Transcript A selection of factors and issues Prepared by Patricia Larkin March 11, 2011

A selection of
factors and issues
Prepared by Patricia Larkin
March 11, 2011

Brief Historical Perspective

Defining Place
◦ Neighbourhood
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Perception of Place
◦ Delineation
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Methodologies
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Place effects
◦ Future directions
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Explanations for spatial variations in health
◦ Compositional – individualistic elements
◦ Contextual – neighbourhood elements
◦ Combination of the two?
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Contextual
◦ Features of local social and physical environment
 Emphasis on SES – [human geography] – harder to
discern?
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Define by Function
◦ Cutchin (geographer) – security , freedom, and
identity
◦ Brower (urban studies) – shelter, housekeeping,
accommodation, connection, meaning, and
recreation
◦ Macintyre (place associated needs) – clean air,
water, food, education, work, social involvement
and play
◦ Ramirez (ecologic public health approach) – macrolevel policy and community combined with
interpersonal and individual factors
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Define by mechanism of effect – so that it can
be measured
◦ Exposures can be calculated for environmental
hazards
◦ Environments that elicit stress
 predispose to other disease
 erode social capital
◦ Environments that elicit health
 Contact with nature
 Walkability, access to good food
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Define by qualities
◦ Indices
 Happiness index, Index of socio-economic deprivation
 Psychosocial hazards scale
◦ Visible blight – graffiti and boarded up buildings
◦ Planning – walkability
◦ Contact with nature - opportunities
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Define by boundaries
◦ Which spatial scale is most relevant to health?
 Move on up from chair to bioregion
◦ Census tracts or neighbourhood boundaries or
shared sense of place?
As the neighbourhood integrates place as well as people, its
conceptualization must consider characteristics of both place
and people, and the interaction between them.” (Dennis et al
2009)
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Unit that helps define impacts of place on health
Depends on point of view; refers to an aspect of the
territory’s reality.
Consider:
◦ humanistic approach emphasizes social bonds in a physical setting –
use word ‘community’
◦ instrumental approach sees the neighbourhood as a functional system
used for planning purposes – use word ‘district’
◦ phenomenological approach considers bonds between places and
people created by time and events; produces a specific dynamic that
influences organization and architectural typologies
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People from lower SES have particular view of their
place – more likely to see it as it is
Environmental problems –
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SES - mediating variables
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◦ more directly discerned – (metaphor of pulmonary and
digestive functions)
◦ operate through process of stress and involve both
psychosocial and physiological pathways (i.e. self-esteem,
self-efficacy, neuroendocrine and immune system
functions)
From this perspective, mixture of perceived problems
in the neighbourhood (noise, dense traffic, drug use
and crime) considered chronic stressors heightening
the level of anxiety, insecurity (From Pompalon et al
2007)
1995 publication
Those with high
school education
level generally have
higher rate of
responses as “high”
risk compared with
college education
level
From 2002 study
The % difference in
perception of ‘high’
health risks between
high school and
college educated
respondents
Public Perception of Population Health Risks
in Canada: Health Hazards and Sources of
Information
Daniel Krewski et al 2006
Human and Ecological Risk Assessment,
12: 626–644, 2006
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Life course and sense of identity – an aside
Seniors
◦ Mechanism of effect, qualities
◦ Instrumental approach to neighbourhood

First Nations and Inuit
◦ Physical environment and culture intertwined

Special case: Extreme events will change
people’s views of place, with subsequent
negative effects on health
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Neighbourhoods can be seen as overlapping
areas in relation to one's needs, the whole
being centered on the residence
◦ Home area - belonging and family
 psycho-social purposes strongest
 within a 5–10 minute walk around someone's residence
◦ Locality - wider area
 residential activities are still highly predictable, familiar
 visited frequently
◦ Urban district - even larger landscape
 social and economic opportunities might vary considerably from one
individual to another
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Rural/Urban – scale very different
◦ Cross municipal boundaries
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Regardless of format, community mapping
efforts help
◦ track economic, social and health trends,
◦ document change over space and time and
◦ visualize spatial phenomena such as variable
distributions and densities (from Dennis et al 2009)
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Example from Lebel et al 2007 – 3 determinations
of neighbourhood; 2 urban, 1 rural
Historical - Map boundaries weighted according to
◦ length of utilization
◦ decade of use
◦ relevance of a limit according to the research theme (social and health
inequalities) and
◦ collected information's accuracy
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SES - StatsCan - Deprivation analysis according to
dissemination area
◦ Material = education, employment and income
◦ Social = single parenting, marital status, and living alone
◦ Availability by DA
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Perception - Key community players only
Historical
perspective
Perception
perspective
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Problems with data
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Rural measures – different considerations?
◦ Some data available at a small area level and capable of
being aggregated to many spatial scales – e.g., shops,
schools
◦ Other data at much larger scale – e.g., investment in
secondary education, or in municipal functions such as
street lighting, street cleaning, garbage disposal, and
water or sewage treatment
◦ Many other examples of data to be analysed …
◦ adequate provision of public transport giving access
within a reasonable time to a grocery store or primary
school?
◦ peripatetic services visiting communities to supply food,
post, or library or dentistry services?
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Multilevel regression analysis
◦ Statistical modelling
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GIS
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Qualitative
◦ Transcribed interviews
◦ Focus groups

Participatory Photo Mapping –
see Dennis et al, 2009
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People from more deprived areas
◦ more readily discuss the adverse effects on health and
wellbeing of structural and contextual features
◦ more readily accept statistics on area inequalities in health
than those based in more affluent areas

Those with least experience of deprivation or
hardship
◦ more likely to draw on behavioural (individualistic)
explanations of area inequalities
 (from Davidson, 2008)

Study at more than one level of aggregation
simultaneously
◦ more informative about the source of variations related to
different geographies
◦ neighbourhoods and localities are relevant for perception of
problems
◦ mainly localities matter for social cohesion
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Rural areas deserve more attention since their
characteristics differ from those of urban areas,
particularly in terms of social cohesion
◦ Although rural areas are experiencing an important
economic decline and a massive population exodus, they
are characterized by strong social ties among residents.
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Davidson R, Mitchell R, Hunt K. Location, location, location: The
role of experience of disadvantage in lay perceptions of area
inequalities in health” Health and Place 2008; 14 (2): 167-181
Day R. Local environments and older people's health: Dimensions
from a comparative qualitative study in Scotland. Health and Place
2008 (June); 14 (2): 299-312
Dennis SF, Gaulocher S, Carpiano RM, Brown D. Participatory
photomapping (PPM): Exploring an integrated method for health and
place research with young people. Health & Place 2009;15: 466–
473
Frumkin, H. The measure of place. Am J Prev Med 2006;31(6)
Krewski D, et al. Public perception of population health risks in
Canada: health hazards and sources of information. Human and
Ecological Risk Assessment 2006; 12: 626–644
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Lebel A. A multi-perspective approach for defining neighbourhood
units in the context of a study on health inequalities in the Quebec
City region. International Journal of Health Geographics 2007; 6(27)
Macintyre S, Ellaway A, Cummins S. Place effects on health: how can
we conceptualise, operationalize and measure them? Social Science
& Medicine 2002; 55: 125-139
Pampalon R et al. Perception of place and health: Differences
between neighbourhoods in the Quebec City region. Social Science &
Medicine 2007; 65:95–111
Richmond CAM, Ross NA. The determinants of First Nation and Inuit
health: A critical population health approach. Health & Place 2009;
15: 403–411
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Siegrist J. Place, social exchange and health: proposed sociological
framework. Social Science & Medicine 2000; 51: 1283-1293
Tapsell, SM. "I wish I'd never heard of Banbury": The relationship
between 'place' and the health impacts from flooding. Health and
Place 2008;14(2): 133
Taylor S, Repetti RL. What is an unhealthy environment and how
does it get under the skin? Annual Review of Psychology 1997; 48
Williams GH. The determinants of health: structure, context and
agency. Sociology of Health & Illness. 2003; 25: 131-154.