Transcript Slide 1

Glasgow Community Health and Well-being
Research and Learning Programme:
Investigating the Processes and Impacts of Neighbourhood Change
GoWell is a collaborative partnership between the Glasgow Centre for
Population Health, the University of Glasgow and the MRC Social and
Public Health Sciences Unit, sponsored by Glasgow Housing
Association, the Scottish Government, NHS Health Scotland and NHS
Greater Glasgow & Clyde.
Understanding and Investigating
Regeneration’s Impact Upon
Health: View from the [Far] North
Ade Kearns
University of Glasgow
Today’s Talk
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Understanding the Linkages.
The Glasgow context.
The GoWell study.
Some health-related findings.
I. Understanding the Links
Social Determinants of Health
• Starting Point:
– WHO Commission on Social Determinants of Health
report on health equity ‘closing the Gap in a
Generation’ (2008)
– Earlier report by Wilkinson, Marmot et al on Social
Determinants of Health (2003).
• Tackle immediate things: ‘Daily Living
Conditions’, e.g. healthy places, and macro
things ‘Power, Money and Resources’, e.g.
progressive taxation, gender equality, political
empowerment etc.
Social Gradient
Absolute and relative disadvantage have
cumulative effects.
Lower social groups suffer more disease and
earlier death.
Chronic Stress
Impacts upon the cardiovascular and
immune systems.
Increases vulnerability to infections,
diabetes, high blood pressure, strokes.
Early Life
Poor pregnancy conditions.
Poor infant experience: low stimulation etc.
Retarded growth. Low educational
attainment. Problem behaviours.
Social Exclusion
Inability to enjoy social participation.
Effects of stigma, discrimination and hostility.
Increased risk of divorce, illness, addictions.
Work
Lack of control, inadequate rewards,
stressful relationships at work are harmful.
Mental health problems. Lower back pain.
Cardiovascular disease.
Unemployment &
Job Insecurity
Psychological problems.
Higher risk of heart disease.
Addictions.
To escape or numb pain of harsh social
conditions. To improve mood. Don’t work!
Poor mental health.
Cause of many health problems and
premature death.
Strongly associated with crime and asb.
Food
Over-reliance on calorie-rich foods with high
fats and salts. Eating processed food.
Obesity. Diabetes. Cancers. Heart disease.
Transport
Heavy through traffic. Respiratory illness.
Accidents.
Lack of paths for walking and cycling.
Divisions caused by roads.
Poor connections to other places.
Social isolation.
Social Support
Supportive and cohesive social relations
make people feel valued and are protective
of health. Absence of such things is linked to
higher stress; depression; poor recovery
from illness; more disability.
Tackling Health Inequalities
• The Scottish Government’s Task Force on
Health Inequalities reported on local
requirements to meet 5 main Govt aims:
– Smarter [Early Years and Young People]
– Wealthier & Fairer
– Greener
– Safer & Stronger
– Healthier
Smarter (Early Yrs
& Young People)
Quality interactions: parents/children.
Providing opportunities of all sorts.
Healthy lifestyles.
Ethos of achievement & ambition.
Wealthier & Fairer
Reduction in poverty-related stress.
Reduction in worklessness & ill health.
Financial inclusion & anti fuel poverty.
Safe spaces for children to be active.
Environmental ‘goods’ to foster
physical & mental health.
Environmental volunteering to
enhance social engagement, health
and wellbeing.
Greener
Safer & Stronger
Healthier
Raising educational attainment as a
preventative measure.
Reducing alcohol and drug
dependency.
Mentoring & supporting young people.
Reducing smoking in deprived areas.
Improving mental health.
Tackling depression.
Increasing resilience and hopefulness.
Ten Lessons…
1. Stress is a Big Issue: stress has psychological
effects but also works through biological
mechanisms to shorten life. Neighbourhood
environment can be a major source of stress
and anxiety, but also others.
2. Mentoring and personal support are required
for individuals and families to cope with
problems and find a route towards personal
progress. This is a big part of the People bit of
People & Place.
3. Community Development is needed both
to enhance cohesion (interaction; mutual
support; harmony), and as a route
towards empowerment.
4. Status and self-esteem often need
enhancement in deprived areas: this is a
people:place interaction that needs proactive intervention where areas are
stigmatised.
5. Young people need more priority. They
need to be brought into regeneration /
transformational processes as there is a
real chance to shift ambitions.
6. Activity rates need boosting. Not just
paid employment (where quality matters)
but also education and training, and
voluntary and community activity This
will help achieve multiple aims.
7. There is a big role for other services, especially
Education and Public Health. Health
behaviours, for example, are partly a function of
residential context but they are also a product of
personality and upbringing, and so are hard to
shift.
8. The local social and physical environment is
important not just for physical health and
security, but also for mental health,
psychological disposition and social integration.
9. It matters how regeneration is
done, as well as what is done.
Empowerment
Sense of control over their own
lives and area.
Self esteem: that they are treated
with same respect as others.
Visible change, esp.
early on.
Sense of progress.
Boosting trust in institutions.
Optimism for the future.
The Regeneration Process
Participation and
Involvement
Keeping people
informed
Problem solving
approach
Self Worth: feeling valued; feeling
that people are interested in them.
Self Actualisation: helping people
realise their own knowledge & skills
Sense of hope.
Sense of progress.
Sense of accomplishment
Building resilience
10. There is a two-way relationship between regeneration & health
Health Policy &
Programmes
Healthier
Individuals
Regeneration Policy
& Programmes
Healthier
Communities
Contribution of Mental Health to
Regeneration Goals
Good Mental Health
Economic Goals:
Employability
Willingness to take up
education & training
Health Goals:
Closing the mental
Health gap
Reductions is drinking
smoking and drugs
Social Goals:
Willingness to take
part in community
Activities
Reduction in anti-social
behaviour
Human Capital
Physical
Health
Social &
Community
Capital
Cultural Capital
Regen. &
Residential
Change
Economic Capital
Fixed Capital
Environmental
Capital
Community &
Neighbourhood
Context
Social
Health
Mental Health
& Wellbeing
II. Glasgow Context
Area Deprivation
• 48% of Glasgow’s data-zones (statistical
neighbourhoods) are within the most
multiply-deprived 15% in Scotland, the
highest of any local authority.
• 9% of the total area of the city is vacant
and derelict land.
Housing
• A third of the city’s population live in social rented
housing. Ownership has been increasing.
• In 42% of the data-zones in Glasgow, the largest
housing tenure is social renting.
• Only a quarter (27%) of the dwellings in Glasgow
are houses; the rest are flats, including over 200
medium- and high-rise blocks.
• In 2001, a third of all dwellings in the city were
deemed to be in ‘urgent disrepair’.
• Glasgow’s 80,000+ council dwellings passed to
the Glasgow Housing Association in 2003.
Health Inequalities
• Life expectancy in Glasgow is the lowest in the
West of Scotland.
• Men in Glasgow have high mortality from lung
cancer, liver disease and mental disorders,
compared to all men in Scotland.
• There is a 14 year gap in male life expectancy
in Glasgow between the least deprived and the
most deprived areas.
• Alcohol related deaths are 8 times higher for
men (3 times for women) in the most deprived
areas compared with the least deprived parts of
the city.
Interventions: Housing
• Improvement of the existing GHA housing stock:
– 45,000 secure doors (to date)
– 40,000 new kitchens and bathrooms
– 35,000 central heating systems
• Demolition of housing stock deemed
unsustainable:
– 19,500 units to be demolished
– Majority in tower blocks (100 blocks out of 200 to go)
• Construction of new rented homes:
– 3,000 by GHA and 3,000 by RSLs
Housing
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Demolition of tower blocks.
New build housing: 9,000 units in 8 areas.
Reduction in densities.
Less social housing.
Mixed tenure communities, e.g. from 90%
social renting to 40 or 50%.
• Fewer flats and more houses with front and
back doors, and gardens.
New Neighbourhoods
• Glasgow City Council is promoting the
construction of 4 new neighbourhoods on
cleared land in or near social housing areas
within the city.
• These are being built by private contractors to
provide owner occupied housing at mid-market
prices. Around 1,000 homes each.
• To attract and retain families in the city.
Area Regeneration
• GCC and GHA have jointly identified 8 social
housing areas as Transformation Areas to
receive comprehensive renewal over the next 15
years or more. Including large scale demolition.
• In addition, GHA has identified a further 7 Local
Regeneration Projects: multi-dimensional
change on a smaller scale. Less demolition.
• Together, these areas cover 35,000 people, or
6% of the city’s population.
III. GoWell Programme
Study Areas
15 GoWell communities in 5 types of area
i.
Transformation areas:
- Red Road, Sighthill, Shawbridge
ii.
Local regeneration areas:
- Scotstoun MSFs, Gorbals Riverside, St Andrews Drive
iii. Housing investment areas:
Houses and Flats: Riddrie, Carntyne, Govan
MSFs: Townhead/Drygate, Birness Drive (MSFs)
iv. Areas surrounding MSFs:
- Wider Scotstoun, Wider Red Road (Balornock/ Petershill/
Barmulloch)
v.
Peripheral estates:
- Drumchapel (including a New Neighbourhood), Castlemilk
…in the context of the city as a whole
GoWell Study Areas
Transformation Areas
Wider Areas (around MSFs)
Local Regeneration
Housing Improvement
Peripheral Estates
1 Community Survey
• Repeat, random, cross-sectional surveys of the
15 communities every 2 years.
– First survey in 2006, second in 2008.
• Up to 6,000 interviews in total each time.
• Head of household or partner is interviewed.
• To tell us:
– How community composition is changing
– How perceptions of neighbourhoods and communities
change as regeneration and housing investment and
newbuild occurs.
2 Tracking/Panel Study
• To follow and re-interview every 2 years around 1,000 2,000 people who live(d) in the Regeneration Areas.
• This will involve three groups:
– Stayers
– Out-Movers (voluntary and involuntary)
– In-Movers (new residents and returners)
• To tell us:
– The impacts upon people of the experience of the regeneration
process.
– What the net effects upon communities are of out-migration
versus in-migration
– Whether people who leave and do not return fare better or worse
than those who remain or return to regeneration areas.
3 Ecological Study of Glasgow
• Examining trends in small area data for Glasgow’s
communities (c700 data zones)
• Classifying small areas by dwelling type and dwelling
mix and relating this to outcome data such as for
education, crime and health.
To tell us:
• How the intervention areas fare over time compared with
other deprived areas in the city.
• Whether there are outcome effects associated with the
residential environment.
• The extent of area inequalities and how these change.
4 Qualitative Research
Governance, Participation, Empowerment and Cohesion:
• Focus groups with residents.
• Interviews with community ‘steering groups’
• Interviews with practitioners, e.g. consultants.
• To examine processes of community engagement and
involvement in the management of housing and the planning
and implementation of regeneration.
• To investigate issues of community cohesion as communities
are changed in terms of housing tenure mix, and as immigrant
communities and other newcomers ‘settle in’
5 Monitoring the Intervention(s)
• Reviewing policy documents for changes in emphasis,
priorities and approach.
• Interviewing practitioners about the nature and pace of
intervention and change.
In order to:
• Provide the background context for our reporting of
community changes.
• Understand what the different partners are doing that
might impact upon our study participants.
• Assess the degree and pace of change between the
waves of our community survey.
6 Nested Studies of ‘Wider Actions’
We are currently studying 3 initiatives:
• Community Janitors (Environmental Employability).
• Youth Diversionary Projects.
• Play Area Improvement Projects
To see
• Whether such initiatives should be ‘mainstreamed’
• Whether they have community level social effects
as well as impacts upon recipients/users
• Whether the effects are sustained or temporary.
IV. Initial Health-Related Findings
Physical Activity
• Overall measure of physical activity computed
from respondents reports of the number of days
per week they undertook moderate or vigorous
physical exercise, plus walking around their
neighbourhood.
• Based on IPAQ: International Physical Activity
Questionnaire.
• Modelled the results to control for personal
characteristics and included objective and
subjective assessments of the local
neighbourhood environment.
…findings…
• Housing: Neither building type nor floor level occupied
had any effect on physical activity rates.
• Physical Environment: physical activity rates higher
amongst those who rate their local environment as of
higher quality, and with fewer incivilities, and cleaner,
more attractive.
• Community: physical activity rates also higher where
people have higher levels of trust in, and reliance on,
neighbours. Activity is lower where people have contact
with their neighbours less than on a weekly basis.
• Amenities: quality of local amenities was not associated
with levels of physical activity.
Effects of High Rise Living
• Analysis restricted to British citizens.
• Including controls for personal
characteristics and area deprivation.
• Looked at the effects of storey height as
well as building type.
• Highly pertinent to debates surrounding
tower block demolition and regeneration in
Glasgow.
…findings…
• Physical health indicators generally worse
among people living in high rise flats compared
with other flats, with increased probability of
long-term illness, recent health problems, and
poor general health.
• In relation to mental health, the effects of high
rise living appear to be an increased likelihood
of: low sense of empowerment over decisions
affecting the local area; and failure to derive as
many psyshosocial benefits from home (e.g.
privacy, control, safety, sense of progress etc.)
…continued…
• Dissatisfaction with dwelling 3 times higher, and
with neighbourhood nearly 2 times higher,
among those living in high rise flats, compared
with those in houses.
• Those in high flat are 2.6 times as likely to have
multiple serious problems with anti-social
behaviour in their area.
• Higher dwelling dissatisfaction particularly acute
in relation to internal noise and poor security of
the home.
Psycho-Social Neighbourhoods
Where you live is important to how you feel
about yourself, but…
• Only in Housing Improvement Areas do most
people feel that ‘Living in this
neighbourhood makes me feel I am doing
well in life’
• This is true of just a quarter of people in
Transformation Areas and a third of people in
Local Regeneration Areas.
Internal Reputation
Agree or Disagree with the statement:
“People who live in this neighbourhood think highly of it”
Good
Bad
Transformation Areas
25
16
MSF Surrounding Areas
45
12
Peripheral Estates
29
10
External Reputation
Disagree or Agree with the statement:
“Many people in Glasgow think this neighbourhood has a bad
reputation”
Good
Bad
Transformation Areas
9
42
MSF Surrounding Areas
24
41
Peripheral Estates
14
43
Analysis of Newspaper Coverage
• Looked at coverage of the Sighthill Estate from
2002 to 2008 across Glasgow based
newspapers: broadsheet and tabloid, morning
and evening press.
• 734 articles in total over 7 years.
• Negative articles about Sighthill out-weighted
positive ones by 3 to 1.
• 35% of the negative stories mention asylum
seekers.
• Positive articles reference primary school
improvements and regeneration, but many
regeneration pieces are ‘mixed’ rather than
positive.
Next Steps
• We will begin analysing the Wave 2 data.
• We will soon be conducting our first survey
of the longitudinal outmovers cohort.
• We will be looking at our data to
investigate the effects of housing tenure
mix within our study areas.
• We will be establishing a longitudinal
qualitative study of the experience of living
through the regeneration process.
www.gowellonline.com