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Neighbourhoods and Health: a Review of the New Zealand Literature

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Neighbourhoods and Health: a Review of the New Zealand Literature New Zealand Geographer (2009) 65, 211–221 doi: 10.1111/j.1745-7939.2009.01164.x Research Article Neighbourhoods and health: A review of the New Zealand literature Anna Stevenson,1 Jamie Pearce,2 Tony Blakely,3 Vivienne Ivory3 and Karen Witten4 1Community and Public Health, Canterbury District Health Board, Christchurch, New Zealand; 2Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK; 3Health Inequalities Research Programme, University of Otago, Wellington, New Zealand; 4Centre for Social and Health Outcomes Research and Evaluation, Massey University, Auckland, New Zealand Abstract: Over the past two decades, there has been a resurgence of interest into place-based influences on health. Researchers have identified that various character- istics of neighbourhoods exert an influence on the health outcomes and behaviours of local residents. Understanding the processes linking places to health provides con- siderable potential for a range of policy interventions. We review the New Zealand- based neighbourhoods and health research. Consideration is given to the types of neighbourhood characteristics, as well the range of health outcomes that have been studied. Finally, we suggest some priorities for further research into the mechanisms underpinning neighbourhood influences on health in New Zealand. Key words: health, health inequality, neighbourhood, New Zealand. It has long been recognised that the places in for residents’ health: physical (e.g. air pollu- which people live, work and play have direct tion), socio-cultural (e.g. social cohesion) and and indirect impacts on individual-level and community resource access (e.g. recreational population-level health outcomes. These ‘place facilities). effects’ occur independently of individual-level Policy interventions at the area level have a demographic attributes, such as age, sex and long history. They also vary widely by type and ethnicity, but are mediated by behaviours, scale.To illustrate this variation, the restoration social position, health-care access and other of a waterway constitutes an intervention alter- physiological parameters that allow neighbour- ing a physical aspect of place; the socio-cultural hood contexts to influence individual health environment may change with the introduction and well-being outcomes (Kawachi & Berkman of a neighbourhood watch programme; and a 2003). In very broad terms, three types of neigh- new medical centre may increase health service bourhood characteristics might be important access and use. The geographical scale of Note about the authors: Anna Stevenson is a public health physician who works with Christchurch City Council and the Canterbury District Health Board on urban design issues; Jamie Pearce is a reader in Human Geography at the University of Edinburgh, UK, and co-director of the GeoHealth Laboratory, Department of Geography, University of Canterbury; Tony Blakely is research professor of Public Health at the Wellington School of Medicine and Health Sciences, University of Otago and the director of the Health Inequalities Research Programme (HIRP); Vivienne Ivory is a research fellow on the HIRP, Wellington School of Medicine and Health Sciences, University of Otago; Karen Witten is associate professor at the Centre for Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Auckland. E-mail: [email protected]; [email protected] © 2009 The Authors Journal compilation © 2009 The New Zealand Geographical Society 212 A. Stevenson et al. interventions that impact on the neighbour- considered to capture the recent resurgence of hood context also vary and may be city-wide, as interest in neighbourhood effects on health, as with the WHO Healthy Cities, or locally based, well as the most significant methodological such as the construction of a new supermarket advances (internationally) in the field. A letter or children’s playground. seeking assistance in locating grey and unpub- If place-based interventions are to improve lished research was sent to a variety of health and well-being, it is necessary that the networks throughout New Zealand including characteristics of a place actually have a causal public health units, local government policy association with health. Currently, the mecha- analysts and academic researchers. nisms by which place affects health are not well To aid both setting the inclusion/exclusion understood and this is a major challenge to criteria and organising the literature into useful research in the field. Considerable momentum domains, we developed a categorisation and has been building internationally in the area ranking criteria against which all elicited pub- over the last 10–15 years, with contributions lications were assessed (Table 1). It should be from disciplines such as geography, epidemiol- noted that the assignment of the papers to the ogy, sociology and public health. categories was not necessarily able to reflect In this paper, we compile a stocktake of the full scope of each paper, and that some New Zealand-based neighbourhoods and papers could have been assigned to several cat- health research. Our primary purpose was to egories. Inclusion required studies to evaluate ascertain what is known about the health the direct or indirect measurement of physical, impacts of ‘neighbourhoods’ in New Zealand. social or community resources of neighbour- We focus on the mechanisms that potentially hoods (i.e. the local context in which people explicate the ways in which the local context reside) and the direct measurement of the influences a range of individual-level health health-related outcomes of people (direct outcomes, health-related behaviours and the mortality/morbidity measure, health-related utilisation of health care. We include studies risk factor or health-care utilisation status) or that not only test directly the association health-related neighbourhood processes. We between one of more neighbourhood charac- were interested in health outcomes that were teristics and the health outcomes of local resi- measured at the individual level but dissemi- dents, but also research that considers nated at either the individual or aggregated processes operating in the residential neigh- (neighbourhood) level. bourhood which have a plausible link to health. Beginning with study design, the studies This paper is the first to scan across the New were first categorised by how they measured Zealand research literature to note the breadth the neighbourhood. Studies were divided into of completed research and highlight any impor- whether they directly measured characteristics tant gaps in the evidence base that present a of the residential neighbourhood or whether barrier to successful policy formulation. they used proxy measures. The studies were then cross-classified by how health (broadly Methods speaking) was measured. In addition to studies that measured individual health status, we Our initial literature search was a scoping exer- included those that measured health-related cise intended to inform the criteria for the final processes and health services utilisation as all selection of papers. We used the search engines three outcomes were important for better Ebsco, Scopus, EMBASE, Index New Zealand, understanding place effects on health. Te Puna, Proquest, Web of Science and the There was some debate as to whether to Otago libraries catalogue. Key search terms include settings-based literature (e.g. provision were ‘neighbourhood’, ‘community’, ‘social of health promotion programmes within environment’, ‘mortality’, ‘morbidity’, ‘wellbe- schools). Settings are important neighbour- ing’, ‘illness’, ‘health service’, ‘New Zealand’ hoods in the sense that they are places where and a variety of health determinants such as people spend a considerable proportion of ‘obesity’, ‘tobacco’ and ‘greenspaces’. The time their life, settings-based research has many period 1996–2008 was selected because it was useful parallels with the more geographically © 2009 The Authors Journal compilation © 2009 The New Zealand Geographical Society Table 1 Cross-classified categorisation framework for retrieved literature – measurement of neighbourhoods by health outcome Category A: Indirect measurement of physical, social or Category B: Direct measurement of physical, social or Measurement of health outcome community resources of neighbourhoods community resources of neighbourhoods Neighbourhoods and health in New Zealand Neighbourhood-level intermediary Studies that indirectly measure some aspect of Studies that directly measure (by observation, mapping or factors/processes neighbourhood using a proxy, such as neighbourhood questionnaires) some aspect of the residential deprivation. These studies do not use data on neighbourhood. These studies do not use data on individual-level health-related outcomes. individual-level health-related outcomes. Health services utilisation access Studies that indirectly measure some aspect of Studies that directly measure (by observation, mapping or at the individual level neighbourhood, using a proxy, such as neighbourhood questionnaires) a specific aspect of the residential Journal compilation © 2009 The New Zealand Geographical Society deprivation, and examine its relationship to neighbourhood and examine its association with individual-level access to and/or utilisation of appropriate individual-level access to and/or utilisation of appropriate health services. health services. Health status or risk factor Studies that indirectly
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