International Journal of Public Health

, Volume 59, Issue 3, pp 427–438 | Cite as

Explanatory models concerning the effects of small-area characteristics on individual health

  • Sven VoigtländerEmail author
  • Verena Vogt
  • Andreas Mielck
  • Oliver Razum



Material and social living conditions at the small-area level are assumed to have an effect on individual health. We review existing explanatory models concerning the effects of small-area characteristics on health and describe the gaps future research should try to fill.


Systematic literature search for, and analysis of, studies that propose an explanatory model of the relationship between small-area characteristics and health.


Fourteen studies met our inclusion criteria. Using various theoretical approaches, almost all of the models are based on a three-tier structure linking social inequalities (posited at the macro-level), small-area characteristics (posited at the meso-level) and individual health (micro-level). No study explicitly defines the geographical borders of the small-area context. The health impact of the small-area characteristics is explained by specific pathways involving mediating factors (psychological, behavioural, biological). These pathways tend to be seen as uni-directional; often, causality is implied. They may be modified by individual factors.


A number of issues need more attention in research on explanatory models concerning small-area effects on health. Among them are the (geographical) definition of the small-area context; the systematic description of pathways comprising small-area contextual as well as compositional factors; questions of direction of association and causality; and the integration of a time dimension.


Small-area context Health Explanatory models Health inequalities Environmental health 



The work for this paper was supported by German Research Foundation (DFG, German: Deutsche Forschungsgemeinschaft), Grant Number: RA 889/2-1. We thank the anonymous reviewer of a previous version for helpful comments.

Supplementary material

38_2014_556_MOESM1_ESM.doc (64 kb)
Supplementary material 1 (DOC 64 kb)


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Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Sven Voigtländer
    • 1
    • 2
    Email author
  • Verena Vogt
    • 2
    • 3
  • Andreas Mielck
    • 4
  • Oliver Razum
    • 2
  1. 1.Section ‘Quality of Health Care, Health Economics, Health System Analysis’ (GE 6)Bavarian Health and Food Safety Authority (LGL)NürnbergGermany
  2. 2.Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
  3. 3.Department of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR)Technische Universität BerlinBerlinGermany
  4. 4.Institute of Health Economics and Health Care ManagementHelmholtz Zentrum MünchenNeuherbergGermany

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