Explanatory models concerning the effects of small-area characteristics on individual health
- 461 Downloads
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.
KeywordsSmall-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.
- Brower S (1996) Good neighborhoods: a study of in-town and suburban residential environments. Praeger Publishers, Westport (CT)Google Scholar
- Bourdieu P (1986) The forms of capital. In: Richardson JG (ed) Handbook of theory and research for the sociology of education. Greenwood, New York, pp 241–258Google Scholar
- Eurostat (2012) NUTS—nomenclature of territorial units for statistics. http://epp.eurostat.ec.europa.eu/portal/page/portal/nuts_nomenclature/introduction. Accessed 18 Feb 2014
- Geronimus AT (1992) The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis 2:207–221Google Scholar
- Giddens A (1984) The constitution of society. University of California Press, BerkeleyGoogle Scholar
- Godbout J (2003) The world of the gift. McGill-Queen’s University Press, MontrealGoogle Scholar
- Haan M, Kaplan GA, Camacho T (1987) Poverty and health. Prospective evidence from the Alameda County study. Am J Epidemiol 6(125):989–998Google Scholar
- Macintyre S, Ellaway A (2000) Ecological approaches: rediscovering the role of the physical and social environment. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, Oxford, pp 332–348Google Scholar
- Macintyre S, Ellaway A (2003) Neighbourhoods and health: An overview. In: Kawachi I, Berkman LF (eds) Neighbourhoods and health. Oxford University Press, New York, pp 20–42Google Scholar
- Maslow A (1968) Toward a psychology of being, 2nd edn. Van Nostrand, New YorkGoogle Scholar
- Northridge ME, Sclar E (2003) A joint urban planning and public health framework: contributions to health impact assessment. Am J Public Health 93(1):118–121Google Scholar
- Portes A (1998) Social capital: its origins and applications in modern sociology. Annu Rev Sociol 24:1–24Google Scholar
- Steinkamp G (1993) Soziale Ungleichheit, Erkrankungsrisiko und Lebenserwartung: Kritik der sozialepidemiologischen Ungleichheitsforschung [Social inequality, illness risk and life expectancy: criticism of social epidemiological injustice research]. Soz Praventivmed 38:111–122Google Scholar
- WHO (2010) Environment and health risks: a review of the influence and effects of social inequalities. http://www.euro.who.int/__data/assets/pdf_file/0003/78069/E93670.pdf. Accessed 18 Feb 2014
- Wilson JQ, Kelling GL (1982) Broken windows. Atl Mon 249(3):29–38Google Scholar
- Wilson WJ (1987) The truly disadvantaged: The inner city, the underclass, and public policy. University Chicago Press, ChicagoGoogle Scholar