective assessment by stakeholders n=6
• Impact evaluations n=10
– Poor reporting of methods, sample sizes, response rates, data
sources
Impacts: self-reported health and mortality
Self-reported health @ 3 years
1 SRB evaluation (panel survey of same residents before and after)
– 3 measures deteriorated (+/- 3.8%, ranges included zero)
– 1 measure improved (range +2% to +4%)
Impacts: self-reported health and mortality
Self-reported health @ 3 years
1 SRB evaluation (panel survey of same residents before and after)
– 3 measures deteriorated (+/- 3.8%, ranges included zero)
– 1 measure improved (range +2% to +4%)
Mortality rates @ 4-6 years
crude mortality: 1 evaluation
– decreased (-0.6%, range -1% to -0.2%)
standardised mortality: 2 evaluations
– decreased (-4, range -7 to -1)
– decreased (-17, range -29 to +12)
Impacts: self-reported health and mortality
Self-reported health @ 3 years- unclear effect1 SRB evaluation (panel survey of same residents before and after)
– 3 measures deteriorated (+/- 3.8%, ranges included zero)– 1 measure improved (range +2% to +4%)
Mortality rates @ 4-6 years- improvement but no comparison with national trend
crude mortality: 1 evaluation– decreased (-0.6%, range -1% to -0.2%)
standardised mortality: 2 evaluations– decreased (-4, range -7 to -1)– decreased (-17, range -29 to +12)
Impacts: employment
Overall improvement
Effect size Range of effects in same direction
Improvement compared to wider trend?
New Life (after 10 years)
+6%
(41% v 47%)
(-9% to +20%)
SRB (after 3 years)
+4%
(56% v 60%)
(+3% to +5%)
Employment rate
Wider trend: compared to changes in regional or national figures over same time period
Impacts: unemployment @ 2-10 years
Nine evaluations Overall improvement
Effect size
Range of effects in same direction
Improvement compared to wider trend?
SRB -1.3%
SRB -10.8% n/a
SRB -4% Estate Action -29.5% SIP -3.8%
SIP -32% New Life -5.3% Urban Programme +3.25% City Challenge +0.3%
Impacts: educational achievement at school
Overall improvement
Effect size
Range of effects in same direction
Improvement compared to wider trend?
Five evaluations
(New Life, City Challenge, SRB x3)
mean +6.25%
Pupils gaining ‘>4 GCSEs’ or ‘>2 Standard Grades’
Impacts: household income
Overall improvement
Effect size Range of effects in same direction
Improvement compared to wider trend?
New Life -16.5% SRB -4%
Households with incomes of <£100/week
Impacts: housing quality & rent
Overall improvement
Effect size
Range of effects in same direction
Improvement compared to wider trend?
UDC (residents from target area now living in improved housing)
+42.5%
Estate Action
(average weekly rent local authority tenants)
+99.3%
Available evidence from existing policy
• population health?» self reported health: unclear
» mortality: small improvement but no comparison with national trends
• socio-economic determinants of health?
• health inequalities?
Available evidence from existing policy
• population health?» self reported health: unclear
» mortality: small improvement but no comparison with national trends
• socio-economic determinants of health? » housing, education, employment, income: small
improvements but rarely in addition to wider trends
» adverse impacts a possibility
• health inequalities?
Available evidence from existing policy
• population health?» self reported health: unclear
» mortality: small improvement but no comparison with national trends
• socio-economic determinants of health? » housing, education, employment, income: small
improvements but rarely in addition to wider trends
» adverse impacts a possibility
• health inequalities?» remains unknown
What does it all mean?
• Positive health and social impacts of regeneration investment cannot be assumed
• Methods to evaluate outcomes need further development
– accountability for massive public investment
– improve effectiveness of future regeneration investment
– identify and prevent unintended negative health and social impacts
Generating usable evidence through evaluation
Evaluations designed with possible evidence use in mind
» Usefulness of cheap routine data v costly panel surveys looking at
impacts for target groups
» Improve reporting- methods, samples, response rates, range of
effects across case study areas
» Outcomes: impacts on determinants of health may be more feasible
than health impacts