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How Goes the Neighbourhood? Rethinking Neighbourhoods and Health Research in Social Epidemiology

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Rethinking Social Epidemiology

Abstract

In this chapter, we describe how social epidemiology has been proficient at describing patterns in neighbourhood health inequalities and even in modelling them in a sophisticated fashion, but has been less capable at fostering an understanding of how these effects relate to the social mechanisms of causation that underlie such inequalities at multiple levels – including with respect to neighbourhoods and more macrosocial contexts. We argue that this paradigm has to be shifted to improve the translation of research about neighbourhoods and health into ­effective health equity interventions, and we outline some specific ways for social epide­miologists to supplement their approach to research. We thereby problematize the social epidemiologic treatment of neighbourhoods as simple containers as a way of clarifying how neighbourhood effects may reflect complex fundamental and ­proximate causes of health disparities. We also describe four assumptions of ­commonly used, ­multilevel models that ought to be closely considered when using this approach to study social mechanisms of causation. Finally, we argue that more diverse use of theory in the study of neighbourhood effects can help social epide­miologists embrace complexity in their research, and we review key recent (and not so recent) geographic perspectives on neighbourhoods and health that can be ­utilized to put “space in its place” and to better understand why some neighbourhoods are less healthy than others.

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Notes

  1. 1.

    As a result of the potential relationship between contextual and compositional factors, it is worth noting that the magnitude of neighbourhood inequality in health has likely been underestimated, given the common practice of reporting contextual effects that have been controlled for individual level compositional factors, such as behavioural (e.g., smoking) and environmental (e.g. air pollution) risk factors that may be on the pathway of social mechanisms of causation (read: social determinants) (Diez-Roux and Mair 2010; Dunn 2010; Macintyre et al. 2002).

  2. 2.

    We do not mean to imply that neighbourhood health disparities can be completely explained by fundamental causes. The agency of individuals should always be considered in trying to understand the extent to which specific social mechanisms of causation are relevant to these disparities. The frameworks of Bernard et al. (2007), discussed in this chapter, and of Shankardass, discussed in Chap. 6, are examples of how we can conceive of the synergy between agency and fundamental causes.

  3. 3.

    The natural environment includes living and non-living things that occur naturally, including, chiefly, soil (“green space”), water (“blue space”) and air. The built environment relates to constructions and services for human activity; for example, buildings, roads and water management systems. The social environment has been defined by Yen and Syme (1999) as including “groups to which we belong, the neighborhoods in which we live, the organization of our workplaces, and the policies we create to order our lives.”

Abbreviations

GIS:

Geographic information systems

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Authors and Affiliations

  1. Department of Psychology, Wilfrid Laurier University, 75 University Avenue West, N2L 3C5, Waterloo, ON, Canada

    Ketan Shankardass

  2. Department of Health, Aging and Society, McMaster University, Kenneth Taylor Hall 226, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada

    James R. Dunn

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  1. Ketan Shankardass
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Correspondence to Ketan Shankardass .

Editor information

Editors and Affiliations

  1. St. Michael’s Hospital, Bond Street 30, Toronto, M5B 1W8, Ontario, Canada

    Patricia O’Campo

  2. , McMaster University, Department of Health, Aging and Society, Main Street West 1280, Hamilton, L8S 4L8, Ontario, Canada

    James R. Dunn

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Shankardass, K., Dunn, J.R. (2012). How Goes the Neighbourhood? Rethinking Neighbourhoods and Health Research in Social Epidemiology. In: O’Campo, P., Dunn, J. (eds) Rethinking Social Epidemiology. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2138-8_7

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