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Stewart, Joanna L. (2016) Glasgow's Spatial Arrangement of Deprivation Over Time: Methods to Measure It and Meanings for Health

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Stewart, Joanna L. (2016) Glasgow's Spatial Arrangement of Deprivation Over Time: Methods to Measure It and Meanings for Health Stewart, Joanna L. (2016) Glasgow's spatial arrangement of deprivation over time: methods to measure it and meanings for health. PhD thesis. http://theses.gla.ac.uk/7936/ Copyright and moral rights for this work are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This work cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] Glasgow’s spatial arrangement of deprivation over time: methods to measure it, and meanings for health. Joanna L. Stewart BA (Hons) MRes MSc Submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy (PhD) Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences, University of Glasgow July 2016 © [Joanna L. Stewart] [July 2016] 2 Abstract Background Socio-economic deprivation is a key driver of population health. High levels of socio-economic deprivation have long been offered as the explanation for exceptionally high levels of mortality in Glasgow, Scotland. A number of recent studies have, however, suggested that this explanation is partial. Comparisons with Liverpool and Manchester suggest that mortality rates have been higher in Glasgow since the 1970s despite very similar levels of deprivation in these three cities. It has, therefore, been argued that there is an “excess” of mortality in Glasgow; that is, mortality rates are higher than would be expected given the city’s age, gender, and deprivation profile. A profusion of possible explanations for this excess has been proffered. One hypothesis is that the spatial arrangement of deprivation might be a contributing factor. Particular spatial configurations of deprivation have been associated with negative health impacts. It has been suggested that Glasgow experienced a distinct, and more harmful, development of spatial patterning of deprivation. Measuring the development of spatial arrangements of deprivation over time is technically challenging however. Therefore, this study brought together a number of techniques to compare the development of the spatial arrangement of deprivation in Glasgow, Liverpool and Manchester between 1971 and 2011. It then considered the plausibility of the spatial arrangement of deprivation as a contributing factor to Glasgow’s high levels of mortality. Methods A literature review was undertaken to inform understandings of relationships between the spatial arrangement of deprivation and health outcomes. A substantial element of this study involved developing a methodology to facilitate temporal and inter-city comparisons of the spatial arrangement of deprivation. Key 3 contributions of this study were the application of techniques to render and quantify whole-landscape perspectives on the development of spatial patterns of household deprivation, over time. This was achieved by using surface mapping techniques to map information relating to deprivation from the UK census, and then analysing these maps with spatial metrics. Results There is agreement in the literature that the spatial arrangement of deprivation can influence health outcomes, but mechanisms and expected impacts are not clear. The temporal development of Glasgow’s spatial arrangement of deprivation exhibited both similarities and differences with Liverpool and Manchester. Glasgow often had a larger proportion of its landscape occupied with areas of deprivation, particularly in 1971 and 1981. Patch density and mean patch size (spatial metrics which provide an indication of fragmentation), however, were not found to have developed differently in Glasgow. Conclusion The spatial extent of deprivation developed differently in Glasgow relative to Liverpool and Manchester as the results indicated that deprivation was substantially more spatially prevalent in Glasgow, this was particularly pronounced in 1971 and 1981. This implies that exposure of more affluent and deprived people to each other has been greater in Glasgow. Given that proximal inequality has been related to poor health outcomes, it would appear plausible that this may have adversely affected Glasgow’s mortality rates. If this is the case, however, it is unlikely that this will account for a substantial proportion of Glasgow’s excess mortality. Further research into Glasgow’s excess mortality is, therefore, required. 4 Table of Contents Abstract ...................................................................................... 2 Table of Contents .......................................................................... 4 List of Tables ............................................................................... 10 List of Figures .............................................................................. 13 Acknowledgements ........................................................................ 19 Author’s Declaration ...................................................................... 20 Publications, Working Papers and Presentations ..................................... 21 Abbreviations .............................................................................. 22 Chapter 1 : Introduction .................................................................. 23 1.1 Thesis background ................................................................. 23 1.2 Thesis aims and research questions ............................................. 24 1.3 Thesis outline ....................................................................... 24 Chapter 2 Literature Review Part 1: deprivation and health ....................... 26 2.1 Introduction ......................................................................... 26 2.2 Poverty and deprivation ........................................................... 26 2.2.1 A brief history of UK poverty research... ................................ ..26 2.2.2 Relative deprivation .......................................................... 29 2.2.3 Individual deprivation and area deprivation .............................. 31 2.2.4 Mapping poverty and deprivation ........................................... 31 2.2.5 Section Summary .............................................................. 33 2.3 Inequalities in health and the determinants of health ....................... 33 2.3.1 Inequalities in health ......................................................... 33 2.3.2 Socio-economic health inequalities ........................................ 36 2.3.3 What influences health? ...................................................... 42 2.3.3.1 Socio-ecological models of health ..................................... 42 2.3.3.2 Context and composition ................................................ 44 2.3.4 Temporal relationships between area deprivation and mortality ..... 47 2.3.5 Section Summary .............................................................. 48 2.4 Chapter summary .................................................................. 48 Chapter 3 Literature Review (part 2): Glasgow’s excess mortality ................ 50 3.1 Introduction ......................................................................... 50 3.2 Inequalities in health – the case of Scotland ................................... 50 3.2.1 Deprivation – the traditional explanation for Scotland’s higher mortality levels relative to England and Wales .................................. 51 5 3.2.2 Does deprivation explain the mortality gap between Scotland and the rest of Britain? ................................................................... 53 3.2.3 Section summary .............................................................. 60 3.3 Inequalities in health – the case of Glasgow ................................... 61 3.3.1 Mortality and deprivation – comparing Glasgow to Liverpool and Manchester ............................................................................ 65 3.3.1.1 Methods used to compare mortality and deprivation in Glasgow with Liverpool and Manchester ........................................ 65 3.3.1.2 ‘It’s not just deprivation’ – the results of Glasgow, Liverpool and Manchester comparisons ..................................................... 66 3.3.2 Where is research currently into Glasgow’s excess mortality? ......... 73 3.4 Could the concentration of deprivation explain Glasgow’s excess mortality ................................................................................. 75 3.4.1 The impact of neighbouring deprivation on health: evidence from Scotland ............................................................................... 78 3.4.2 The influence of the socio-economic context of surrounding areas on health – a systematic literature search ....................................... 80 3.4.2.1 Findings from the systematic search .................................. 82 3.4.2.2 Postulated causal mechanisms for how the spatial arrangement of deprivation might influence health: competing hypotheses .......................................................................... 84 3.4.2.3 The influence of the socio-economic context of surrounding areas on health – the evidence................................................... 87 3.4.2.4
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