IJE Advance Access originally published online on March 21, 2007
International Journal of Epidemiology 2007 36(2):355-357; doi:10.1093/ije/dym033
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Commentary: Investigating neighbourhood effects on health—avoiding the ‘Local Trap’
Department of Geography, Queen Mary, University of London, Mile End Road, London E1 4NS, UK.
E-mail: s.c.j.cummins{at}qmul.ac.uk
Accepted 8 February 2007
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Introduction |
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 Top Introduction Falling into the 'Local...ConclusionReferences |
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In recent years, the challenge in understanding neighbourhood effects in epidemiology has moved on from simply describing that ‘place’ matters independently of the ‘individual’ to identifying the plausible causal pathways by which neighbourhood social and material environment may affect health. Much of this more recent work has relied on an underlying conceptual model described by Macintyre1 as ‘deprivation–amplification’—a situation where residents of deprived neighbourhoods have poorer local access to health-promoting resources than their counterparts in more affluent areas. This theoretical model forms the basis of Pearce and colleagues’2 interesting national study of spatial accessibility to health-promoting neighbourhood resources in New Zealand. In contradiction to the established ‘deprivation–amplification’ hypothesis, their study suggests that access (as measured by network travel times) to a wide variety of health-promoting resources is greater in deprived compared with more affluent neighbourhoods.
Though this is the first national study to demonstrate such an association, the findings are not necessarily new. Similar counter-intuitive findings have also been reported for the plausible contextual predictors of poor diet3 and physical activity.4,5 If we look further back, The Alameda County Study provides evidence that the presence of plausible health-promoting neighbourhood commercial resources (such as grocery stores) is positively associated with an increased risk of death.6 It has been suggested that these ‘null’ findings may be because the spatial distribution of environmental ‘goods’ and ‘bads’ by area deprivation varies by the type of resource investigated, the time period under investigation and the nation in which the study is conducted, with the last point particularly salient as the vast majority of positive findings originate in the US.1,7 However, Pearce and colleagues suggest that the consistency and strength of their results indicate that poor locational access to community resources in deprived neighbourhoods in New Zealand is unlikely to be an explanation for the relatively poor health outcomes found there. The authors quite rightly acknowledge the limitations of their study and cite possible systematic differences in resource quality, the assumption of motorized travel and the mediating effect of the social environment as possible explanations for their results. One further, and often neglected, question remains—how can individual exposure to ‘context’ itself be better conceptualized?
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Falling into the ‘Local Trap’ |
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TopIntroductionFalling into the 'Local...ConclusionReferences |
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The ‘deprivation-amplification’ hypothesis is underpinned by an assumption that only the physically ‘local’ matters in terms of the health-damaging and health-promoting features of the social and physical environment. This idea that the ‘local’ scale (i.e. small areas or neighbourhoods) is the ‘only’ meaningful unit of interest in research and the development of policy has been referred to as the ‘Local Trap’.8–10 Though the origin of the ‘Local Trap’ lies in development planning and studies of urban democracy, the ‘Local Trap’ concept can be usefully extended to contextual studies of population health by questioning whether the ‘local’ is always the appropriate scale for analysis.
As an illustration of this point, Kwan and colleagues,11–13 utilizing GIS-derived ‘time–space’ aquaria, have demonstrated that the spatial routines people follow in their daily lives are in fact, complex and highly individualized. Their work suggests that only using the ‘local scale’ of neighbourhoods and small administrative areas as proxies for exposure to ‘context’ not only results in a large degree of measurement error but also takes no account of the real-world ‘action–spaces’ of individuals. In a recent study, which combined GIS and ethnographic methods, it was discovered that the contextual resources required for the maintenance of family life were not necessarily synonymous with geographical proximity.14 This study demonstrated that ‘contextual’ resources such as childcare, shopping opportunities and medical services were in fact external to the local neighbourhood; up to five miles away in some cases and that these resources were not necessarily those that were the closest or the most accessible, but instead are conditioned by the real-life spatial trajectories of individuals. For example, childcare and food shopping may be undertaken nearer work than home. Qualitative work on food access has reported that families do not necessarily use better quality retail provision even if locally available because of concerns over budgeting and the social and symbolic experience of shopping itself15,16—is this kind of resource provision seen as appropriate or desirable? Individual constructions of what is ‘local’ also differ—in one study a respondent noted that her usual food shopping was conducted several miles away, even though good local provision was available, as this is where she had grown up and lived for many years.17 For this individual, though the resource was physically distant, it was socially proximate and thus any area-based policy aimed at ‘local’ change in healthy food provision would have little effect on shopping behaviour.
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Conclusion |
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TopIntroductionFalling into the 'Local...ConclusionReferences |
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Do Pearce and colleagues’ fall foul of the ‘Local Trap’? Yes, but then again, so do the majority of other researchers in this field. Existing studies of place and health—particularly those using multi-level regression strategies—have tended to focus on a ‘fixed and invariant spatial scale’,18 generally that of ‘local’ areas or neighbourhoods. Thus the ‘Local Trap’ may be one further reason for the inconsistent international evidence. At present, techniques to improve assessment of context could be made by linking the ‘time–space’ biographies of individuals to the actual use and quality of contextual resources, but this will be a difficult, time-consuming and expensive task (though the CAPABLE project is a promising recent attempt).19 As has been argued elsewhere,20,21 the increasing analytical sophistication of social epidemiology has driven work forward at a rapid pace but there has been much less effort (and rigour) directed at improving the underlying theoretical model itself. Thinking carefully about how ‘context’ can be defined, measured and represented at an individual level over time and in social and physical space still remains a challenging, but necessary task, in order to truly understand ‘contextual’ effects on health.
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References |
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1 Macintyre S. Deprivation amplification revisited; or, is it always true that poorer places have poorer access to resources for healthy diets and physical activity? Int J Phys Act Behav Nutr. (in press).
2 Pearce J, Witten K, Hiscock R, Blakely T. Are socially disadvantaged neighbourhoods deprived of health-related community resources? Int J Epidemiol (2007) 36:348–55.
3 Winkler E, Turrell G, Patterson C. Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane Food Study. Health Place (2006) 12:306–19.[CrossRef][Web of Science][Medline]
4 Scotland and Northern Ireland Forum for Environmental Research. Investigating environmental justice in Scotland: links between measures of environmental quality and social deprivation. In: Edinburgh. In: Scotland and Northern Ireland Forum for Environmental Research (2005) (last accessed on 5 March 2007). Available at: http://www.sniffer.org.uk/whats_new.asp.
5 Ellaway A, Kirk A, Macintyre S, Mutrie N. Nowhere to play? The relationship between the location of outdoor play areas and deprivation in Glasgow. Health Place (2007) 13:557–61.[CrossRef][Medline]
6 Yen I, Kaplan GA. Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. Am J Epidemiol (1999) 149:898–907.
7 Cummins S, Macintyre S. Food environments and obesity–neighbourhood or nation? Int J Epidemiol (2006) 35:100–04.
8 Purcell M, Brown J. Against the Local Trap: scale and the study of environment and development. Prog Dev Stud (2005) 5:279–97.[CrossRef]
9 Purcell M. Urban democracy and the Local Trap. Urban Stud (2006) 43:1921–41.
10 Born B, Purcell M. Avoiding the Local Trap: scale and food systems in planning research. J Plan Educ Res (2006) 26:195–207.[CrossRef]
11 Kwan MP. GIS methods in time-geographic research: geo-computation and geovisualization of human activity patterns. Geografiska Annaler (Series B) (2004) 86:267–80.[CrossRef]
12 Kwan MP, Lee J. Geovisualization of human activity patterns using 3-D GIS: a time-geographic approach. In: Spatially Integrated Social Science—Goodchild MF, Janelle DG, eds. (2004) New York: Oxford University Press.
13 Kwan MP, Murray AT, O'Kelly ME, Tielfelsdorf M. Recent advances in accessibility research: representation, methodology and applications. J Geograph Systems (2003) 5:129–38.[CrossRef]
14 Matthews S, Detwiler J, Burton L. Geo-ethnography: coupling Geographic Information Analysis Techniques with ethnographic methods in urban research. Cartographica (2005) 40:75–90.
15 Dobson B, Beardsworth A, Keil T, Walker R. Diet, choice and poverty: social cultural and nutritional aspects of food consumption among low-income families (1994) Loughborough: Family Policy Studies Centre.
16 Williams P, Hubbard P. Who is disadvantaged? Retail change and social exclusion. Int Rev Retail Distr Cons Res (2001) 11:267–86.
17 Cummins S, Findlay A, Petticrew M, Sparks L. Reducing inequalities in health and diet: the impact of food retail development. Environ Planning A. (in press).
18 Glass TA. Commentary: culture in epidemiology—the 800 pound gorilla? Int J Epidemiol (2006) 35:259–61.
19 CAPABLE Project, UCL Centre for Advanced Spatial Analysis. (last accessed on 5 March 2007). Available at: http://www.casa.ucl.ac.uk/capableproject/.
20 Cutchin MP. The need for the "new health geography" in epidemiologic studies of environment and health. Health Place. (doi:10.1016/j.healthplace.2006.11.003).
21 Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding and representing ‘place’ in health research: a relational approach. Soc Sci Med. (in press).
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