From urban neighbourhood heterogeneities to health inequalities: social mechanisms, environmental exposures and their interaction
Epidemiology and Medical Biometry/Statistics
Final Report Abstract
The aim of the project „From urban neighbourhood heterogeneities to health inequalities: social mechanisms, environmental exposures and their interaction“ (NeHiS) was to develop innovative methods and their applications to investigate how heterogeneities between urban neighbourhoods lead to health inequalities. A particular focus lied on the role of social mechanisms. To achieve this we had three interconnected research themes. The first one was to investigate – with the use of empirical data analysis and agent-based simulation studies – which are the respective roles of social mechanisms and environmental exposures in the genesis of health inequalities. The second aspect concerned the presentation, evaluation and application of a new approach to the measurement of neighbourhood effects on health which did not require predefined neighbourhoods. The third aspect concerned conceptual considerations which included a comparative analysis of the literature in sociology and epidemiology and the development of instruments to further investigate social mechanisms. We have been able to obtain longitudinal evidence of a mediator effect of social cohesion on the relationship between environmental factors and health. In particular we were able to see an increased mediating effect of time on physical health. In a comparative study of three survey based at three different European cities, we have seen consistent evidence of spatial effects on two cardiovascular risk factors over the three cities which were not due to the spatial correlation of common predictors of those risk factors. As a result, we could conjecture that social mechanisms like social norms could explain this phenomenon. In an agent-based simulation study we developed stochastic models to test if the mechanism of social contagion could possibly have an effect on health inequalities to a differential in the distribution in environmental health stressors. We have proposed a new approach – the so-called correlation neighbourhood - to measuring spatial effect on health outcomes which can also be used as a measure of spatial health inequality in urban areas. This new approach has been evaluated for the type of spatial data which are available from social survey. The method was applied in the context of an empirical data analysis in which we were able to show that this approach could bring new evidence of spatial effect on health missed by existing methods. The same approach was also used within the agent-based modelling study in which we used changes in the parameter of the correlation neighbourhood over time to evaluate changes in health inequalities over time. Also, part of the legacy of NeHiS is the current DFG funded research unit PH-LENS. The overall concept used in the unit is the results of our conceptual considerations on an interdisciplinary approach to investigating a research question. More precisely, in a sub-project DEPRIV, we further investigate factors at various spatial scale related to accommodation of vulnerable populations (refugees). The statistical methodologies to include their measure in bespoke indexes of multiple deprivation builds on the methods we have developed in NeHis. Further legacy lies in the free software we developed, which facilitates the access to the correlation neighbourhood approach to non-specialist and include the newly developed measures of uncertainty for the estimated parameters of the correlation neighbourhood. In the project NeHiS we have been able to provide new evidence of the mechanistic role of social mechanisms in the development of spatial health inequalities due to environmental factor. We have done so by developing and evaluating new conceptual approaches to measuring spatial effect on health and health inequalities which are now available to the wider scientific community.
Publications
- Correlation neighbourhood: an ego-centred approach for the evaluation of health inequalities in urban areas. Deutsche Gesellschaft für Epidemiologie Tagung 2018
Odile Sauzet
- Social mechanisms in the epidemiological literature on neighbourhood health inequalities. Deutsche Gesellschaft für Epidemiologie Tagung 2018
Kim Zolitschka
- (2019). Social Mechanisms in Epidemiological Publications on Small-Area Health Inequalities—A Scoping Review. Frontiers in public health, 7, 393
Zolitschka, K. A., Razum, O., Breckenkamp, J., & Sauzet, O.
(See online at https://doi.org/10.3389/fpubh.2019.00393) - An ego-centred approach for the evaluation of health inequalities in urban areas. European Public Health conference 2019
Odile Sauzet
- Social cohesion as a mechanism behind neighbourhood effects on mental or physical health. European Public Health conference 2019
Sara Kress
- Social cohesion as a mechanism behind neighbourhood effects on mental or physical health: mediation analysis using data form the German Socio-Economic Panel 2004-08. Deutsche Gesellschaft für Epidemiologie Tagung 2019
Sara Kress
- (2020). Does social cohesion mediate neighbourhood effects on mental and physical health? Longitudinal analysis using German Socio-Economic Panel data. BMC public health, 20(1), 1-7
Kress, S., Razum, O., Zolitschka, K. A., Breckenkamp, J., & Sauzet, O.
(See online at https://doi.org/10.1186/s12889-020-09149-8) - (2020). Equality in Living Conditions as a Prerequisite for Health Equity. Deutsches Ärzteblatt International, 117(29-30), 491
Razum, O., & Sauzet, O.
(See online at https://doi.org/10.3238/arztebl.2020.0491) - Can small-area health inequalities be reduced through neighbourly mediated, social mechanisms? An agent-based modelling study. Deutsche Gesellschaft für Epidemiologie Tagung 2020
Kim Zolitscka
- (2021). A method to define the relevant ego-centred spatial scale for the assessment of neighbourhood effects: the example of cardiovascular risk factors. BMC Public Health, 21(1), 1-7
Breckenkamp, J., Razum, O., Spallek, J., Berger, K., Chaix, B., & Sauzet, O.
(See online at https://doi.org/10.1186/s12889-021-11356-w) - (2021). An ego-centred approach for the evaluation of spatial effects on health in urban areas based on parametric semivariogram models: concept and validation. BMC medical research methodology, 21(1), 1-12
Sauzet, O., Breiding, J. H., Zolitschka, K. A., Breckenkamp, J., & Razum, O.
(See online at https://doi.org/10.1186/s12874-021-01300-2) - Eine Methode zur Bestimmung der relevanten ego-zentrierten räumlichen Dimension für die Bewertung von Nachbarschaftseffekten: das Beispiel kardiovaskulärer Risikofaktoren. Deutsche Gesellschaft für Epidemiologie Tagung 2021
Jürgen Beckenkamp
