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      Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland

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          Abstract

          It has commonly been suggested that in modern cities individual or household deprivation (for example, low income or education) is amplified by area level deprivation (for example, lack of jobs or good schools), in ways which damage the health of the poorest and increase health inequalities. The aim of this study was to determine the location of a range of resources and exposures by deprivation in a UK city. We examined the location of 42 resources in Glasgow City, Scotland, in 2005–2006, by quintile of small area deprivation. Measures included number per 1000 population, network distance to nearest resource, and percentage of data zones containing at least one of each type of resource. Twelve resources had higher density in, and/or were closer to or more common in, more deprived neighbourhoods: public nurseries, public primary schools, police stations, pharmacies, credit unions, post offices, bus stops, bingo halls, public swimming pools, public sports centres, outdoor play areas, and vacant and derelict land/buildings. Sixteen had higher density in, and/or were closer to, or more common in, more affluent neighbourhoods: public secondary schools, private schools, banks, building societies, museums/art galleries, railway stations, subway stations, tennis courts, bowling greens, private health clubs, private swimming pools, colleges, A & E hospitals, parks, waste disposal sites, and tourist attractions. Private nurseries, Universities, fire stations, general, dental and ophthalmic practices, pawn brokers, ATMs, supermarkets, fast food chains, cafes, public libraries, golf courses, and cinemas showed no clear pattern by deprivation. Thus it appears that in the early 21st century access to resources does not always disadvantage poorer neighbourhoods in the UK. We conclude that we need to ensure that theories and policies are based on up-to-date and context-specific empirical evidence on the distribution of neighbourhood resources, and to engage in further research on interactions between individual and environmental factors in shaping health and health inequalities.

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          Most cited references46

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          Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.

          Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms-individual risk factor epidemiology and an ecological approach. Keyword searching of Index Medicus (Medline) and additional references from retrieved articles. All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries. The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects. The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.
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            Bringing context back into epidemiology: variables and fallacies in multilevel analysis.

            A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multi-level analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations.
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              Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment.

              Spatial access to recreational facilities and perceptions of the neighborhood environment and physical activity levels were examined by the socioeconomic status of area of residence (SES). A cross-sectional survey of adults (18-59 years) (n = 1,803) stratified by SES using a geographic-based index was conducted. Respondents in low SES areas had superior spatial access to many recreational facilities, but were less likely to use them compared with those living in high SES areas. They were more likely to perceive that they had access to sidewalks and shops, but also perceived that their neighborhood was busier with traffic, less attractive, and less supportive of walking. After adjustment, respondents living in low SES areas were 36% less likely to undertake vigorous activity. While they were more likely to walk for transport, this was not statistically significant (OR, 1.27; 95% CI, 0.98-1.64), nor were other SES differences in walking for recreation and walking as recommended. Modifiable environmental factors were associated with walking and vigorous activity, especially perceived access to sidewalks and neighborhood attractiveness. Spatial access to attractive, public open space was associated with walking. Creating supportive environments--particularly sidewalks in attractive neighborhoods--has the potential to increase walking and vigorous activity.
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                Author and article information

                Journal
                Soc Sci Med
                Social Science & Medicine (1982)
                Pergamon
                0277-9536
                1873-5347
                September 2008
                September 2008
                : 67
                : 6
                : 900-914
                Affiliations
                MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK
                Author notes
                []Corresponding author. sally@ 123456sphsu.mrc.ac.uk
                Article
                SSM6351
                10.1016/j.socscimed.2008.05.029
                2570170
                18599170
                53062737-17e1-40c9-b4cb-1cd1531d3d75
                © 2008 Elsevier Ltd.

                This document may be redistributed and reused, subject to certain conditions.

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                Health & Social care
                uk,scotland,deprivation amplification,location of resources,area deprivation,environmental justice,health inequalities

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