Neighbourhoods & Health: An Introduction James R. Dunn, Ph.D. - - PowerPoint PPT Presentation

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Neighbourhoods & Health: An Introduction James R. Dunn, Ph.D. - - PowerPoint PPT Presentation

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Neighbourhoods & Health: An Introduction James R. Dunn, Ph.D. Scientist, Centre for Research on Inner City Health, St. Michaels Hospital Associate Professor, Geography & Public Health Sciences, University of Toronto CMHC Scholar in

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Neighbourhoods & Health: An Introduction

James R. Dunn, Ph.D.

Scientist, Centre for Research on Inner City Health, St. Michael’s Hospital Associate Professor, Geography & Public Health Sciences, University of Toronto CMHC Scholar in Successful Societies, Canadian Institute for Advanced Research

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

The Social Gradient in Health

Source: Humphries and van Source: Humphries and van Doorslaer Doorslaer, 2000 , 2000

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Income and Social Status

  • Canadian studies show that on average:

– Men in the top 20% of the income scale live 6 years longer than those in the bottom 20%. They can expect 14 more years of disability-free life. – Women in the top 20% of the income scale live 3 years longer than those in the bottom 20%. They can expect 8 more years of disability-free life.

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Mortality Rates by Neighbourhood Income: Urban Canada, 1971-1996

5 10 15 20 25 30 35 40 45 1971 1986 1991 1996 Q1-Richest Q2 Q3 Q4 Q5-Poorest

%

Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E, March 2001

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PYLL(0-74) by Cause, 1996

30.9 19.2 17.6 5.3 4.9 4.8 3.8 13.5 23.1 5 10 15 20 25 30 35

Neoplasms I ncome-Related I njuries Circulatory I nfectious Perinatal I ll-defined Congenital All other

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

“medicine and politics cannot and should not be kept apart”

Sir Geoffrey Rose, MD (1992)

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

The Logic of Neighbourhoods & Health Research

  • health behaviours and health status are the
  • utcome of more than just individual

factors (e.g., income, attitudes, etc.)

  • health behaviours are significantly shaped

by ‘health opportunity structures’

  • e.g., availability of parks & rec, healthy foods, etc.
  • health outcomes shaped by more than just

individual socio-economic status

  • low SES individuals = > ‘deprivation amplification’
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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Attributes of Neighbourhoods with Links to Health: 5 R’s

  • risks: environmental contaminants, crime,

violence, noise, and dangerous roadways

  • r pedestrian pathways or crossings
  • resources: health & social services,

commercial services, schools, recreational

  • pportunities, libraries, public transit, built

environment - physical activity

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Attributes of Neighbourhoods with Links to Health: 5 R’s

  • relationships: social support, social

capital, social cohesion, ‘weak ties’ collective efficacy, etc.

  • representations: the reputation of a

neighbourhood

  • residents may internalize = > self-worth
  • may have an effect on service provision, movement
  • f people, investment in the neighbourhood
  • resilience?
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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Pathways Linking Neighbourhoods & Health

  • Direct:
  • behavioural
  • stress / coping
  • I ndirect:
  • neighbourhood reputation
  • political power
  • Both direct & indirect:
  • social relationships, social capital, etc.
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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Current Activities

a) Toronto-IRONhI: Intensive Research on Neighbourhoods & Health Initiative

  • structured observation of social & physical disorder
  • concept mapping re: n’hood features that affect mental health

& well-being

  • Rapid Small-Area Health Needs Assessment

b) Toronto Area Health Study

  • neighbourhood factors in inequalities in mental health

c) SMH Health Database Initiative

  • n’hood variation in health & health determinants
  • Ontario Urban Health Atlas Volumes 1-? in development: child

health, mental health, respiratory health…

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Neighbourhoods & Health: An Introduction: CUHI Policy Forum, May 10, 2007

Future Themes, Directions, Issues

  • policy is leading the research – good news in a way
  • evaluating complex, population-level interventions

– new methods for understanding how & why of health effects of complex neighbourhood intervention

= > ‘realistic evaluation’: mechanism + context = outcome

  • knowledge translation & receptor capacity in multiple

sectors

  • more work on ‘natural experiments’, eg. Regent Park,

Priority N’hoods Strategy, etc.

  • panel study of residents clustered in n’hoods with

tracking of movers